A webinar hosted on February 25 2016 from 11:00 – 12:00 CET provided W4GF advocates with an update on the Global Fund Key Performance Indicator (KPI) Framework based on the Global Fund Strategic Framework 2017 – 2022.

The webinar agenda included:

  • Updates on the Global Fund Strategic KPI Framework from the Global Fund Secretariat
  • Key thinking and background on KPIs on women and girls and gender from the Global Fund Secretariat
  • Questions and discussions from webinar participants
  • Next steps and action

1.    Understanding Corporate and Operational KPIs
The Global Fund Board hopes to keep Corporate KPIs at a minimum, as they are used at a Board leave to hold itself accountable – existing for the highest level monitoring and allowing the Global Fund to focus on the most important areas. Operational KPIs allow the Global Fund to assess and provide more explanatory views on the day-to-day management of the organisation. It was noted that operational KPIs are developed by the Global Fund Secretariat and do not need final approval by Committees or the Board. There are many other ways that the Global Fund Secretariat uses to track its work related to grant management and with the Fund Portfolio Managers (FPMs) and Country Coordinating Mechanisms (CCMs).

2.    Consultation Processes and Timelines
The Global Fund provided a timeline and an update on conducted/planned consultations thus far in addition to the consultation with W4GF advocates:

Conducted Consultation:

  • 12 Jan   – United States
  • 26 Feb – United Kingdom
  • 1 Feb   – European Commission
  • 1 Feb   – Private sector
  • 5 Feb   – Technical Evaluation Reference Group (TERG)
  • 2/12 Feb  – Civil society

Consultations Planned:

  • 12 Feb – United States
  • 19 Feb – Private Foundations
  • 3 Mar – Point 7 before the Board Committees
  • 7 Mar – Pre-committee information session
  • 9 Mar – joint SIIC/FOPC session

In addition, the Global Fund Secretariat has been invited to the Communities Delegation Retreat on the 29 February and 1 March in Nairobi, Kenya to provide an update on the KPI development.

The Global Fund has received considerable feedback from 21 constituencies with more  being submitted. All comments and questions received are being responded to in writing and have been compiled into a 120-page document which has been circulated to the members of the Strategy, Investment and Impact Committee (SIIC). The first tranche (around 30 pages) of the 120 page compiled document responding to comments will be shared in a week with Global Fund Committees for feedback ahead of the Committee sessions along with the presentation being shared with W4GF today.

The Committee sessions will focus on providing feedback on the major issues arising. The March 9th session is very short and wont allow for in-depth discussions, so after the committees the Global Fund Secretariat will revise the KPI Framework and have another consultation on March 23rd or the week of April 3rd. This will be the final review ahead of the 35th Board meeting in the last week of April for approval.

Developing the operational KPIs without having the final and full Strategic Operational Framework is challenging so once this is finalised it will be aligned with the KPI Framework. This will all be approved by the Global Fund Board at the 36th Board meeting.

 

3.    Global Fund Constituency/Delegation Feedback on the KPI Strategic Framework
The Global Fund Secretariat shared the common issues received from the Global Fund Board, which included:

  • Split between “corporate” and “operational” KPI Development schedule for operational KPI framework
  • Progress monitoring for sub-objectives not covered by a Corporate KPI
  • Data availability
  • Malaria elimination – (questions around if this should be in the KPI framework)
  • Service coverage vs. service delivery – (should this be measured as a simple number or as a coverage measure trying to assess what share of people who need these services are receiving them?)
  • Treatment coverage for key populations – (should the Global Fund include treatment in this and should this be expanded beyond HIV to TB and malaria?)
  • Gender and age disparities beyond HIV
  • Omissions – Some issues are not being dealt with that are in the strategy: such as Challenging Operating Environments (COEs), transition, differentiation, partnerships, risk.)

4.    Gender and the KPIs
Heather Doyle from the Global Fund Secretariat shared that the Karolinska Institute was commissioned to review existing indicators around gender equality given that gender equality (for the first time) has a place amongst the objectives in the Global Fund Strategy 2017 – 2022. The presentation is available here.

