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Global Fund Performance Incentive Scheme for Public Service:

Feedback of DPG Health and AIDS

On Behalf of DPG Health and AIDS Danida, DPG H Troika Chair

GIZ, DPG H Troika/TNCM MemberJune 4, 2013

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Global Fund – TZ National Coordinating Mechanism

Global Fund to Fight AIDS, TB and Malaria (GFATM) is the sixth largest donor to Tanzania (AMP, FY11/12)

• USD 1.2 billion since 2002; currently 8 grants with MoF, MoHSW, PSI & AMREF• Top ups for grant managers and key staff included in all grants until 2012• Removal of top ups from HIV grant (Round 8) after sharing of DP Allowance

Guideline in 2012–Proposal and budget were already endorsed by Tanzania National

Coordinating Mechanism (TNCM), coordinating and decision making structure at national level where DPs take part (DPG H, DPG A, PEPFAR, UN)

• Development of performance incentive scheme as condition precedent to be fulfilled for grant implementation to start

• Support of PEPFAR to complete the condition precedent• Incentive scheme endorsed by Local Fund Agent and submitted to GFATM • DPG-Health raised its concerns about the potential conflict with Agreement on

Allowances (May 2013) with GFATM and TNCM

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Proposed GF Performance Incentive Scheme

• 3-year (FY 13/14 – FY 15/16) performance incentives to key civil servants responsible for management of GFATM HIV grant (Round 8)

• Expressed Rationale: Transition away from “top-ups” (as previously provided) in compliance with GoT/DP agreement; desire for better grant performance.

• Max. US$ 500,000 to be distributed annually on the basis of performance as evaluated by the LFA through the PU/DR

• Distribution of payments according to performance in: Programmatic progress 35%, grant management 15%, PSM 20%, Timeliness 10%, Overall evaluation and grant rating 20%

• Distribution among recipients: MoF (11.1%), TACAIDS (13.4%), MoHSW-PMU (11.1%), PMO-RALG-PMU (7.1%), NACP (35.2%), NIMR (8.9%), MSD (1.13%)

• Recipients/ implementers selected 140 staff (incl. very senior)

• Monitoring of performance conducted by the LFA as per the performance framework and the official PU/DR evaluation guidelines of the Global Fund

• Ownership: Concerned parties discussed the framework and completed the eligibility sections internally

• Expansion to other GFATM grants in Tanzania that are still using top-ups

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DPG Health Concerns

• Violates key underlying principles of DPG and GoT agreement • Process of stakeholder input and discussion, as well as reflection on previous

and existing initiatives has been cursory– Previous experience of SASE not considered; limited evaluation of previous

GFATM top-ups; little coordination with the many performance incentives currently being designed in the health sector or broader PO-PSM efforts.

• Potential conflict of interest in process of development– Many of those to benefit are negotiating

• Dangerous precedent of isolated DP action in advancement of narrow institutional objectives– Key staff incentivized to perform in terms of GFATM objectives have

broader responsibilities across GoT• Does exit strategy exist?• Expansion to other GFATM grants in Tanzania

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Expression of DPG Health Concern

Verbally: • DPG Health/DPG Aids meeting with GFATM mission in September 2012

and March 2013• Some DPs have raised with their GFATM Board constituency the

importance to analyze evidence and lessons learned of similar approaches in other countries

Written: • DPG Health participation at TNCM meeting 27 May 2013; presentation of

joint DPG H letterDPG Aids not supportive of a joint statement;Participants: PS PMO, TACAIDS, NACP, NMCP, MOF, MoHSW PMU, PEPFAR, DPG-H and DPG-A, PSI, AMREF and non-gov rep.;No clear endorsement, final decision to be taken by PO-PSM as authority for remuneration policy

Formal Presentation: • DPG Main, May 2013

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DPG-AIDS Views

• Principle : DPG-Main cannot overule TNCM’s decision

• If pilot endorsed by PO-PSM Commission on remuneration:

– DPs to propose TNCM to do a formal evaluation of the pilot in 2015 to inform subsequent renewals

– TNCM secretariat should work in collaboration with TWG Health Care Financing in the development of the ToRs and the conduct of the evaluation

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Way Forward and Our Ask Today

1. DPG Main to clarify policy and definitions related to top-ups and allowances through exchange of letters with GoT

2. DPG Main to join DPG Health letter to ensure Performance Incentive Scheme is aligned with comprehensive reform of PO-PSM remuneration policy– Addressed to GoT and Global Fund Secretariat and/or Board

3. DPG Main members – particularly DPs who are TNCM members and were active in development of the Allowance Guidelines – to support removal of performance incentive scheme from GFATM grant [proposal of DPG-AIDS is to go ahead with the pilot, if endorsed by PO-PSM, but ensure impact evaluation is done]