HPF_III_Evaluation_Report_Final_2016

Evaluation of the Health
Pooled Fund
(HPF-III)
Asrade Abate, MD, MSc
September, 2016

Evaluation of the Health Pooled Fund (HPF III) Federal Ministry of Health, Ethiopia
2 | P a g e
Table of Contents
Executive Summary .............................................................................................................................4
Background ..............................................................................................................................................6
Objective s ................................................................................................................................................7
Methodo logy ...........................................................................................................................................8
Results .....................................................................................................................................................10
1.1. PARTICIPATION & DISBURSEMENT..................................................................................................10
1.2. DESIGN of HPF..................................................................................................................................12
1.3. PLAN, REQUEST & APPROVAL..........................................................................................................12
1.4. FUND UTILIZATION...........................................................................................................................13
1.4.1. System strengthening ...................................................................................................................14
1.4.2. Technical Assistance .....................................................................................................................14
1.4.3. Service Delivery.............................................................................................................................15
1.5. FUND ADMINISTRATION..................................................................................................................16
1.6. MONITORING AND EVALUATION.....................................................................................................17
Recommendations ..............................................................................................................................19
ANNEX I - References .......................................................................................................................21
ANNEX II – Que stionnaire-1 ..........................................................................................................22
ANNEX II – Que stionnaire-2 ..........................................................................................................24
ANNEX III – Memorandum of Understanding........................................................................25

3 | P a g e
Acronyms
ADC Austrian Development Cooperation
APR Annual Performance Report
ARM Annual Review Meeting
CSA Central Statistical Agency
DCI Development Cooperation of Ireland
DFID Department for International Development
DP Development Partner
EFY Ethiopian Fiscal Year
EPHI Ethiopian Public Health Institution
ETB Ethiopian Birr
FMHACA Food, Medicine and Healthcare Administration and Control Authority
FMOH Federal Ministry of Health
GTP Growth and Transformation Plan
HPF Health Pooled Fund
HPN Health, Population and Nutrition
HSDP Health Sector Development Program
HSTP Health Sector Transformation Plan
IC Italian Cooperation
IHP International Health Partnership
JCCC Joint Core Coordinating Committee
JRM Joint Review Mission
JSC Joint Steering Committee
M&E Monitoring and Evaluation
MCH Maternal and Child Health
MDG Millennium Development Goals
MDGPF Millennium Development Goals Pooled Fund
MNCH Maternal, Newborn and Child Health
MOU Memorandum of Understanding
MTR Mid-term Review
PFM Pooled Fund manager
PFSA Pharmaceutical Fund and Supply Agency
PPD Policy, Plan Directorate
RHB Regional Health Bureau
RNE Royal Netherlands Embassy
SDG Sustainable Development Goals
TAs Technical Assistants
TOR Terms of Reference
UN United Nations
UNICEF United Nations Children’s Education Fund
USD United States Dollar
WBP Woreda Based Planning
WHO World Health Organization
WrHO Woreda Health Office

4 | P a g e
Executive Summary
For about a decade, the Health Pooled Fund (HPF) had been supporting the implementation of HSDP II,
HSDP III, and HSDP IV HSDP in three consecutive cycles. At the outset, the Health Pooled Fund was
established to contribute to the fulfillment of the goals of the HSDP by supporting its implementation
process through flexible, time-sensitive and less cumbersome funding mechanisms. At the time of its
establishment, four development partners were involved namely: DFID, DCI, RNE, and UNICEF in July
2005 by contributing a total of 650,000 Euro.
This evaluation was carried out to assess the performance of the HPF III in supporting the
implementation of HSDP IV which lasted for four years, from 1st of July 2011 to 30th of June 2015. The
evaluation covered the period July 2011 to June 2016 and was executed in accordance with standards
and conformed to the guideline provided in the TOR. Initially, the consultant conducted desk review of
relevant documents; develop appropriate tools for key informant interviews; and also conducted field
visits relevant to the HPF-III. The data collected was analyzed using qualitative evaluation techniques
covering the Health Pooled Fund’s activities as a whole and its entire operations. In this regard, this
evaluation ascertained that design of the fund was fairly consistent with development strategy of
stakeholders; the fund was logically flexible to finance the implementation of complex tasks relevant to
HSDP; and representation by key DPs in the country was acceptable, but only a few members
participated: Department for International Development, Italian Co-operation, Austrian Development
Cooperation, and USAID.
During implementation period of HPF-III, the total amount of fund inducted by all partners was
$6,246,689.90. In comparison to the preceding round of HPF (HPF-II), a decline was observed in terms of
number of contributors; and also fund absorption capacity. The average amount of fund, computed
alongside the duration of the project, was roughly comparable with the preceding round. In fact, under
normal circumstances, the HPF-III was anticipated to attract more partners and raise additional fund, or
else stand no less. The decline in the number of DPs that subscribed to the fund was lesser due to a
withdrawal action taken by previous contributors of the fund: Royal Netherlands Embassy, Development
Cooperation of Ireland, as well as UNICEF. Conversely, a new partner, USAID, joined the scheme.
In general, the benefits of HPF did commensurate with the inputs and remarkable achievements were
observed. Through this fund, several important activities were supported including financing key events
which profoundly contributed to improved outcomes and also amplifying the sector's inputs towards the
GTP. In particular, the HPF-III was supporting the implementation of activities mainly focused on system
strengthening; technical assistance; and service delivery and provision of resources for commissioning
relevant studies on key health sector issues in Ethiopia. Among the core accomplishments of the HPF
were HSS, ME, Capacity building, Planning, ARM, JSC, TA, and Operational Research. In addition, it
helped to reduce regional inequalities of health; finance key policy dialogues to strengthen the health
system through policy revision and finalization of HSTP; and supporting the Emergency Referral
Initiative.
The fund administration was flexible, swift and less cumbersome despite some challenges that imposed
difficulty for flexibility. The fund administrator (UNICEF) had a close collaboration with the FMOH and
also advised by the JCCC. The procurement of goods and services, administration of the contracts of
consultants, rental of conference venues and transportation were carried out effectively. The

5 | P a g e
recruitment of TAs was, however, was not fully carried out by UNICEF due to challenges in rules and
regulations related to procurement.
With regard to challenges, this evaluation unveiled significant constraints in the course of unlocking the
full potential of the fund. First and foremost, participation was low and significant contraction was
noted in the number of prevailing contributing donors which eventually lead to shrinkage of finance
availed through HPF account ensuing substantial funding gaps. Here, underlying factors implicated were
retraction of previous HPF contributors; inadequate HPF relevant advocacy work; soft activism to
convene subscription by new members; mild effort applied to increase resource mobilization from
existing members; and irregularities as well delays in disbursement to the HPF account.
On the other hand, a peculiar challenge was identified linked to fund absorption. The fund absorption
capacity showed a declining trend along consecutive rounds of HPF implementations. Collectively, all
three rounds of HPF necessitated arrangements for cost extensions resulting in stretched project
periods. In fact, stumbling upon such occurrence didn’t improve over the years as was manifested by the
performance of the HPF-III which run through recurrent cost extension and consultations with various
HPF contributors. This declining trend, in turn, instigated holdup of scheduled disbursements, expiry of
disbursed grants, call for cost extensions and rescheduling of project lifespan. Conversely, in view of the
spirit and potential capacity of the fund, availed resources were only fairly adequate to sustain the
progress of potential HSDP targets and relevant activities.
Several recommendations have been presented in this evaluation so as to improve the performance of
the fund. Among the core recommendations were updating the fund’s framework and broaden the
scope of strategic areas; in-depth review of the MOU document with attention to its details by
eliminating vague descriptions, adding more clarity and incorporating additional procedures with
detailed criteria; improving the annual preparation of plans focusing on details of activities, precise
budget allocation; strengthen the effort to conduct advocacy work and increase resource mobilization to
pull additional funds; improve fund absorption by applying a strong effort during the planning process
by incorporating passionate and invaluable HSTP objectives; hire appropriate number of staffs who will
be exclusively assigned to facilitate fund’s operations; implement a tracking mechanism, using time-
stamps placed on documents, in order to trace the overall fund request, approval and release process;
share documentation of travel reports, relevant benefits and results timely; and in-depth discussion
needs to be held with all partners regarding participation and continuity of the fund.