Guiding principles of selecting indicators included:

  • The importance of learning from previous work and not proposing new indicators when existing valid and reliable indicators are already available;
  • The importance of working collaboratively with key technical partners;
  • Indicators should drive investments to better address gender-related barriers to health; and
  • Proposed indicators should respond to future trends in the HIV, tuberculosis and malaria epidemics, and align closely with the new five-year strategic framework, remaining relevant throughout its lifespan.

Additionally, adherence to accepted indicator standards (e.g. UNAIDS)

A high level corporate KPI recommended to the Board for consideration is: The incidence of new HIV infection within the past 12 months among young people aged 15-24, disaggregated by sex and age group (for a selection of high-burden countries (Such as Southern and Eastern Africa))

Rational includes: Reducing the absolute and relative incidence of HIV infection disproportionately affecting adolescent girls and young women in high-burden settings; Harmonizing strategic investments to address gender-inequality whilst scaling up investments in women and girls.

Limitations include: Continuing to improve the accuracy of incidence estimates; Need for collaborative baseline and target setting, guided by currently reported data, modelled HIV incidence and thorough data triangulation.

The second proposed operational indicator is: The percentage of grant recipients reporting age-and sex-disaggregated data on a majority of key indicators

Regarding operational KPIs the Global Fund is considering having an indicator around prevention that links back to Southern Africa. The Global Fund also is consulting with Stop TB Partnership to explore indicators on TB and data disaggregation and measuring successful treatment for women and men. In terms of malaria – there might not be an indicator around gender equality but there could be one around pregnant women who access malaria services through ANCs.

5.    Discussion
At the moment there is only one corporate indicator on gender that measures incidence but overall the Framework has a number of other operational KPIs especially around gender and sex disaggregated data. It is unlikely that the Global Fund will set disaggregated targets for those indicators but they will make sure that the data is broken down by sex and data to ensure no inefficiencies. This is due to the lack of will of the collection of sex-disaggregated data collected by technical partners and countries.

The Global Fund expects to have only 12 corporate KPIs to ensure focus and will have these supported by good operational KPIs backed up by thematic reporting at each stage of the results chain.

A number of consistencies provided feedback on other gender indicator and asked:

  • Are there other gender and age disparities that should be included within the corporate or operational KPIs?
  • What about paediatric ARV coverage?
  • What about Malaria, TB?
  • Is the Global Fund looking at sex or gender disparities?

Responses from the Global Fund:

  • In terms of bringing in an ARV coverage indicator there is no guidance from technical partners that this would be the right thing to do at this stage
  • In terms of TB and malaria and gender disparities there is no major programme in global plans (other than related to malaria and pregnancy). They are considering having an indicator of intermittent preventive treatment in pregnancy (IPTp) but there are concerns on the quality of the data.
  • In the Karolinska report the two indicators around TB there that were proposed are
    • Number of notified cases of all forms of TB (i.e. bacteriologically confirmed and clinically diagnosed), new and relapse, disaggregated by age and sex (GF, WHO)
    • Number and percentage of all forms of TB cases (i.e. bacteriologically confirmed and clinically diagnosed), successfully treated (cured plus treatment completed), disaggregated by age and sex (GF, WHO)

Seven other additional priority operational indicators are proposed and these can be viewed in the presentation:

 

6. Participants Questions and Answers
Q: Are there efforts to align the indicators with the Sustainable Development Goals (SDGs) especially the one on the health and inequalities? And are there plans to have an indicator to measure investments on gender equality?

  • The SDGs measure a global effort and the Global Fund is measuring a proportional response and not the entire global effort so whilst these are aligned they are different. The Global Fund is one player amongst many and in many countries only 10% of national funding. Setting a target on investment is very challenging and the only reasons indicators look at this for example around human rights is because we know there is a huge deficit in money going to this so there is a great need to increase this.
  • The Global Fund has a full time intern who is trying to work on a baseline on investments that advance gender equality, which has been challenging.  One of the challenges is that addressing gender inequality can happen in so many ways and all approaches are encompassed in different Global Fund modules and grants so its hard to set a baseline and then assess the quality of programmes.  The Global Fund would like to share this piece of work if they can finalise it given its complexity

Q: With regards to the corporate indicator on gender – can you clarify the intent of the indicator because now it measures incidence, but not necessarily gender equality? How do the proposed KPIs speak to the third objective in the Strategy at all? This indicator will not measure progress in terms of the key issues that face women daily in terms of the gender inequality and how do these speak to human rights violations that also go beyond Southern and Eastern Africa as does gender inequality?

