TRIP REPORT INDONESIA 3-14 March 2014 Attendees Country Stakeholders: CCM, PRs, LFA and Partner representatives from the Indonesia portfolio Global Fund: Gail Steckley, Rozina Merali, Sandra Kuzmanovska, Inna Ivanova, Doungkamon Vongin, Shahid Khan. Overall objectives of the mission (a) participate in TWGs Field Oversight Visit to Gorontalo; (b) participate Board site visit; (c) Country dialogue meetings with CCM and partners to discuss NSP development, NFM allocation and submission requirements; (d) discuss with Hay Group on Salary Survey; (e) discuss and support Malaria NFM Concept Note preparation: programmatic priorities, draft programmatic gap analysis/budget, agree on milestones/timeline toward final CN submission(f); meet with LFA (g); meet with IHP PR; (h) discuss HSS NFM options; (i) discuss TB/HIV Joint Concept Note The agenda for the visit was as follows: Monday (3 March) • Meeting with CCM Sec. on CCM workplan/budget 2014 Tuesday (4 March) • Board site visit • CCM meeting with Mark Dybul • CCM meeting with Board constituency Wednesday-Saturday (5-8 March) • Site visit in Gorontalo Monday (10 March) • Meeting with LFA • Meeting with Hay Group on Salary Survey
• CCM meeting on NFM and allocation Tuesday-Wednesday (11-12 March) • Malaria NFM Concept Note Workshop Wednesday (12 March) • Meet with MOH, NAC, LBH Masyarakat, TWG on human rights aspects of HIV NSP Thursday (13 March) • Meeting with ISEAN-HIVOS Program • HSS NFM discussion • Follow up meeting on salary survey with CCM steering committee Friday (14 March) • TB/HIV Joint Concept Note Summary
Monday (3 March) Meeting with CCM Secretariat • CT Program Officers met with CCM Executive Secretary and Finance Officer to discuss detail of CCM workplan 2014 together with budget and request for reprogramming. All budget items and reprogramming were discussed and agreed. CCM Sec will send revised budget and indicators for 2014 to the CT by 21 March 2014. Tuesday (4 March) CCM meeting with Executive Director, Mark Dybul • Executive Director appreciated the strong functioning and the oversight role of the CCM Indonesia. • NAC team explained issue of VAT on condoms and their follow-ups with custom authorities. ED mentioned that the Minister was aware of this problem and hopefully it would be resolved through internal coordination. • There were questions about sharing experience of those countries that have already gone through the NFM process. Mark responded that overall experience is positive and we will further learn down the road and make necessary improvements accordingly. • Responding to a question about the exit strategy, Mark mentioned that countries with growing economies e.g. Indonesia, Mexico etc. should increase their health budget as overall Indonesia’s spending on health is very low. However, there is not a set date for the exit. Wednesday-Saturday (5-8 March) • GF Program Officers together with 4 TWG Chairs and PRs travelled to Gorontalo for Field Oversight Visits. CT is waiting for feedback from TWG Chairs and participants of the visit to finalize the report. FOV report will be distributed to PR and sites visited through CCM Secretariat. 1
Monday (10 March) Meeting with the LFA • CT met with the LFA to discuss plan for PUDR review, NFM timeline and other current tasks. Discussion Salary Survey with Hay Group • It appeared that the report from Hay Group did not report the basic salary in all cases, and only include the proportion of salaries paid by Global Fund. This point was already clarified and requested when FPM met with Hay Group in January that full 12 months basic salary should be used. The analysis is also flawed, as this partial salary data is used, for example, to comment on salary compared to minimum wage. It is noted also that the external data is incomplete, given that only 2 of the proposed comparators agreed to take part in the study – but it was agreed to focus on completion of a useful internal equity comparison. The current version is not acceptable to the GF as the report will not be useful for salary comparison and Hay Group did not complete TOR in the contract. • Later on Thursday, the salary survey steering committee agreed that Prof Pri would contact Hay Group (Ibu Dyah, who is the contract signatory), to express dissatisfaction and request that Hay complete the work as per the contract. The poor quality of this report otherwise reflects badly on Hay’s good reputation as