6 | P a g e
Background
Within the framework of Ethiopia’s Action Plan of Harmonization and Alignment for Aid Effectiveness,
the FMOH and the HPN Development Partners developed a Health Sector Harmonization Action Plan
which was duly integrated into the successive Health Sector Development Program (HSDP III-IV). The
establishment of a Health Pool Fund (HPF), as a means of support to the implementation process of
HSDP, was agreed upon between the FMoH and development partners as part of the measures taken to
implement the Health Sector Harmonization Action Plan.
For about a decade, the Health Pooled Fund (HPF) had been supporting the implementation of HSDP in
three consecutive cycles: HPF I, HPF II, an HPF III including the periods of cost extension. At the outset,
the Health Pooled Fund was established by four development partners namely: Development
Cooperation of Ireland (DCI), Royal Netherlands Embassy (RNE), and Department for International
Development (DFID) and UNICEF in July 2005 by contributing a total of 650,000 Euro. The first round was
implemented for about 1.5 years, (between July 2005 and December 2006); and the second round was
implemented for 3 years (between July 2007 and June 2010). The third round of the HPF, for which this
evaluation was carried out, supported the implementation of HSDP IV for four years, from 1st of July
2011 to 30th of June 2015. A summary of the rounds of HPF, implementation periods and also
contributing partners and are depicted in the following sections.
An independent evaluation have been conducted for the first and second round HPF and concluded that
funds had been used for the purpose intended and that both FMOH and Development Partners had
benefited from reduced transaction costs, flexible and swift responses for urgent needs. Based on the
positive experiences with the two phases of the HPF and taking into account the recommendations of
the evaluation, The United Kingdom, AusAID, Italian cooperation agreed to support the extension of the
Health Pooled Fund (HPF-III) into a new phase of five years (2010/11 to 2014/15) in line with the HDSP-
IV period. USAID also supported the HPF III activities with a separate grant agreement through UNICEF.
The HPF III has been implemented since July 2011. The general objective of the HPF-III is to contribute to
the fulfillment of the goals of the HSDP IV by supporting its implementation process through flexible,
time-sensitive and less cumbersome funding mechanisms, in line with the Harmonization Action Plan of
HSDP-IV and Growth and Transformation Plan (GTP I). As per the memorandum of agreement signed
between the FMOH and contributing development partners, UNICEF administering health pool fund on
behalf of the FMOH.
To this end, the FMOH and the Joint Core Coordination Committee (JCCC) agreed to evaluate and
document lessons from HPF III implementation. The JCCC gave mandate to UNICEF for issuance of
contract for a consultant to conduct an independent evaluation on the benefit of the HPF-III, whether
implementation was in line with international health partnership (IHP+) compact for aid effectiveness
and as per agreed Memorandum of Understanding, and also to provide information for future policy
decision.

7 | P a g e
Objectives
The objective of the evaluation was to assess whether the Health Pooled Fund served its intended
purpose; and document performances of the fund, challenges and make recommendations. The specific
objectives of the evaluation included:
 To assess the effectiveness and efficiency of HPF III in strengthening the capacity of FMOH in
planning, budgeting, monitoring and evaluation of HSDP IV.
 To assess its contribution in provision of technical assistance.
 To evaluate its contribution in strengthening the service delivery.
 To assess whether the HPF III has been implemented in line with the IHP+ compact.
 To evaluate the governance mechanism of HPF III, the decision making process and “client”
satisfaction (FMOH, HPF III administrator and development partners).

8 | P a g e
Methodology
The evaluation covered the period July 2011 to June 2016. The evaluation was executed in accordance
with standards and conformed to the guideline as provided in the TOR. The consultant conducted desk
review of relevant documents; developed appropriate tools conducted key informant interview; and
conducted field visits. The data collected was analyzed using qualitative evaluation techniques and in
accordance with the objectives and targets specified in the TOR. The evaluation covered the Pooled
Fund’s activities as a whole and its entire operations.
Pre-evaluation steps:
As part of the pre-evaluation activities, the following documents were reviewed:
1) Terms of reference (TOR) for the Health Pool Fund III Evaluation.
2) The Memorandum of Understanding (MOU) between DPs and the FMOH.
3) Relevant documents from Health Sector Development Plan (HSDP III and IV).
4) Health Sector Pooled Fund I and II, Final Evaluation Reports.
5) Minutes of JCCC meetings.
6) International Health Partnership (IHP+) compact for aid effectiveness.
7) Financial Statements and reports of HPF-III produced by UNICEF.
8) Annual reports on Health Pooled Fund III activities, through to June 2016.
9) Proposals of fund requests submitted to JCCC.
10) Payments policy guidelines and procurement rules and procedures.
11) Other supporting documents relevant to HSDP IV and HPFIII.
Specific tasks in relation to the preparation for data collection and analysis consisted of developing tools
to capture key aspects and interview guides for respective key interviews. During this evaluation,
interviews were conducted with key informants from various stakeholders including government, HPF
contributors, HPF administrator, JCCC members and other relevant stakeholders. A total of about 20 key
informants were interviewed and the list of interviews conducted is provided in the table below.
SN Key Informants - Institutions/ Development Partners (total of #20) Number of KIs
1 Federal Democratic Republic of Ethiopia, Ministry of Health (FMOH)
2  State Minister 1
3  FRM Directorate 1
4  Policy, Plan Directorate 1
5  HSS Directorate 1
6 Department For International Development (DFID) 1
7 Italian Co-operation(IC) 1
8 Austrian Development Cooperation (ADC) 1
9 USAID 1
10 The United Nations Children’s Fund in Ethiopia (UNICEF Ethiopia)
11  UNICEF Ethiopia Health Section Chief, and Health Specialist 1
12  UNICEF Ethiopia Health Pool Fund Administrators 3
13  UNICEF Regional Office Somali, Beninshangul Gumuz 2
14 JCCC Members and Organizations other than the HPF Donors 5
16 Client/contractor 1
Table 01: List of key-informants interviewed for this evaluation

9 | P a g e
For this evaluation, structured questionnaires were developed with a purpose of collecting data from
FMOH, DPs, JCCC members, stakeholders and also consultants providing technical assistance for FMOH.
The questionnaires were discussed with technical experts of UNICEF and comments obtained were
incorporated. The questionnaires were prepared to reflect the performance of the fund using a standard
qualitative evaluation approach. In general, the questionnaires constitute various performance
indicators categorized under themes including overview, coherence, relevance, efficiency, sustainability,
ownership, and potential impact of the fund. Through this approach the various achievements of the
HPF; effectiveness and efficiency; fund administration (flexibility, speed, transparency, accountability,
cumbersomeness); level of advocacy; planning, monitoring and reporting were among the major
parameters that were taken up in the process. The questionnaires are annexed with this report. All of
the questionnaires were administered by the consultant through face to face in-depth interviews and
discussions.

10 | P a g e
Results
In summary, the three round of HPF were implemented for about 1.5 years, (between July 2005 and
December 2006); 3 years (between July 2007 and June 2010); and 4 years (1st of July 2011 to 30th of
June 2015) respectively. The summary of rounds, implementation periods and also contributing partners
are depicted in the table below.
1.1. PARTICIPATION & DISBURSEMENT
In HPF III, a total of four DPs were able to join at the onset and contribute to the fund: Department for
International Development, Italian Co-operation, Austrian Development Cooperation, and USAID. The
first three partners signed the MOU directly with the FMOH and disbursements by these partners were
merged, as unified contribution of the HPF-III, and availed through the Health Pooled Fund account.
However, the fourth partner (USAID) joined the fund by signing a bilateral agreement with UNICEF,
delegated by FMOH and in line with the spirit, framework and clauses of the Joint MOU. Thus,
disbursements from USAID were managed separately. AusAID was able to disburse only once.
HPF
(rounds)
Period
(start)
Period
(end)
Years
Partners
(count)
Utilization
(%)
Remarks
HPF I Jul 1, 2005 Dec 30, 2006 1.5 4 85.1% with cost extension
HPF II Jul 1, 2007 Jun 30, 2010 3 6 32.9% with cost extension
HPF III Jul 1, 2011 Jun 30, 2015 4 3 34.3% with cost extension
Table 02: Duration, performance & utilizationof rounds of HPFsover a decade of implementation.
The opening disbursements for HPF-III, sum of grant contribution that corresponds to an amount of USD
$1,337,458.00, were received by the 30th
of June 2012 from DFID, AusAID and IC. During implementation
period of HPF-III, the total amount of fund inducted by these three partners was $4,106,689.90. As of
15th
of December 2015, all funds inducted by these three partners have been utilized though full
exhaustion lingered behind the HPF-III schedule. The table below exhibits detailed information on
annual disbursements and fund utilization.
Development
Partners
2011/12
(EFY04)
2012/13
(EFY05)
2013/14
(EFY06)
2014/15
(EFY07)
2015/16
(EFY08)
Total
[per partner]
DFID 703,125.00 294,370.00 563,463.64 608,766.23 0.00 2,169,724.87
IC 133,333.00 0.00 375,469.34 0.00 0.00 508,802.34
AusAID 501,000.00 516,530.00 410,632.69 0.00 0.00 1,428,162.69
USAID 0.00 0.00 0.00 0.00 2,140,000.00 2,140,000.00
Total [per year] 1,337,458.00 810,900.00 1,349,565.67 608,766.23 2,140,000.00
Grand Total 6,246,689.90
Utilization (%) 34.3%
Table 03: The contributions by individual partners from July 2011 – December 2015