  • There are 12 high level indicators and it would be challenging to have an indicator that speaks to the lived experience of women and girls –The indicator chosen is responding to a huge programmatic gap that the Global Fund is seeing in adolescents. An adolescent working group did a six-country study on Global Fund processes and included KPIs and incidence came out strongly – it speaks to sub set of countries and is not a global indicator. In terms of gender equality it would translate to incentivising countries to address gender equality.
  • The other operational indicators would speak more to the details – with Stop TB we talked about adding an indicator that looked at availability of HIV pos women to GENEX testing and screening and the Global Fund is having two conversations with the malaria community which have not moved beyond malaria and pregnancy.
  • On key populations the Global Fund has had discussion on how they are addressing gender inequities for female key populations – this is a data issue to some extent but there is a need to look at this in a more nuanced way.

 Chat Box Comments:

  • My fear is if we leave this as it is then we will have countries reporting scaling up of procurement of PMTCT commodities as scaling up programs for women and girls
  • I guess that is the big issue here, balancing practical issues about existing baselines and data availability and quality and coming up with relevant indicators. Acknowledging that corporate and operational KPIs indicate both practical and political aspirations of corporations subscribing to them. Lack of data on or current means of getting them does not justify not exerting effort to change how things are
  • I am sorry but I am sceptical about this, especially in regions like Latin America where the Global Fund in coordination with UNAIDS directs all investments of the Global Fund for gay men. I really hope you can progress in investing in women; maybe you don’t need to ask your Board, ask us, women. This is a comment and I don’t expect an answer.
  • The narrative and response provided shows that more must be done to capture gender inequalities. If this KPI is what we are left with, then this is just lip service to gender equality, which for the first time shows up in the strategic framework. The language in the strategy is strong and will happen if we make sure it is measurable. Understanding the constraints from the secretariat, will help us understand what other advocacy entry points there are?

The KPI on gender incidence is largely driven by DFID and PEPFAR and this is why there is a focus on those selected countries. This indicator does address gender in Objective 1A but fails in transitioning countries.

We need to do more in terms of communities with diverse identities – the Global Fund has been speaking to technical partners who say that the data around key populations is not there but the Global Fund is thinking of an operational KPI that could change the status – for example investing in community based monitoring and research to measure/monitor levels of access to services of key populations and this is a work in progress.

The KPI around human rights – there is room to ensure gender dimensions in some of the human rights areas – and this could relate back to MHIS – there must be a robust/strong system that can ethically and sensitively (grounded in human rights) collect data to sustain programmes.

KPIs are important but they are the tip of the iceberg and do not capture everything that needs to happen. The Global Fund are hosting a consultation this coming week and expect that one outcome will be strong process recommendations – for example that there has to be a proper gender analysis in Concept Notes that goes beyond asking one question – these issues will not be captured by KPIs but can be addressed through other ways.

 

7. Next steps
How can we come up with a KPI that measures what we want from communities?  We cannot be left with an indicator that only measures incidence in 13 countries?

There is still possibility to provide feedback on the corporate KPIs and the operational KPI discussion has just started so W4GF was encouraged to make a submission, which will be presented to the SIIC prior to the Meeting on the 8 – 10 March.

The webinar was hosted by the W4GF Secretariat – Ms Rachel Ong (Global Coordinator) and Ms Sophie Dilmitis (Programme Coordinator); and attended by 8 W4GF advocates including: Bad Black (Come Out Post Test Club), Claire Mathonsi, (the International AIDS Alliance); Luisa Orza (ATHENA); Maurine Murenga (International Community of Women living with HIV (ICW) Kenya; Resty Nalwanga (Uganda Network of Young People Living with HIV and AIDS (UNYPA); Ms Rodelyn Marte (Asia Pacific Council of AIDS Service Organizations (APCASO) Thailand), Sakunthala Mapa, (International Planned Parenthood Federation, UK), Gracia Violeta Ross Quiroga (REDBOL), and Resource people from the Community, Rights and Gender (CRG) department from the Global Fund Secretariat included Andrew Kennedy (Manager, Strategic Controlling, Global Fund);  Heather Doyle (Senior Technical Advisor on gender), and Mr David Traynor (Advisor to the CRG Department).