Assessment of the health for all project

The purpose of the assessment was to review HFA’s project design and its implementation and assess how it is supporting the project’s goals. The assessment was inductive, participatory, and cyclical in nature, and its goal was not to evaluate the project’s performance, which was done in the 2018 HFA mid -term evaluation (MTE). The assessment focused on assessing how effective the project’s design and implementation have been to date and made recommendations for the two-year extension. The methodology included a thorough desk review of relevant project and background documents and secondary data, key informant interviews (KIIs), an online survey of those key informants that could not be interviewed virtually or in-person, and an assessment of a sample of top- and low-performing HFA-supported health facilities. Representatives from the Angola Ministry of Health (MOH) and USAID/Angola accompanied the assessment team in the health facility visits. For each health facility, the assessment team completed a KII with the officer in charge and filled out a checklist based on the Service Availability and Readiness Assessment (SARA) Tool developed by USAID and the World Health Organization. Data collection was done in either English or Portuguese. The findings indicate that the HFA project is performing in accordance with its design and has implemented the 2018 MTE recommendations. However, a number of design assumptions have not been fulfilled, which limited its impact. Malaria case management has improved but this is not consistent yet, and causal pathways do not permit a clear line of sight between project activities and outcomes. The HFA project has increased long lasting insecticidal net (LLIN) coverage through its participation in the last distribution campaign. The coverage of prevention of malaria in pregnancy (MiP), is about 30 percent, far from the desired 80 percent target. According to the MOH policy, MiP and routine LLIN distribution is limited to antenatal care (ANC) clinics, the immunization program, and maternity hospitals, and only an estimated 28 percent of HFA -supported facilities provide ANC. Notably, HFA’s Scope of Work (SOW) did not require the project to cause a change in the above-mentioned policy. Family planning coverage is stagnant in the 42 facilities supported by the project. District Health Information Software2 (DHIS2) rollout is reported to be the most important achievement of the HFA project. The project is now focused on addressing data quality and use challenges. The HFA project has invested about 70 percent of its resources and effort in training, but handing over of this component to the MOH and the sustainability of this investment is uncertain at this time. Online training is reported to have increased access to affordable and possibly sustainable in-service capacity at the MOH; the platform has yet to be transferred to the MOH. The assessment team presents a number of recommendations for the HFA project to sustain its impact in the two-year extension period and an overview of lessons learned.