11 | P a g e
Unlike the grants received by aforementioned
partners, the USAID grant was managed
separately and also received late. In particular,
USAID disbursed a two series grant with
cumulative sum of USD $2,140,000.00. The
initial USAID grant was inducted on January 1,
2015 with an expiry date of grant set to end of
June 2016. Of which, the amount utilized by
29th of February 2016 was USD $857,253.57,
leaving the unspent balance of USD
$1,282,746.43. Obviously, utilization of this
particular grant was also behind the schedule
vis-à-vis the stipulated duration of the HPF-III.
In comparison to the preceding round of HPF (HPF-II), a decline was observed in terms of number of
contributors; and also fund absorption capacity. In contrast, the HPF II was able to draw in six partners
with a total disbursement of $3,769,368.08. The average amount of fund, computed alongside the
duration of the project, was roughly comparable with the preceding round. In fact, under normal
circumstances, the HPF-III was anticipated to attract more partners and raise additional fund, or else
stand no less. The decline in the number of DPs that subscribed to the fund was lesser due to a
withdrawal action taken by previous contributors of the fund: Royal Netherlands Embassy, Development
Cooperation of Ireland, as well as UNICEF. Conversely, a newer partner, USAID, joined the scheme in
HPF-III.
Nonetheless, this evaluation unveiled significant constraints in the course of unlocking the full potential
of the fund. First and foremost, participation was low and significant contraction was noted in the
number of prevailing contributing donors which eventually lead to shrinkage of finance availed through
HPF account ensuing substantial funding gaps. Here, underlying factors implicated were retraction of
previous HPF contributors; inadequate HPF relevant advocacy work; soft activism to convene
subscription by new members; mild effort applied to increase resource mobilization from existing
members; and irregularities as well delays in disbursement to the HPF account. In fact, the funding gaps
were filled up by donors as well as the fund manager (UNICEF), nonetheless, impacts from these gaps
were not negligible. Occasionally, donors were asked to step up disbursements in advance of the actual
schedule. In other instances, the fund administrator was urged to inject money in to the HPF account
which was reclaimed from disbursements made later in the course.
On the other hand, a peculiar challenge was identified linked to fund absorption. The fund absorption
capacity showed a declining trend along consecutive rounds of HPF implementations. Collectively, all
three rounds of HPF necessitated arrangements for cost extensions resulting in stretched project
periods. In fact, stumbling upon such occurrence didn’t improve over the years as was manifested by the
performance of the HPF-III which run through recurrent cost extension and consultations with various
HPF contributors. This declining trend, in turn, instigated holdup of scheduled disbursements, expiry of
disbursed grants, call for cost extensions and rescheduling of project lifespan. Conversely, in view of the
spirit and potential capacity of the fund, availed resources were only fairly adequate to sustain the
progress of potential HSDP targets and relevant activities.
Figure 1: HPF-III contribution by DPs between 2011 & 2015

12 | P a g e
Partners
•Disburse
FMOH
•Utilize
JCCC
•Monitor
UNICEF
•Admin
Partners
• Disbursement
• DFID
• USAID
• AusAID
• IC
FMOH
• Utilization
• Plan
• Review
• Approval
JCCC
• Monitoring
• Review planning
• Endorsement
UNICEF
• Administration
• Procurment
• Effect Payment
• Report utilization
1.2. DESIGN of HPF
In line with the purpose of the HPF-III, its design was crafted to allow partners to contribute to the
fulfillment of goals of the HSDP by supporting the implementation process through flexible, time-
sensitive and less cumbersome funding mechanisms that reduces transaction costs. In this regard, this
evaluation ascertained that design of the fund was fairly consistent with development strategy of
stakeholders; the fund was logically flexible to finance the implementation of complex tasks relevant to
HSDP; and representation by key DPs in the country was acceptable, but only a few members
participated. The funding scheme was praised by most respondents as the best approach for planned
targets with superior performance compared to other alternatives covering similar agendas. In
comparison, the HPF III had also learnt from previous rounds of the fund, applied the experiences and
progressed very well. Consequently, through the HPF III, several important activities relevant to HSDP
were accomplished and notable achievements were recorded. Yet, most respondents have foreseen a
higher performance capacity through the fund by unleashing its full potential.
The contracted span of HPF objectives and strategic areas; little dynamism of annual plans alongside
activities; elusiveness of MOU as well as openness for interpretation; insubstantial and unclear linkage
between activity plans and outputs; and strict requirements for tight financial audit by contributing
partners were some of the significant bottlenecks relevant to the design. These constraints were also
found to be among the prominent factors that slowed down potential partners so as to sign up and join
the HPF, as well, played essential role in relation to withdrawal action taken by previous key HPF
partners.
1.3. PLAN, REQUEST & APPROVAL
In accordance with the provisions of the HPF’s MOU, core duties and responsibilities were shared among
partners. In general, the core tasks were scheduled disbursements of grants; annual synthesis of activity
plans with commendation, submission, review and approval of funding requests; endorsement of
approvals for fund release; effecting fund release and procurement; and monitoring. Scheduled
disbursements to the HPF account were effected by Development Partners (DPs); the FMOH synthesized
annual plans, reviewed funding requests and made approvals; fund utilization was monitored by the
JCCC; and procurement was effected through UNICEF, to which fund administration was entrusted.
Figure 2: Activity Cycleof disbursing, utilization, monitoring, and administration process.

13 | P a g e
In detail, a series of steps and procedures were undertaken in the implementation process. The FMOH,
the owner of the fund, was responsible for synthesis of annual activity plans, particularly the PPD of the
FMOH was in charge of developing the annual activity and expenditure plans. In compliance, synthesis
of annual activity plans; request processing; and approval for fund release was carried out by FMOH. In
the beginning of each Ethiopian Fiscal Year, each annual activity plan was presented to the JCCC and
discussed. The JCCC scrutinized presented plans; ratified if expenditures were within the limits; and
finalize the documents to produce a jointly approved annual activity and expenditure plan. The plan was
fairly detailed, timely and most fund requests were in accordance with the objectives.
In the course of fund discharging, subsequent to endorsement of the annual plan, the fund request,
review and approval process comes in to view which requires a series of steps and clearances that need
to be undertaken. In brief, the process consists of preparation and /or receipt of various proposals for
funding; review of proposals and approval by the FMOH; presentation of approved requests to the JCCC
for endorsement. The JCCC was assigned to monitor the implementation of activities ensuring
appropriate and efficient use of the fund in the spirit of its purpose. In particular, JCCC’s
endorsement was required for a special set of funding requests: those beyond the annual plan or those
that exceed the agreed budget by more than 10%. In most instances, routine requests were processed in
accordance with the joint annual plan and on the fly approved by the FMOH itself. However,
expenditures that surpass the cost ceiling of 10% were reviewed by JCCC before execution. Fund
discharge was initiated upon submission of approved requests by FMOH. The submission should be
accompanied by a complete documentation including written authorization for payment by FMOH and
sometimes proof of endorsement by JCCC, particularly minute recordings, where applicable.
Commonly, the preparation of annual plan was customary and predictable. Mainly, this was due to lack
of flexibility to accommodate additional strategic areas, objectives and also initiatives. Compared to
potential activities that need to be invested on, the planning process was only fairly adequate, but not
passionate. Indeed, the plan didn't match up to the fund availed; thus, resulting in late and low fund
exhaustion. The review also unraveled that individual users were not well acquainted with the purpose
of the fund. For instance, TAs who were hired through the HPF were found to have scanty knowledge
about the fund; most HPF users at FMOH were not aware of steps and procedures for fund approval;
and frequent complaints were received by UNICEF regarding low DSA scales. These instances signify the
low level of advocacy conducted about purpose, features and values of the HPF.
1.4. FUND UTILIZATION
In general, the benefits of HPF did commensurate with the inputs and remarkable achievements were
observed. Through this fund, several activities were financed including important events which
profoundly contributed to improve outcomes and also amplify the sector's inputs towards the GTP. In
particular, the HPF-III was supporting the implementation of activities focused on system strengthening,
technical assistance and provision of resources for commissioning relevant studies on key health sector
issues in Ethiopia.
Among the core accomplishments of the HPF III were HSS, ME, Capacity building, Planning, ARM, JSC,
TA, Gap filling; HSDP priorities, and Operational Research. In addition, it helped to reduce regional
inequalities of health; finance key policy dialogues to strengthen the health system through policy
revision and finalization of HSTP; supporting Emergency Referral Initiative which facilitated inter-facility
referral for 6,188 laboring mothers, neonatal cases and other emergencies. The HPF was owned and
managed by the FMOH. Unlike other similar schemes, the HPF III maintains a unique advantage, offering
a great space for flexibility, to support enormous investments through HSDP and beyond.