a firm that delivers sound and meaningful salary survey reports. The Global Fund would provide any assistance needed in communicating the need for PRs to share salary data for purposes of this analysis. It is noted that to date Hay has not yet requested the Global Fund or CCM to take this step. • Should Hay then not be willing to further revise their report with complete data and meaningful analysis, we can follow up with a joint letter from the Global Fund and the CCM, addressed if necessary to Hay’s managing director in Indonesia. • In the meantime, the LFA will provide whatever complete salary data they have regarding the key positions selected for the salary survey, so that we can at least see what data is available CCM meeting on NFM and allocation (refer to slide presentation for more detail) • TWG chairs provided an updated on National Strategic Plan development for ATM. Each disease has plan of meeting for consultation with partners and CSOs. FPM encouraged that the country dialogue should include the technical advice and engagement of international organization such as WHO, UNAIDS and UNICEF, as well as possibly engagement of LBH Masyarakat on human rights and access related to malaria (eg. Illegal miners) The importance of early work on building TB/HIV collaboration was also discussed and agreed.. • 3 things CT has highlighted to the CCM regarding the New Funding Model. o Program Split: CCM is given the indicative amount of allocation for each disease through a formal allocation letter. The CCM has to confirm the amount to be allocated to each disease before the submission of the first Concept Note. The CCM can propose different program splits and it needs to be submitted with the reason/data if not following GF indicative amount. For the Malaria team to be able to work on the Concept Note submission on 15 May 2014, it was agreed that the CCM will submit the program split to the Global Fund by 31 March 2014. o CCM Eligibility and Performance Assessment: CCM eligibility requirement #1 and #2 should be fulfilled by the time of concept note submission. Technical assistance by the consultant will be provided to the CCM to support eligibility and performance assessment process. Detail of CCM requirement and assessment can be found on the Global Fund website. o Willingness-to-pay commitment: From the Global Fund data, Indonesia has met the requirement of Willingness-to-Pay. CCM needs to submit the Willingness-to-Pay commitments information to the Global Fund before the first submission of the Concept Note, and indicate the data sources for commitments and for future monitoring of expenditure against commitments. • NFM requires good health economic analysis. Lack of data is a big challenge. National data could be adequate to meet the requirement, however Indonesia should continue improvement for provincial and district data.
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Tuesday-Wednesday (11-12 March) •
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2 days workshop to prepare for submission of Malaria NFM CN covers the following topics; o Indonesia Malaria Portfolio Analysis by Country Team o Programmatic Gap Tool, Modular Tool and Indicators o Financial Gap Analysis o Introduction to Grant Management Platform (online tool/application) o Group work on programmatic gap analysis and indicators o Group work on detailed budget/intervention o Group work on implementation mapping and risk assessment o PR assessment using capacity assessment tool o PSM NFM preparation Participants included academics, NGOs, maternal health and child health departments from Kemkes, TWG members and PRs. CCM informed that draft Malaria NSP will be ready in May/June by the time CCM submits the Concept Note. Endorsement of the NSP is expected at the end of 2014. CT suggested that the malaria response stratification should be well clarified in the concept note, where the fund will be invested for and why (i.e lacking fund from the local government) CCM does not yet have the cost data for the national malaria program. This is required in order to complete programmatic and financial gap analysis. In this regards, TWG would urgently seek technical assistance (initially in Indonesia, if necessary through WHO) to assist with developing and compiling costing data related to the national malaria program. Timeline and major deliverables are discussed. Please refer to Annex 2 for detail.
