Unit | Systems Performance and Monitoring

Drug delivery at a hospital pharmacy, Burkina Faso

Well-functioning health systems and programmes are fundamental for providing effective, proper and sustainable health care to populations in low and middle income countries. Performance assessment and monitoring provides an important basis for analysing the outcome and impact of different programmes and projects on health systems, and more generally, on public health. Through improving the performance quality and functioning of health services and programmes we contribute to the development of accessible, equitable and efficient health systems.

Development of Sustainable Health Systems

We carry out research and project implementation, supporting the development of sustainable health systems to alleviate poverty and reduce health deficiencies. This involves rethinking solutions for pharmaceutical, as well as financial management, performance assessment, and monitoring and evaluation mechanisms.

Expertise and Services

Our key mandate is the Local Fund Agent (LFA) with the Global Fund to Fight AIDS, Tuberculosis and Malaria created in 2002 to significantly increase resources to fight the three of the world's most devastating diseases (HIV and AIDS, Tuberculosis, and Malaria), and to direct those resources to areas of greatest need. As a partnership between governments, civil society, the private sector and affected communities, the Global Fund represents an innovative approach to international health financing. The Global Fund does not have a country-level presence outside of its offices in Switzerland. Instead, it hires LFAs to oversee, verify and report on grant performance. LFAs are selected through a competitive bidding process and play an important role in verifying the performance of Global Fund funded programmes. They act as advisory body and can be seen as the “eyes and ears on the ground” of the Global Fund.

The LFA is contracted to independently oversee program performance and the accountable use of funds and works closely in particular with the relevant Fund Portfolio Manager from the Global Fund, to provide the following services: work performed before the Global Fund signs a grant agreement with the Principal Recipient. This includes assessing the Principal Recipient's capacity to implement the grant, reviewing proposed budgets and work plans and otherwise assisting the Global Fund in grant negotiations; work performed during program implementation. The LFA's review of a grant as it approaches Phase 2 (years three to five of the grant's lifespan) is crucial in assisting the Global Fund to make its decision on whether to continue funding beyond the first two years; work performed with respect to grant closure. When a grant ends, the LFA is involved in assisting the Global Fund with closure of the grant; and ad hoc assignments undertaken at the request of the Global Fund, such as investigations relating to the suspected misuse of funds.

Local Fund Agent Mandate

Swiss TPH has been acting as a LFA since 2003 in a total of 23 different countries in Africa, South East Asia, Middle East, and Latin America and the REDCA region. Key personnel for each country have a background and expertise in Public Health, Program and Monitoring & Evaluation, Finance, or Procurement and Supply Management. Other Swiss TPH experts in HIV/AIDS, malaria, tuberculosis and other global health topics are involved as required. Swiss TPH is currently LFA in the following countries: Benin, Burundi Burkina Faso, Chad, Djibouti, Gambia, Guinea, Liberia, Mali, Niger, Sao Tomé and Principe, and Senegal, and for the Multi-country Middle East Response grant covering Yemen, Iraq, Palestine, Syria, Lebanon and Jordan.

Gavi Programme Capacity Assessments

Programme Capacity Assessments (PCAs) assess the (current or proposed) financing modality for receipt of Gavi cash grants, and the in-country structures to oversee the use of Gavi support provided in the form of cash, vaccines and vaccine related devices with appropriate transparency and accountability. The PCA allows Gavi to gather and assess information on a country’s Public Financial Management systems and grant recipients’ financial and programme management systems, to evaluate the potential risks and to make relevant recommendations for the management of resources provided by Gavi. Based on the PCA findings, Gavi and the government will agree on the grant management modalities as Annex to the Partnership Framework Agreement between Gavi and each country, which sets out the terms and conditions for the management of Gavi grants in that country.
Swiss TPH has been performing PCAs in the following countries: Bolivia, Liberia, Chad, Mali, São Tomé and Príncipe, and Senegal.

UNITAID Mid or End of Project Evaluations

Swiss TPH has been awarded a long-term agreement with UNITAID covering the period from June 2014 – December 2016 for mid-term and end-of-grant evaluations of UNITAID projects.
Under this agreement, several evaluations have taken place, among them the end of project evaluation of the support for MDR-TB Scale Up Initiative 2007-2013; the mid-term evaluation of the DNDi market entry of improved paediatric protease inhibitor-based fixed dose combinations project; and the end of project evaluation of the ESTHERAID project completed in December 2014.   

Health Facility Assessments

Program and data quality should be evaluated through various methods. Key elements of a sound monitoring and evaluation (M&E) strategy include Health Facility Assessments (HFA), possibly combined with Quality of Care (QoC) modules, and Data Quality Review (DQR). HFA and DQR provide information for national and sub-regional planning, program improvement, assurance purposes and validation of routine systems. Done systematically, an HFA can show trends over time for key indicators. WHO guidance recommends an HFA is done every two years in a country. DQR allows for the evaluation of the data quality generated by the health information system at different levels of the health pyramid.

Swiss TPH has been awarded an three-year Indefinite Quantity Contract with the Global Fund to Fight AIDS, Tuberculosis and Malaria for the period April 2016 – April 2019 for the data Quality Assurance (QA) of the HFA, QoC and DQR funded by the Global Fund and implemented in the countries by the Ministry of Health or other related bodies. Independent assurance of the quality of the survey is important to enable the Global Fund and other stakeholders to use the results of the HFA/QoC/DQR for program information and grant improvement. The services covered by the Swiss TPH QA consist in verifying the quality of the sampling, the data collection, the analysis and the reporting of the HFA/QoC/DQR.