14 | P a g e
1.4.1. System strengthening
In brief, core accomplishments in this category were: M&E activities including HSDP-IV reviews (Mid-
Term-Review), Joint Review Mission (JRM), and Policy Dialogue Workshops. The HPF III sponsored
several events and availed the platform for exchange of views among participants; enabled common
understanding on various agendas; in-depth analysis of performance reports, progress made and
constraints identified; and endorsement of upcoming plans and initiatives. Of which, the Health Sector
Annual Review Meeting (ARM), and Joint steering Committee (JSC) were events of prime significance
uninterruptedly funded through the HPF.
The ARM, a regular annual meeting, convened more than a thousand participants across-the-board
including health institutions and other relevant stakeholders (universities, partners, NGOs, civil societies,
associations). Similarly, the JSC, a performance monitoring and evaluation summit that summoned
managements of FMOH, Agencies and RHBs, had been financed through the HPF on a quarterly basis.
Particularly, the ARM session enabled participants grasp the opportunity to openly debate and
understand various agendas; conduct focused exchange of views on presentations; and forward inputs
for further improvement. Further, these events strengthened coordination and partnership among
government, donors and stakeholders; and help review individual performance level equated to national
average. Besides, Woreda-Based Planning (WBP) and supportive supervisions, mostly financed through
the HPF, had contributed to strengthening the capacity of Woreda health offices.
In addition, the fund was utilized to finance capacity building activities through provision of training and
also sponsoring policy makers and key implementers to obtain transnational exposure and sweeping
experiences in various areas including health policy. As such, the HPF financed participants on local and
international conferences to acquire updated information and evidence that could be adapted to local
context. Especially, the benefits of travel, mainly international travel, were multifold: experience
sharing, bringing innovations home, and country image building were among the core advantages.
Besides, Ethiopia was also able to contribute to key global debate and dialogue on contemporary health
related issues and to engage with international development partners.
1.4.2. Technical Assistance
One of the key objectives of the HPF III was the recruitment of Technical Assistants (TAs) with the aim to
provide support to the health system, particularly the implementation of HSDP IV at various levels.
These included capacity building of staff in various directorates at the FMOH, Agencies, and regional
bureaus; and also coordinate and assist regions that require specialized support. Indeed, the HPF had
been the principal fund that provided resources to finance salaries, top-ups and hardship allowance for
international and/or national consultants. In this regard, a total of about 77 consultants were hired. Of
the 77 technical assistants, about 25 (32.4%) technical assistants were working in different directorates
in FMOH and PFSA where specific needs for technical support had been identified, particularly IT, audit,
procurement, policy related research, and grant management. For instance, at the FMOH, the TAs
delivered specialty service by providing technical assistance to strengthen the audit and procurement
process at the Finance and Procurement Directorate, particularly the Grant Management Unit.
On the other hand, 34 (42.4%) of the TAs were deployed to four regions which required special support:
Somali (14), Afar (7), Gambella (6) and Beninshangul Gumuz (5). These TAs were placed in offices at
regional, zonal and Woredas level and delivered their support focusing on initiating equity responses
and also accelerating the performance of HSDP IV in those specified regions. By the end of 2015, about
32 technical assistants, assigned to regions, continued their service. As marked by various reports, the

15 | P a g e
principal areas of engagement of these TAs, particularly at regions included provision of training for
health workers; participation in design and development of documents and guidelines; support the
enhancement of service utilization; provision of system strengthening and M&E support; contributions
towards health facility infrastructure development and equipping; and also supporting the response to
emergencies in relation to the drought.
The deployment of TAs was effected as per the 2014 agreement between FMOH and UNICEF. In
compliance with the agreement, the TAs were recruited and deployed to regions by FMOH and UNICEF
payed their top-up and hardship allowance upon submission of payment request and performance
report. A few complaints were identified with regard to delayed payments of salaries, but the issue
required in-depth investigation in order to identify underlying causes.
1.4.3. Service Delivery
The fund was applied in the implementation of cutting-edge initiatives including the Emergency MNCH
Referral Initiative. Thus, several hospitals received the assistance targeted to improve referral and
provision of emergency medical service in Addis Ababa. FMOH deployed 13 (16.8%) health providers to
facilities handling emergency issues and referral services in public and private hospitals. Likewise, four
technical assistants, hired through the HPF, were deployed to Tikur Anbessa Specialized Hospital (TASH)
with the aim to support the human resource management and procurement service. In addition, the
fund was also utilized for development of standards, guidelines and manuals; and also assisted the
emergency response for draught management.
In terms of utilizations, core challenges were low fund absorption, late fund exhaustion and recurrent
cost extensions. Thus far, by the end of this evaluation, a significant amount of untapped money was
seen deposited in the HPF account. Possibly, underlying factors that contributed to inefficient fund
utilization were contraction of HPF III objectives, limited scope of funded HSDP IV targets, low-key
planning that didn’t conform to fund availed through the HPF III; underutilization of budget in some
proposed targets; and inadequate fund allocation to certain activities which were often overlooked. On
the contrary, over expenditures were noticed, in projects like ARM. Respondents compared the value-
for-money in such over expenditures weighed against other HSDP priorities.
The eligibility of travels was one of the most emphasized and heavily criticized agenda by respondents
during this assessment; consequently, several critiques were stipulated by respondents as equated to its
benefits. Along these lines, several challenges associated with expenditure, management and cost
control for international travel were identified. One of the major issues specified was in relation to the
measurability of outputs correlated with travels. Conceivably, the critiques were backed by citations of
shortcomings linked to outputs of travels. In most cases, travel narratives and relevant outcomes were
improvised or not shared by travelers upon return. Even for few reports collected from travelers, the
narratives were incomplete and unarticulated; and lack description on objectives and relevant details. In
a few cases, the purpose of travels was not credible to a certain extent whilst it could have been
financed by the FMOH itself. This specific challenge was cited as a key factor that attributed to the
withdrawal of DPs who question the eligibility of travels compared to other priorities.
In addition, other challenges include the utilization of HPF III funds as first hand option for overhead
expenditures; and also little activism to explore alternative sources of funding to cover administrative
costs where applicable. Implementation delays were also noticed mainly due to delayed disbursement
of contributions; lengthy process in the course of deployment of Technical Assistants (TAs); delayed
submission of expenditure requests; and also incomplete documentation resulting in delayed settlement

16 | P a g e
of payments. Challenges specified with regard to TAs include increased turnover, vague scope; outdated
guideline and absence of exit strategy despite the rising number of TAs.
1.5. FUND ADMINISTRATION
In terms of accountability, duties and responsibilities adopted by UNICEF during the implementation
period of the HPF were multifold: contributing partner; fund administrator; and also a delegate for
FMOH in various instances. Until the completion of this evaluation, UNICEF was assigned as the sole
administrative manager of the HPF on behalf of the FMOH for all the three rounds of the HPF. As such,
UNICEF was delegated to administer the HPF-III on behalf of the FMOH. The rationale for the fund’s
separate management was to facilitate a swift and flexible procurement; thereby remove administrative
burden of these tasks from FMOH and expedite the implementation of HSDP. An operational fee of 7%
was deducted, from each disbursement, for administration costs incurred by UNICEF. This review
observed that the charged fee was within acceptable limits. In fact, the fee was smaller when compared
to operational fee claimed by others for managing similar operations.
The fund operations were run in consultation with the JCCC’s instructions and in accordance with
UNICEF’s regulations, directives and procedures. Accordingly, UNICEF received disbursements from DPs
and stored the fund in a special account. Since grants were received in various currency formats (USD,
Euro, and Pound), the United Nations operational rate of exchange was applied to convert the grants
into United States Dollars based on exchange rates on the date of receipt.
Overall, the Fund administration was flexible, swift and less cumbersome despite some challenges that
imposed difficulty for flexibility. In this regard, all travel related requests were executed on time despite
the presence of several late hour requests. Besides, UNICEF waived the required procedures for travels
made by high-ranking officials and arranged “No Clearance” special travel plans that affirm with relevant
protocols of the officials. Procurements were effected upon receipt of official authorization signed by
PPD/FMOH; and accompanied by relevant supporting documents. The fund administrator had a close
collaboration with the PPD/FMOH and also advised by the JCCC. The procurement of goods and services,
administration of the contracts of consultants, rental of conference venues and transportation were
carried out effectively. The procurement process was fairly in line with the rules and regulations of
UNICEF; in compliance with the agreed terms of the MOU; and also consistent with internationally
accepted practices to ensure value for money.
UNICEF possesses a well-established and advanced fund management system used by various customers
worldwide and also earned a huge trust from several partners globally. UNICEF provided high caliber
staffs, adequate service and a reliable procurement system for the amount charged. Besides, several
urgent tasks presented to UNICEF on short-notice were handled well. The fund management by
UNICEF’s had recognizable benefits attributed to UNICEF's global collaboration as well as affiliation with
various businesses and services providers; acclaimed reputation for collaboration with various
development partners; and also the established technical capacity and input by the high caliber staff.
The financial administration process was subjected to auditing procedures, both internal and external,
by employing regulations, rules, directives and procedures applicable to UNICEF. As such, most partners
mentioned that they have full confidence and trust since the fund is administered by UNICEF.
During the implementation period of HPF III, UNICEF communicated and shared information with the
FMOH, JCCC and partners on several issues and also advised partners of the decision in that regard
including date of scheduled disbursements; status of expenditures; and inadequacy of funds in the HPF

