Evaluation of the Tuberculosis Control Assistance Program (TB CAP)

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According to data from the PMU, the three organizationsthat have coordinated the most core project workplans inthe first three years are WHO (28), the PMU (12), and theUnion and KNCV (9 each). The two organizations thathave coordinated the most annual country workplans in thefirst three years were KNCV (13) and the Union (8) (seeTable 1).Thus the number of country workplans coordinated byeach partner was relatively stable in each of the first threeyears of TB CAP. The proportion of the total TB CAPcountry workplan budget, however, has significantlydecreased each year for FHI (from 36% in APA1 to 10%in APA3) and the Union (from 31% to 11%), hassignificantly increased for KNCV (from 23% to 44%), andremained relatively stable (+/–10%) for other partners.Several partners stated that although this process has notled to serious oversights or grave problems, it is not always clear why a coordinating partner was chosen,and in a few cases partners felt their skills were overlooked or another partner was chosen to coordinateTB CAP work in a country where they had more to offer.The evaluation team heard of no instance where a partner requested to be a collaborator and was turneddown. Some partners felt there were instances when there were too many collaborating partners, and itwas unclear what each was bringing to the project. There was some concern expressed about a partneragreeing to collaborate and failing to carry out agreed activities on time.RecommendationsThe PMU should provide information and a recommendation to the board about assignment ofcoordinating partners for country and core projects. The decision on selection should rest with theboard.The board should establish a clear, transparent procedure for selecting coordinating and collaboratingpartners. All partners should be clear about the criteria used for selection.The major criteria for selection of a coordinating partner should be its quality and capacity.The board should adopt a conflict of interest statement, and members with a conflict should recusethemselves from selection decisions.Balancing allocation of work among partners while ensuring the highest quality of support would beadvantageous to the harmony of TB CAP. A partnership is at its best when all contributors arecarrying an appropriate load. The PMU should seek to identify when issues related to allocation ofprojects arise, determine the cause, and present the situation to the board for resolution.The PMU should only coordinate country projects when all other measures have first been attemptedand the success of the TB CAP project is at risk.Creating Country WorkplansTable 1. Distribution of TB CAPWorkplans, APA1 to APA3CoreWorkplansCountryWorkplansATS 7 0FHI 4 6JATA 4 2KNCV 9 13MSH 5 6PMU 12 2UNION 9 8WHO 28 5Once selected, the coordinating partner must work with any collaborating partners to draw up a detailedannual workplan and budget. The approach to planning varies, however. In some cases, collaboratingpartners are heavily consulted on all aspects of the workplan; in others the partners are asked only forinput on their section.16 EVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP)
In general, however, it is expected that planning will be done in cooperation with the NTP and itsapproval gained before workplan and budget are submitted for approval to first the PMU, then theMission, and then the USAID CTO.In most countries the TB CAP coordinating partner works closely with the NTP, and the workplanreflects NTP priorities. Some Missions reported they were heavily involved in drafting the workplan,others that they received only a final draft. A few NTPs reported that they saw a proposed workplan onlyafter it was nearly complete. In some countries the Mission or NTP asked TB CAP for short-term, limitedTA so the planning was limited to the specific activity requested.Regardless of the variances, however, these aberrations were almost always based on the desires of theparticipants. None of those interviewed complained that they were excluded from a part of the process inwhich they wanted to participate or that the change in process directly resulted in poor implementation.Some did refer to inconveniences or inefficiencies resulting from their not being involved earlier andexpressed a desire to be included in the future. However, it seems likely that the greatest negative impactof these variances is the lack of clarity on how the process should be performed, and a lack of evidencefor consensus on the single most effective approach (regardless of individual wishes) to develop aworkplan.Sometimes changes in Mission or NTP priorities require that TB CAP fill in gaps by adjusting theactivities in the workplan. TB CAP is seen by NTPs as a source of flexible financing that can plug gaps tokeep the program going.RecommendationsIn countries where TB CAP assistance is requested for multiple years, initial workplans should beapproved for the entire term, with annual adjustments to correspond as closely as possible tosequential needs identified in national strategic TB plans and based an the availability of funds.For multiyear workplans, a realistic and longer timeframe should be allowed for planning andapproval of the initial plan. Shorter, more streamlined planning and approval processes should applyto annual updates.The PMU should determine an acceptable lead time for workplan development, identify projects thatfar exceed that time, and analyze the causes of delays. The PMU should then identify strategies toreduce delays, such as the use of tools like workplan templates to facilitate faster start-up or closeroversight and management of the work planning process by PMU staff.Missions should allocate annual TB CAP funds based as closely as possible on annual workplanadjustments and budget requirements.There is a need for defining and providing guidance on logical, sequential, incremental steps NTPsshould take, depending on how developed their program is.Approving Country WorkplansSome consider approval by the USAID Mission and USAID/Washington for procurement to be a problemthat causes delays. This problem is seen as having improving over time, with the USAID CTO movingdecisions along.A common concern of partners is that approval of workplans is delaying implementation. Often the timeto develop or approve a workplan seems excessive. Based on a random sample of 10 workplans, four tookmore than four months to develop a draft, and in four instances Mission approval took two or moremonths. USAID CTO approval seems faster, with only two plans requiring more than 40 days (averageEVALUATION OF THE TUBERCULOSIS CONTROL ASSISTANCE PROGRAM (TB CAP) 17
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Page 8 and 9: PVOTATBTB CAPTBCTATB/HIVTREAT TBThe
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Page 30 and 31: two weeks). There is a solid consen
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Page 36 and 37: to ensure a regular supply of drugs
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Page 40 and 41: ProportionFigure 4. TB patients Tes
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Page 70 and 71: March 19, SurabayaVisit to Puskesma
Page 72 and 73: April 1, Team 2Travel to Kachia LGA
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Country Organization Name PositionI
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TreatmentDrugsM&EMDRNumber of suspe
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Global Health Technical Assistance
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