Wednesday (12 March) Meeting with MOH, NAC, UNAIDS, LBH Masyarakat, TWG on human rights and gender consultancy to support HIV NSP development. • LBH Masyarakat has been contracted by GF Secretariat (CRG department) for this work. LBH Masyarakat already engaged in NSP working groups and can provide guidance and support on safe and open dialogue, including with KPs. • It was noted that TB stakeholders also need to be involved in the analysis. Thursday (13 March) Meeting with ISEAN-HIVOS Program • PR introduced the new members of PMU – Grant Officer and Training Coordinator. Grant Officer’s main tasks are to support capacity building on financial management. Training and monitoring visits are planned with SR. • Concerning the issues with GWL-INA financial management, PR informed that the new arrangement to enhance the internal control is in place. Fund will still be transferred to GWL-INA bank account since it is separated for GF grant. However, PR takes control and authorization for payment needs to be done by the PR. GWL INA is responsible for documentation retention, but HIVOS should keep copies for now. • CT reminded PR that the appointment of auditor for 2013 needs to be reviewed and approved by the GF. CT also advised that the audit should include the follow-up review for GWL-INA, and any missing supporting documents, if any, should be provided so that the performance of GWL-INA can be re-evaluated. HSS NFM discussion (refer to slide presentation for more detail) • Meeting was preceded by a presentation of IAC-AIDS Digital. # of downloads so far has been disappointing, greater effort at marketing and promotion is needed. System draws on data from Komdat. •
CT explained options for HSS allocation. Indonesia can use all or part of existing funds for HSS (stand-alone or components), or use all or part for 1 or more disease programs - all of the options will be an NFM application. As a Band 3 country, Indonesia is encouraged but not required to request funding for HSS. 3
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CCM should consider past performance and programmatic gap to decide on options and implementation arrangement. Choice of implementation arrangement should be clearly explained in terms of impact on 3 disease programs. CCM will need to estimate actual funding needs for ongoing HSS grant in 2014; and decide about future funding allocation from 2015. Any funding for HSS needs to be deducted from total allocation for disease programs. PR provided an update on SIKDA and Komdat development. Still facing challenges integrating disease software into SIKDA. Also working on integrating an e-logistics model with Binfar. PR noted that APBD resources are also being invested; this needs to be documented and quantified.
Friday (14 March) TB Technical Assistance Plan • TA plan for 2014 has been finalized using the TB Team format, with approaches and possible providers of high priority TA items identified. The plan has been endorsed by the CCM. • GF needs to provide guidance on the policy regarding Indirect Cost Recovery (ICR). • For TB phase 2, it is agreed that KNCV will provide much of the TA as an SR, with MTAF also contributing and assigning one staff person to the KNCV team. • Several meetings have been held with PRs and 1-year workplan and TA area are identified. There will be 12 areas of TA needed for MOH and 8 for Aisyiyah, including PMDT, TB-HIV, MDR-TB, procurement and supply system, laboratory renovation. Currently, there are 2 technical officers to support the expansion of PMDT in Malang and Java. Staff from new site will have a chance to do on the job training at the existing well-performing site. There are also plans for recruiting TA to support the engineering of laboratory renovation. • It was informed that the technical requirements for renovation / installation of BSL 2 laboratory are very specific and significant. Only a few companies have the qualification to do the work according to the specs and standards required. In Indonesia, apart from Trisakti there are some other companies that have been tried by partners in the past. However according to laboratory experts the quality of the work was not always satisfying. A recent review of the procurement process for services appeared to highlight gaps in the process whereby the specific technical requirements of BSL2 laboratory could not be ascertained. The CT has recommended, in discussion with partners, that the supplier awarded the contract (BBL) could proceed with the works on the condition that the works was subcontracted to Trisakti. • AusAid expressed their willingness to leverage the effort of the Global Fund and the country. Support can also be done through TA. • GF noted that we have not received adequate updates on the Financial Management TA initiated in 2013. The PR (MOH) did not seem well briefed on the priorities identified and could not provide clear information on the status. GF is waiting for a proper status update and workplan. TB/HIV Joint Concept Note • CT clarified that the purpose of the joint concept note is to increase efficiency and impact and reduce duplication of the implementation of the 2 disease programs. Cross cutting activities will be done under TB/HIV joint implementation ex capacity building, HR, M&E, laboratory. Strategic plan should identify what are the overlapping areas at all levels in the system. • Since Indonesia has recently undergone a Renewal for TB, with Phase 2 starting on 1 January 2014, Indonesia can request an extension to the HIV program to permit alignment through a joint concept note in 2016 once the TB Phase 2 has had more time to demonstrate results. It will also provide more time to incorporate TB Prevalence Survey data into the National Strategic Plan. • The length of HIV extension is to be further discussed and agreed with the Country Team (6 to 12 months) and more information on extension process will be given to the country once available. The TWGs need to balance the benefit of longer extension to get more results from TB program; against the cost of delay in integration (less funding remaining to initiate the joint program; less time to update HIV strategies). • The extension request will be an opportunity for HIV program to consider any priority reallocation or reprogramming based on IBBS or mapping data or other new results. 4
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Even though the joint concept note is scheduled for 2015, CT advised that HIV and TB programs should begin establishing new coordination mechanisms at national, provincial and facility levels now, including assess opportunities for collaborative activities towards improved service delivery and results. There was discussion of a joint HIV/TB NSP. GF clarified that this is not a GF requirement, but may be beneficial in some settings. At a minimum, separate TB and HIV NSPs need to demonstrate clear coherence in the TB/HIV and associated HSS or other cross-cutting activities.