17 | P a g e
account. In a few occasions, particularly when the balance in the HPF account was insufficient to make
scheduled disbursements, UNICEF filled the gaps and made disbursements in consultation with the JCCC.
In addition, UNICEF also presented valuable feedback to the FMOH including progress of activities and
cautionary notes on pending activities; alerts pertaining to grant expiry; and also encouraged on time
budget utilization.
In the procurement process, the fund administrator claimed several challenges, principally complexity of
assignments and increased workload. In this regard, several factors were identified that attributed to
challenges. Requests did not adhere to agreed conditions for fund administration or were not in
accordance with the HPF's procedures as stated in the MOU. The most frequent barriers in fulfilling the
required pre-requisites consisted: incomplete documents (Incorrect names, dates), 11th hour requests,
ineligible requests, unauthorized requests, and detoured requests. Urgency coupled with detoured
requests (bypassing the sequence of approval) was one of the most frequent challenges observed in
certain cases. Travel requests were mostly delivered to UNICEF shortly before due time, but achieved by
UNICEF's staff who committed after-hours work. Complaints were heard from staff due to after-hour
workloads and urgency of certain tasks which put the staff under pressure.
On the other hand, prominent communication gaps were identified between the record and registration
office and UNICEF causing delayed arrival of approved requests to UNICEF. The late arrival of requests
was mostly due to lags at record unit at FMOH while delivering the required documents. Sometimes,
UNICEF received employment and payment documents from TAs themselves by hand.
With regard to payment of TAs, challenges were due to submission of payment requests for cumulative
number of months allied with large number of newly hired consultants. In addition, unavailability of
standalone staff exclusively assigned for the task in FMOH was aggravating factor. Perhaps, JCCC
overlooked the idea of hiring adequate staffs exclusively for managing the fund despite requests were
presented to JCCC.
UNICEF undertakes various audits, both internal and external audits including those by MOFED. In this
regard, there were requests that did not comply with UNICEF's financial rules and procedures for fund
management. Similarly, some of these requests did not comply with financial rules and procedures of
MOFED. By the end of this evaluation, UNICEF's upgraded its financial regulations and a new procedure
called VISION is instigated which requires additional steps. Thus, fund release process is expected to
take additional steps.
1.6. MONITORING AND EVALUATION
The Joint Core Coordinating Committee (JCCC), composed of members from the Federal Ministry of
Health and HPN Partners, was chaired by the Head of the Policy, Planning Directorate of the Ministry of
Health. The Committee was delegated the responsibility to endorse annual HPF-III activity and
expenditure plans; monitor the fund's appropriate and efficient utilization; and also advise on the
procurement of goods and services. Exclusive of oversight by the UNICEF’s system itself, the fund
administration was observed through layers of monitoring schemes and robust monitoring activities
were performed. These include detailed reports of expenditures linked to themes were summited and
reviewed on regular basis; Value-For-Money (VFM) was scrutinized with in-depth inspection for
particular expenditures and items tagged under reservations; and also auditing was conducted by
MOFED and external auditors.

18 | P a g e
Furthermore, activity plan and achievements were tracked; details of all expenditures were monitored
regularly through presentation of reports by UNICEF; as well individual DPs were able to monitor
contributed grants with respective detailed expenditure statements for each projects effected.
Expenditures greater than 10% of the plan were discussed and fund release was granted as observed
from recorded minutes of the JCCC meeting. The contribution to draught management; the new
initiative of Emergency MNCH Referral; and ARM expenditures were among the biggest issues discussed
during the meetings.
In accordance with the MOU, the fund administrator submitted regular reports including brief summary
of the activities and narrative to the JCCC, individual donor reports, and also periodic financial utilization
progress update reports. As such, semi-annual/annual utilization and progress updates reports were
submitted by UNICEF. In addition, UNICEF submitted individual reports to partners on particular grant
utilizations, details of expenditures, and also exhaustion. The reports were reviewed and endorsed by
the JCCC and were circulated to the donors. By the end of each round of HPF, the JCCC coordinated an
independent final evaluation of the fund, contracted and executed by UNICEF. Information exchange
was fair among the partners; minutes of the JCCC were circulated, and progress updates were shared.
The monitoring activity by the JCCC was fairly challenged due to emergence last-minute consultations
for endorsement of expenditures for which FMOH had authorized execution. One such example,
intensely debated by the JCCC due to unusually high cost, was the cost allocated to preparation of the
ARM for the year 2015.
To this end, the governance procedures were fairly transparent; and HPF was modestly
representativeness and inclusive of key development partners. With regard to sustainability, outcome
linked to the planning and monitoring components of the HPF objectives have a tendency to endure.

19 | P a g e
Recommendations
Design and Framework of HPF
The fund’s framework should be updated to broaden the scope of strategic areas and enrich respective
activities in such a way that it keeps a room to accommodate more objective, themes and activities on
top of existing ones. Hence, it equates with development strategy of partners; enable FMOH to fast-
track important HSTP activities; and catches the attention of DPs and draws them to the partnership.
The fund’s design should also incorporate more transparency aimed at achieving Value-for-Money.
Memorandum of Understanding
The MOU document needs in-depth review with attention to its details by eliminating vague
descriptions and adding more clarity so that it evades potential ambiguities and interpretations. Further,
the MOU should be redecorated by incorporating additional procedures with detailed criteria in order to
classify expenditures in to groups. For instance, potential expenditure groups could consist of: allowed
expenditures; expenses not eligible to be funded through HPF; administrative expenses; and routine
expenses. As such, the procedure will help to regulate limits and cost thresholds of prospective
procurements in each of these identified groups. Boundaries should be made to control the number of
travels and also set eligibility criteria to varieties of travels allowed as could be grouped by classes of
travels (local/international) and respective themes and objectives. In addition, the MOU should create a
room to adjust and be inclusive of procedures of participating partners.
Annual Plan of HPF
Annual preparation of plans should focus on details of activities; precise budget allocation and
forecasting; inclusion of activities pertinent to HSTP targets; and inclusion of OR at the heart of the
design so that it informs and strengthens policy formulation and decision making. The synthesis of
proposals and activity plans should clearly show the linkage between objectives and anticipated results
asserting with the VFM.
Resource Mobilization
The FMOH should strengthen its effort to conduct additional resource mobilization and pull additional
funds, particularly from existing HPF partners. This could be accomplished by conducting robust
advocacy relevant to HPF and should be highly emphasized since the benefits are multifold. On one
hand, the promotion will attract additional contributing partners to the scheme which simultaneously
opens the door to pull resources; and boost number of grants and amount disbursed to the HPF
account, thereby it widens the potential to invest in more strategic areas. On the other hand, the
advocacy will help recruit more fund recipients, stakeholders including RHB and agencies, to utilize the
resource availed through the HPF. As such it minimizes the persisting challenge of low and late fund
absorption; as well help secure additional strength from the recipients to partake and push the HSTP
agenda further. The HPF should also consider contributions from partners not only in terms of finance
but also seek for technical and other kinds of supports.
Fund Utilization, Monitoring and Reporting
The fund should be utilized to support projects that couldn't be funded through other schemes.
Meaning, apply HPF as a primary source for financing cross-cutting issues and also monitor project
activities through operational researches. As such, the annual plans should allocate adequate funding
for operational researches; evidence-based implementation/monitoring; and also encourage submission
of such proposal. On the contrary, the HPF should be set as the last option to resort to when other