Within that long term agreement, Swiss TPH has been selected to perform HFAs in Vietnam, Congo, Côte d’Ivoire, Togo and Bangladesh as well as a Special Study related to the identification of factors that contribute to favourable MDR-TB treatment outcomes in Eastern Europe/Central Asia (EECA).

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font-size: 11px; widows: 1; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Benin<\/p><\/p>","latitude":"6.354770","longitude":"2.421000","projects":{}},"1":{"title":"Burkina Faso, Ouagadougou","description":"<p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Swiss TPH<\/p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Rond Point du 02 Octobre<\/p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">06 BP 10807<\/p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Ouagadougou 06<\/p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Burkina Faso<\/p><\/p>","latitude":"12.379050","longitude":"-1.523750","projects":{}},"2":{"title":"Cameroon, Yaound\u00e9","description":"<p>Projet Pr\u00e9vention VIH\/SIDA en Afrique Centrale<br \/>Swiss TPH - KfW- OCEAC<br \/>B.P. 15665, enface de la morgue de l'h\u00f4pital centrale de Yaound\u00e9<br \/>Yaound\u00e9<br \/>Cameron<\/p>","latitude":"3.848030","longitude":"11.502080","projects":{}},"3":{"title":"Chad, N'Djamena","description":"<p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Swiss TPH<\/p><p style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\" class=\"bodytext\">Boulevard de SAO, Quartier Moursal, Station Sabarna<\/p><p style=\"margin: 0px; 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background-repeat: no-repeat no-repeat;\">sis \u00e0 la Cit\u00e9 Minist\u00e9rielle, Commune de Dixinn<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Conakry<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Guinea<\/p><\/p>","latitude":"9.641190","longitude":"-13.578400","projects":{}},"5":{"title":"Mali, Bamako","description":"<p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Swiss TPH<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Rue 232\/ Porte 507<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Hippodrome<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Bamako<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Mali<\/p><\/p>","latitude":"12.665770","longitude":"-7.972910","projects":{}},"6":{"title":"Niger, Niamey","description":"<p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Swiss TPH<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Boite postale 11.195&nbsp;<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Niamey<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Niger<\/p><\/p>","latitude":"13.511600","longitude":"2.125390","projects":{}},"7":{"title":"Senegal, Dakar","description":"<p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Swiss TPH<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Cit\u00e9 Iba Ndiaye Diadji, Lot 1 &amp; 2<\/p><p class=\"bodytext\" style=\"margin: 0px; padding: 0px; font-family: Verdana, Arial, sans-serif; font-size: 11px; line-height: 16px; background-repeat: no-repeat no-repeat;\">Sacr\u00e9 Coeur Pyrotechnie<\/p><p class=\"bodytext\" style=\"margin: 0px; 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Selected projects at this location:

Abakar M.F et al. Vaccine hesitancy among mobile pastoralists in Chad: a qualitative study. Int J Equity Health. 2018;17(1):167. DOI: 10.1186/s12939-018-0873-2

Abdul-wahid Habib A.M. Malaria treatment adherence in the context of reactive case detection in Zanzibar. Basel: Swiss Tropical and Public Health Institute, 2018. MSc Thesis

AbouZahr C et al. How can we accelerate progress on civil registration and vital statistics?. Bull World Health Organ. 2018;96(4):226-226A. DOI: 10.2471/BLT.18.211086

Accordini S et al. A three-generation study on the association of tobacco smoking with asthma. Int J Epidemiol. 2018;47(4):1106-1117. (ALEC). DOI: 10.1093/ije/dyy031

Adamczick C, Dierig A, Welzel T, Schifferli A, Blum J, Ritz N. Double trouble: visceral leishmaniasis in twins after traveling to Tuscany - a case report. BMC Infect Dis. 2018;18:495. DOI: 10.1186/s12879-018-3394-0

Agorinya I.A et al. Socio-demographic determinants of low birth weight: evidence from the Kassena-Nankana districts of the Upper East Region of Ghana. PLoS One. 2018;13(11):e0206207. DOI: 10.1371/journal.pone.0206207

Ahoua A.R.C et al. Anti-inflammatory and quinone reductase-inducing compounds from Beilschmiedia mannii. Planta Med. 2018(in press). DOI: 10.1055/a-0798-3155

Akama T et al. Identification of a 4-fluorobenzyl L-valinate amide benzoxaborole (AN11736) as a potential development candidate for the treatment of Animal African Trypanosomiasis (AAT). Bioorg Med Chem Lett. 2018;28(1):6-10. DOI: 10.1016/j.bmcl.2017.11.028

Ali A.M et al. Population pharmacokinetics of the antimalarial amodiaquine: a pooled analysis to optimize dosing. Antimicrob Agents Chemother. 2018;62(10):e02193-17. DOI: 10.1128/AAC.02193-17

Ali F.N. Systematic review of tuberculosis control in Ethiopia with special emphasis on pastoralists: adaptation of DOTS for mobile pastoralists. Basel: Swiss Tropical and Public Health Institute, 2018. MIH