TB FLD stocks • Partners have flagged the impending stock out of TB FLDs. It was noted that this may be a national budget and ordering issue, and that as soon as the order is placed, drugs can be made available quickly. Advance planning needs to be put in place to avoid recurrence of this situation through inclusion of adequate funding in national budget for regular and buffer stock.
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ANNEX 1: Items for Follow-Up Description CCM To send GF revised CCM workplan/budget and performance indicators To decide on program split and confirm with the Global Fund. The allocation decision should include the final option for HSS stand-alone or under disease components. To submit the commitments information on Willingness-to-pay To fulfill CCM Eligibility requirement #1 and #2 and working toward meeting all requirements by the end of 2014.
Responsible
Timeline
CCM Secretariat
DONE
CCM
31 March, 2014
CCM
Before the first CN Submission (15 May, 2014) #1,#2 before the first CN submission (15 May, 2014)
CCM
To follow up with Hay and LFA on salary survey and ensure finalization of report Malaria NFM Identify TA (health economist) to support costing of national malaria program / gap analysis. To submit draft concept note for GF initial review and feedback Through country dialogue, prepare and submit completed CCM endorsed Malaria NFM Concept Note HSS To decide on NFM option and confirm the GF GF To support the country on Malaria NFM CN submission To support the country on HSS NFM To inform CCM, TWG HIV and PR on the extension process and requirement
CCM / salary survey working group
Other Items TB – MOH to submit status report on Financial Management TA to date. TB: Continue urgent follow up with Binfar and Bappenas as needed to secure budget and procure FLDs.
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#3 to #6 before the end of 2014. 31 March, 2014
TWG
31 March, 2014
CCM, Malaria TWG
15 April, 2014
CCM, Malaria TWG, PRs
15 May, 2014
CCM, HSS TWGs
31 March, 2014
CT
15 May, 2014
CT CT
On-going Once available
MOH-TB / KNCV
April 15, 2014
MOH TB
March 31, 2014
ANNEX 2: NFM Malaria Timeline Malaria CT visit / NFM workshop
Mar-14
Program Split National program costing
31-Mar
WTP commitments
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
X
X
Oct-14
Nov-14
Dec-14
11-Mar
31-Mar Before CN Submission
Programmatic gap analysis Financial gap analysis modular template Share draft templates with CT CT feedback Mock TRP (RBM) CT Visit Indonesia to support preparation Implementation mapping / capacity assessment CCM completion and endorsement Submission of the CN CT's review of the CN (with IND PR travels to Geneva??) CT review (finalized) CT develops PSC CT Submission of the PSC to TRP TRP review LFA capacity assessment
15 April 23 April 21 April
Manila
28 Apr – 2 May st 1 draft with CN Submission Before CN Submission
15-May 2123May 2630May 2630May
2-6Jun 09-Jun 1620Jun by June 30
CT Submission of docs to GAC-1
14-Jul
1st GAC review
31-Jul X
Grant making LFA review of documents
X 15-19 Sep
CT Visit CT Submission of docs to GAC-2
24-Oct
2nd GAC
31-Oct X
Board approval Grant signature
15-Dec
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