20 | P a g e
alternative funds are unavailable, particularly for administrative costs. As a substitute, the FMOH should
seek own and alternative resources instead of HPF as a firsthand pick.
The FMOH should discuss important matters with the JCCC before approval of requests, particularly in
relation to the VFM. The JCCC, in this respect should also closely monitor the VFM. Co-chairing by
partners should be considered to allow fair fund approval process. In addition, detailed documentation
of travel reports, relevant benefits and results should be timely shared by the travelers up on arrival. In
line with this, the HPF should be praised and promoted for its benefits, particularly in relation to travels.
Fund Administration
Improve fund absorption by applying a strong effort during the planning process by incorporating
passionate objectives; evaluating requests in accordance with the annual plan; executing proposed
projects promptly; and conforming to agreed terms and conditions for fund utilization. The plan should
also incorporate appropriate project milestones and/or log-frame that should be shared among
partners. The fund administrator has been regarded and also found highly valuable in the spirit of
managing the fund as per the agreed terms and condition. Further, UNICEF was found to have a credible
amount of trust from partners; and hence, played on as a check and balance party between partners
and FMOH.
Hire appropriate number of staffs who will be exclusively assigned to facilitate fund’s operations. In this
regard, the evaluation results suggested the deployment of three staffs that will be financed through the
HPF: Fund management consultant at the FMOH); and two Administrative Assistants who will work to
facilitate the fund request at the FMIOH and UNICEF. Besides, a tracking mechanism needs to be set
using document time-stamps so as to trace the overall fund request, approval and release process.
Continuity and Sustainability of HPF
In-depth discussion needs to be held with all partners regarding participation and continuity of the fund.
In addition, the discussion should also explore possible causes for partners’ withdrawal action from the
HPF; and consult with the partners to re-assess their status. Also, HPF needs to adapt to unanticipated
changes of funding by seeking interim solutions when partners face challenges, as in reduction of
funding level. Thus, the FMOH should establish a system to address funding fluctuations through
revision of plans, adjusting expenditure level and also try to find alternative approaches and sources.
In the end, some documents and procedures need to be updated. These include updating the HPF’s
design framework, MOU and objectives by incorporate additional strategic. In addition, standard
templates will be required for fund request process; log system to track document transmission and
submission; and also travel arrangement.

21 | P a g e
ANNEX I - References
1. Health Sector Development Plan and Performance Reports (HSDP III, HSDP IV). FMOH,
Addis Ababa.
2. Health Sector Pooled Fund Evaluation Report. HPF Evaluation Team, April 2007, Addis
Ababa.
3. Health Sector Pooled Fund Evaluation Report. Asrade Abate, Aug, 2010, Addis Ababa.
4. Annual Report of Performance of Health Pooled Fund III. UNICEF, Aug, 2012, Addis
Ababa.
5. Annual Report of Performance of Health Pooled Fund III. UNICEF, Oct, 2013, Addis Ababa.
6. Annual Report of Performance of Health Pooled Fund III. UNICEF, Aug, 2014, Addis
Ababa.
7. Annual Report of Performance of Health Pooled Fund III. UNICEF, Sep, 2015, Addis Ababa.
8. Annual Report of Performance of Health Pooled Fund III. UNICEF, Dec, 2015, Addis Ababa.
9. Mini Ethiopian Demographic Health Survey. Central Statistical Agency, 2014, Addis
Ababa.

22 | P a g e
ANNEX II – Questionnaire-1
Code#: ________________
Full Name: ______________________
Organization: _______________________
Position: _______________________
Involvement: _________________________
A. Partners’ Participation
1) Did your organization participate in the design and/or implementation of the HPF?
2) What was your organization’s financial contribution to the HPF?
3) Why didn’t your organization participate in HPF III?
4) Did your organization play any role in promoting HPF among stakeholders?
B. Scope, Objectives, & Design
5) What is your opinion on the scope of HPF? (Adequacy of fund, and Eligible areas of funding)
6) Were HPF’s time lines, milestones and targets appropriate?
7) Were there any shortfalls in the design of the HPF?
8) Was the work of HPF consistent with development strategy of its principal stakeholders?
9) Did members and donors in the HPF represent the key partners in the country?
10) Were all contributions DPs received on time and according to the disbursement schedule?
a) What were the causes for the delay?
b) What measures were taken by donors to manage the funding gap?
c) Were resources adequate to sustain progress?
11) Do you consider the JCCC to be inclusive in terms of members?
12) Were the structure, role, authority and interactions with governance bodies appropriate?
13) Were governance procedures of HPF adequate in terms of transparency and objectivity?
C. Plan, Use & Management
14) Did the FMOH has annual expenditure plan for appropriate and efficient utilization of HPF?
15) Did the FMOH follow standard procedures to authorize execution of plans?
16) Did the FMOH ensure appropriate and efficient use of the fund in the spirit of its purpose?
a) Value for money (VFM)?
b) Utilization within the limits of its budget?
c) Activities not being part of the Annual Plan/exceed the agreed budget?
17) Were all the required procedures adhere to upon request for spending?
18) Were all requests made, received and executed in line with HPF’s proposal?
19) How much time does UNICEF take, on average, to process an authorized spending?
20) What were contributions of UNICEF to the fund?

23 | P a g e
21) What’s your opinion about UNICEF to put charge on DPs for 7% operational fee?
22) What was the workload of the HPF on UNICEF?
23) Do you think human resource allocated by UNICEF is adequate for managing the fund?
24) Why JCCC did overlooked the idea of hiring staffs, exclusively for the purpose of managing the
fund?
25) Were there procedures against UNICEF’s regulation for procurement?
26) Do you think administration/management of HPF should be continued by UNICEF?
D. Outputs / Outcomes
1) Were benefits of HPF commensurate with inputs in terms of cost, time and effort?
2) Was HPF a viable option for strengthening implementation of HSDP IV?
3) What has been the value-added of the HPF to support implementation process of HSDP IV?
4) What was HPF’s comparative advantage relative to alternatives covering similar issues?
5) What were the major contributions of the HPF in the implementation of HSDP?
6) What distinguished outputs of HSDP could be attributed to the HPF?
7) What do you perceive as the greatest successes regarding HPF?
8) What do you perceive as the greatest challenges of HPF?
9) Were there inefficiencies in utilization? What were the main barriers to effective utilization?
10) Do you think that HPF achievements will endure?
11) Do you think the HPF should continue as it is? What improvements do you suggest?
12) What is your current stand, to join and contribute to the next round HPF?

24 | P a g e
5 Highly satisfactory 4 Satisfactory 3 Fairly satisfactory
2 Less satisfactory 1 Not satisfactory
ANNEX II – Questionnaire-2
Code#: _______________________
Please Rate the following by choosing values provided in the box below. (Mark boxes)
SN Rate 5 4 3 2 1
0 Do you like Ethiopia? (sample completed) X
1 Extent to which HPF design was appropriate to attain its objectives
2 Strength and weakness of the HPF in terms of:
Objectives
Design
Implementation
Monitoring
3 Responsibility of FMOH for receiving, processing & approving request
4 JCCC's meetings in terms of:
Regularity of the meetings
Effectiveness of the meetings
Attendance by all members
5 JCCC's approval process for the HPF as per the MOU in terms of:
Monitoring mechanisms
Transparency
Timeliness
6 JCCC's decision making process to allocate and utilize resources
7 Efficiency of the process of the procurement of service and goods
8 Administration of the HPF by UNICEF in terms of:
Less cumbersomeness
Flexibility
Transparency
Timeliness
9 Financial / progress reports submitted by UNICEF for JCCC in terms of
Timeliness
Accuracy
10 Selection of clients and contracting process in terms of
Transparency of selection
Clear TOR for assignment
11 Overall fund administration process by UNICEF
12 Effectiveness of HPF as a working-model for joint donor engagement
13 Overall rating of the extent of achievement HPF objectives
14 Degree of political commitment among key stakeholders
15 Improved efficiency of HPF-III as compared to HPF-II
16 Achievement of HPF relative to best practices in other countries

25 | P a g e
ANNEX III – Memorandum of Understanding
(Converted from Original PDF MOU document)
JOINT MEMORANDUM OF UNDERSTANDING BETWEEN THE GOVERNMENTS OF THE
UNITED KINGDOM,ITALY,AUSTRALIA,THE UNITED STATES, THE UNITED NATIONS
CHILDREN'S FUND AND THE FEDERAL MINISTRY OF HEALTH OF ETHIOPIA ON THE
MANAGEMENT OF THE HEALTH POOLED FUND FOR SUPPORT TO THE IMPLEMENTATI
PROCESS OF THE HEALTH SECTOR DEVELOPMENT PROGRAMME OF ETHIOPIA (HPF-IV)
1 July 2011- 30 June 2015
I.GENERAL
The Federal Democratic Republic of Ethiopia, Ministry of Health (FMOH) is committed to
ensuring the accessibility of effective health services at every level of the health system through
the implementation of the fourth Health Sector Development Programme (HSDP-IV). Within
this plan, the FMOH and Development Partners of the Health Population Nutrition (HPN)
have developed a Health Sector Harmonization and Alignment Action Plan that supports the
country's action plan of harmonization alignment for aid effectiveness.
The Ethiopia Country compact signed in Addis Ababa on 26th August 2008 sets out the
framework or increased and more effective aid, and accelerated actions toward the
achievement of the he lth Millennium Development Goals (MDGs). The Ethiopia Joint
Financing Agreement (JFA) was signed on 15 April 2009 between the FMoH and seven
development partners. The JFA sets out the jointly agreed terms and procedures for the
management of the MDG Performance Fund (MDG/PF), including planning financial
management, governance framework and decision-making, reporting, review and evaluation
audit and supply chain management.
The MDG/PF is a pooled funding mechanism managed by the FMOH using the Government of
Ethiopia procedures. In the framework of the Ethiopia IHP+ compact, it provides flexible
resources, consistent with the 'one plan, one budget and one report' concept, to secure
additional finance to the HSD-IV. It is the Government's preferred modality for scaling up
Development Partners assistance in support of HSDP- V.
The Health Pooled Fund {HPF) was first established in 2005 to support the implementation
process of HSDP and achievement of the MDGs in Ethiopia. The HPF is considered part and
parcel of the MDG/PF as it supports the same scope and similar activities as the MDG/PF; its
objectives, internal regulation funding and disbursement are fully controlled by the FMOH
according to the HSDP priorities. However, at the same time the HPF is quite distinct from the
MDG/PF in its administrative management - which is done by UNICEF in the role of Pool Fund
Administrative Manager on behalf of the Policy, Planning and Finance Department of the
Ministry of Health (PPFGD/ FMOH), and in its focus on technical support, coordination and
other services that need swift decision and funding. The rationale for its separate
management is related (i) to facilitate the swift and flexible response to procurement of
national and international technical assistance and international travel; and 2) to remove the
administrative burden of these tasks from FMOH.
The first phase of the HPF was implemented between 1 November 2005 and 31 March 2007
with joint funding from the Governments of Ireland, The Netherlands and The United Kingdom
as well as from UNICEF. The HPF-1 was managed by UNICEF Ethiopia. An independent

26 | P a g e
evaluation of the first HPF, conducted in March/April 2007, concluded that funds had been used
for the purposes intended and that both FMOH and Development Partners had benefited from
reduced transaction costs. Based on the positive experiences with the initial HPF and taking into
account the recommendations of the evaluation, a number of HPN Partners had agreed to support
the extension of the Fund into a new phase of 3 years: The HPF-11. The general objective of the
HPF-11 was to contribute to the fulfillment of the goals of the HSDP-111, by supporting its
implementation process through flexible, time-sensitive and less cumbersome funding
mechanisms, in line with the Harmonization Action Plan of HSDP-111. Development Partners'
contributions (DCI, RNE, DFID, IC, ADC) to the HPF-11 amounted to a total of US$ 4,152,985.34
million (US$ 4,152,985.34 programmable). Together with UNICEF contribution of US$ 539,928.43
the HPFII total programmable budget amounted to US$ 4,509,661.63. The second phase of the
HPF will end on
30 June 2011.
An independent evaluation of HPF-11 was conducted in August 2010. The objective of the
evaluation was to assess whether the fund has served its intended purpose. The
evaluation report provided views of the performance, effectiveness, efficiency and eligible
utilization of HPF-11 in accordance with its objectives, and drew lessons and made
recommendations.
In general, the evaluation revealed that HPF-11 is widely seen as an effective, timely,
responsive and demand-driven fund channeled towards the most urgent and critical
needs of HSDP by strengthening the planning and coordination and implementation
process. The establishment of the MDG/PF has drawn a lot of lessons from the HPF.
The evaluation team concluded that the HPF-11 has significant benefits in allowing funding to
respond to priority needs of the HSDP more efficiently. The involvement of donors has
been participatory. UNICEF, as a Pooled Fund Manager, provided substantial support in
managing the fund and also filled important funding gaps throughout the implementation
process.
II. THE FUNDING DEVELOPMENT PARTNERS
1. The Development Partners that have currently decided to participate in this pooling
arrangement a to contribute funds are: The United Kingdom, represented by the Department
For International Development (DFID),Australia, represented by AusAID, Italy, represented
by the Italian Co-operation (IC), The United State of America,represented by USAID, Spain,
represented by the Spanish Agency for Development Cooperation (AECID) and
UNICEF.
At any stage during its implementation, other Development Partners may join the HPF by
signing the Joint MOU as well as by signing a Bilateral Agreement with UNICEF (see Annex
I) which will trig the disbursement of the contribution into the Pool Fund managed by
UNICEF as the Pool F Administrative Manager on behalf of the FMOH/PPFD. All partners to
the HPF-111 and signatory to is Joint MOU acknowledge that its clauses and terms
provide the overall framework for the implementation and management of the HPF-111.
All signatories to this MOU acknowledge that the Joint MOU as well as its Annexes - the
signed complementing Bilateral Agreement (Annex 1), he HPF-111 Proposal (Annex II) and
the Reporting Templates (Annex Ill)- are binding. All funds received in the Special Account
will be recorded in United States dollars. The United Nations operational rates of
exchange shall be used to convert into United States dollars all funds received in other
currencies, based on the United Nations operationalrates of exchange in effect on the date
of receipt.

27 | P a g e
2. The HPF-III will be part of HSDP's wider pooled funding scheme and will support the
implementation on activities as specified in the Proposal for the HPF-111 (Annex ll) and will
not be used to meet the cost of import or customs duties (or any similar fees) imposed by the
Government of Ethiopia on the go ds imported or services provided. These activities will
include:
a) SYSTEMS STRENGTHENING- Support capacity of PPFDG/ FMOH in planning,
budgeting, monitoring and evaluation of HSDPIV:
• Strengthen the capacity of FMOH in co-ordination of activities in the health sector.
• Enable health policy makers and key implementers to participate in local and
international conferences, seminars, short study trips or visits that contribute to useful
gains of experiences and exposure in health policy development and implementation.
• Support the monitoring and evaluation programs of HSDP-IV (such as ARMs, JRMs,
HSDP Mid-Term Reviews and Final Evaluations) to improve its implementation and
to facilitate the sector's inputs towards the Growth Transformation Plan/ Millennium
Development Goals monitoring and reporting process as well as the tracking of
progress in terms of the relevant indicators and targets in the GTP/HSDP-IV policy
matrix.
• Build capacity and provide training at all levels of the health system (Federal,
Regions, Woredas) in planning, M&E,and Harmonization and Alignment.
• Sponsor meetings of the MOH and the private health sector and providing TA on
development of standards, guidelines and manuals on Public Private Partnerships.
b) TECHNICAL ASSISTANCE
• Provide resources for the recruitment of international and/or national consultants to
assist the Ministry in (i) policy related research, assessments and innovations
and (ii) providing Technical Assistance (TA) in areas where specific needs for
technical support have been identified (IT, Audit, Procurement and others).
c) SUPPORT SERVICE DELIVERY
• Provide resources for commissioning relevant studies on key health sector issues
(operational research) in Ethiopia.
• Provide resources for other relevant process activities in support of the
implementation of HSDP -IV priorities.
• Cover the cost of workshops for policy dialogue and formulation, and seminars on
important health issues in Ethiopia. HPF resources will be accessed via UNICEF for
the above-mentioned programme areas and activities in line with the HSDP-IV
priorities.
Ill.DELEGATION TO UNICEF TO MANAGE THE HPF-III
In line with the HPF-111 Proposal and in consultation with all the HPF-111 donors, the Federal
Ministry of Health has officially requested UNICEF to assist the implementation of the HPF-111
by holding and administratively managing the fund. The Development Partners contribution
will be charged a 7% fee for administration and operational incurred cost by UNICEF.

28 | P a g e
IV.THE FEDERAL MINISTRY OF HEALTH AND THE JCCC
As indicated in the Proposal for HPF-iii (Annex II):
1) The Joint Core Coordinating Committee (JCCC) of the Federal Ministry of Health and HPN
Partners, chaired by the Head of the Policy,Planning and Finance Department of the Ministry
(PPFGD-FMOH), has the delegated responsibility of endorsing the Annual HPF-111 Activity
and Expenditure Plan and controlling the Fund's appropriate and efficient utilization.
PPFGD/ FMOH is in charge of developing the draft Annual Activity and Expenditure Plans
and finalizing it with JCCC in July,at the beginning for each Ethiopian Financial Year -and
no later than 31 51
July.
2) The JCCC, the technical arm of PPFGD, will advise on the procurement of goods and services
needed to implement the HPF-111 effectively. Procurement itself will be carried out through
UNICEF Procurement Procedures in line with internationally accepted practices to ensure value
for money.
3) Based on the jointly approved Annual Activity and Expenditure Plan and within the limits of its
budget, the PPFGD-FMOH is responsible for receiving, processing and approving requests for
funding, and ensuring the appropriate and efficient use of the Fund in the spirit of its
purpose. The JCC's endorsement is needed for approval of activities not being part of the
Annual Plan or for activities which exceed the agreed budget (line) by more than 10%. This
approval needs to be recorded in the minutes of the JCCC meeting.
4) Upon approval for funding by JCCC, written authorization for payment together with the
relevant supporting documentation (including the JCCC minute recording the approval)will be
transmitted to UNICEF by the Head of the PPFGD-FMOH.
5) PPFGD-FMOH will inform the HPF-111 donors on progress of HPF-111 and on key relevant
decisions by timely circulating the Minutes of the JCCC meetings. Also, the PPFDG-FMOH will
inform the FMOH. HPN Partners Joint Consultative Forum, which meets every three months, on
progress of HPF-111 activities and expenditure.
6) Whereby donors to the HPF-111 were not members of the JCCC, the JCCC Secretariat and/ or
the PPFD-FMOH are responsible to keep them informed by way of sharing the relevant
minutes of the JCCC meetings and other form of communication. The HPF donors who are
member to the JCCC shall channel to the JCCC any comment/ concern/ suggestion raised by
HPF donors not included in the JCCC membership.
7) At the end of EFY 2007 (April-May 2015), the JCCC will coordinate an independent final evaluation
of HPF-III, by an external organization.
V. THE UNITED NATIONS CHILDREN'S FUND (UNICEF)
As aforementioned and also detailed in the Proposal for HPF-111 (Annex II), the JCCC and
PPFGD/FMOH have requested UNICEF Ethiopia to continue the role of Pool Fund Administrative
Manager (PFAM).
1. In its role of PFAM, UNICEF will administratively manage the HPF-111 on behalf of the FMOH
and in accordance with the provisions of this Joint MOU. The Donors acknowledge that
the Contribution will be co-mingled with other contributions to the HPF-111 and that it will
not be separately identified or administered.

29 | P a g e
2. The HPF-111 shall be administratively managed by UNICEF in accordance with its regulations,
rules, directives and procedures applicable to Special Accounts, including those relating to
interest. The HPF Ill shall be subject exclusively to the internal and external auditing procedures laid
down in the financial regulations, rules, directives and procedures applicable to UNICEF.
3. UNICEF will effect payments for activities financed by the HPF-111 upon receipt of official
authorization signed by the Head of the PPFGD/ MOH (and any relevant supporting document as
above specified). The procurement of goods and services, administration of the contracts of hired
consultants, payments for such services as in the rental of conference venues and facilities,
transportation and printing will follow the UNICEF rules and regulations.
4. UNICEF will, upon receipt of authorization from the PPFGD-FMOH, undertake the procurement of
goods and services, and administer the contracts of hired consultants. In close consultation a d
collaboration with the PPFGD-FMOH, effect payments for such services as the rental of
conference venues and facilities, transportation for such occasions as Joint Annual Review
Meetings (JARMs), Review Missions (RMs), printing of documents etc.
5. UNICEF will submit to the Donors of the HPF-111 regular reports. In particular:
 Six Monthly financial utilization progress update and a brief summary of the activities
undertaken by the fund recipients during the semester in question, to be submitted
within 1 month after the end of the reporting period - see template in Annex Ill.
 Overall annual progress (narrative and financial) reports for every Ethiopian fiscal
year, to be submitted 2 months after the end of the reporting period-see template
in AnnexIII.
 A finalnarrative and financial report six months after completion of the project, covering
the entire period of the project,
 A final certified financial statement of accounts within six months of financial closure
of the grant as per UNICEF rules and regulations.1
6. Reports will be based on the inputs provided by the PPFGD/ MOH and by the JCCC. Reports
shall be reviewed and endorsed by the JCCC prior to circulation to the HPF-111 Donors.
7. Donors to the HPF-111 acknowledge that all Progress and Final Reports (narrative and
financial, including the final certified statement of accounts) on the implementation of the
activities and the execution of the Fund will be drawn up in the spirit of One Plan, One Budget
and One Report, s avoiding accounting to individual donors.
8. Disbursements will be made to the extent that funds are available in the Ethiopia Health Pooled
Fund Account. Where the balance in the Ethiopia Health Pooled Fund on the date of a
scheduled disbursement is insufficient to make that disbursement, UNICEF shall consult with
the Joint Coordinating Committee and make a disbursement. if any, in accordance with the Joint
Core Coordinating Committee's instructions. UNICEF shall promptly notify the Donors in such
circumstances and shall advise the Donors of the Joint Core Coordinating Committee's decision
in that regard.
9. UNICEF will sign a bilateral Agreement (Annex I) with each of the contributing donors to the
HPF-III to trigger the disbursement of funds. The bilateral Agreement, as per template in Annex
in line with the spirit, framework and clauses of this Joint MOU.
10. Obligations assumed by the Donor and UNICEF under this Joint MOU shall survive the
expiration or termination of this Agreement to the extent necessary to permit the orderly
conclusion of activities, the withdrawal of personnel, funds and property, the settlement of
accounts between the Parties and the settlement of contractual liabilities required in respect of

30 | P a g e
any subcontractors, consultants or suppliers. Donors to the HPF-111 acknowledge that any
balance remaining in the HPF-111 account shall be used for a purpose mutually agreed upon by
UNICEF, the HPF- III Donors and the JCCC. If the decision if for unspent balances to be
returned upon completion of the programme, these will be on a pro-rata basis.
11. All financial accounts and statements shall be expressed in United States dollars.
VI. REPORTING
1. UNICEF will submit six monthly financial utilization progress reports and a brief summary
of the activities of the activities undertaken during the semester in question, to be
submitted one month after the end of the reporting period-see template in Annex Ill.
2. UNICEF will also provide Annual progress (narrative and financial- Annex Ill) reports for
every Ethiopian fiscal year. They are to be submitted within 2 months after the end of
the reporting period and in particular by 31st August 2012, 31st August 2013, 31st
August 2014-as per template in Annex Ill.
3. A final narrative and financial report no later than six months after completion of the
project, covering the entire period of the project -i.e. by 30th September 2015.
4. A joint final certified financial statement of accounts produced by 31 51
December 2016.
VII. SETTLEMENT OF DIFFERENCES
1. This MOU is neither a treaty nor an instrument of treaty status. Consequently, differences
which may arise concerning the interpretation or application of the MOU will not be subject
to adjudication or arbitration by any national or international court or tribunal but will
instead be dealt with in an amicable way as the appropriate method of achieving the
peaceful settlement of those differences.
2. The Parties will consult together at any time upon request of either Party regarding any
matter relating to the terms of this Memorandum and will endeavor jointly in a spirit of
cooperation, g faith and mutual trust to resolve expeditiously any difficulties or
misunderstandings that may arise.
VIII.COUNTER-TERRORISM PROVISIONS
1. Consistent with UN Security Council Resolutions relating to terrorism, including UNSC
Resolution 1373 (2001) and 1267 (1999) and related resolutions, both the UNICEF and
the Donors signatory to this agreement are firmly committed to the international fight
against terrorism, and in particular, against the financing of terrorism. It is the policy of
the Donors signatories to this agreement to seek to ensure that none of its funds are
used, directly or indirectly, to provide support to individuals or entities associated with
terrorism.
2. In accordance with its policy, UNICEF undertakes to use all reasonable efforts to ensure
that none of the Contribution is used to provide support to individuals or entities
associated with terrorism. If, during the course of this Agreement, UNICEF discovers a
link with any organization or individual associated with terrorism, UNICEF will inform
immediately the Donors to the HPF- II who are signatories to this MoU.
IX. AMENDMENT TO THE PRESENT MOU
1. This MOU may be amended at any time or extended upon consensus of all signatory
parties. If and when a new Development Partner wished to join the HPF-111 during its
implementation, it can do so by signing the present MOU and a bilateral agreement (as
per Annex I) with UNICEF which triggers the disbursement of the contribution into the
Fund managed by UNICEF on behalf of FMOH.

31 | P a g e

HPF_III_Evaluation_Report_Final_2016

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (20)

Similar to HPF_III_Evaluation_Report_Final_2016

Similar to HPF_III_Evaluation_Report_Final_2016 (20)

More from Asrade Abate

More from Asrade Abate (6)

HPF_III_Evaluation_Report_Final_2016