Fixed Amount Reimbursement Agreement Project Quarter III (January-March 2017) Deliverables Verification Draft Report

The project focused on reducing maternal, neonatal, and child mortality through integrated systems and service delivery investments, while strengthening MoH stewardship and capacity to improve accountability and improve accountability and transparency. The verification exercise, conducted by LSA from August 1-31, 2017, aimed to ensure that the selected deliverables were conducted in compliance with the agreed standards and were managed fairly. The exercise involved a five-person team, led by Julius N. L. LSA's MEL Advisor for Health, and included Mark T. Bassie, Mulbah K. Howard, O. Ebenezer, and Lorpu M. Yekeh. The project supported the provision of health services in Bong, Lofa, and Nimba counties, with the Government of Liberia (GOL) pre-financing FARA v2.0 through the national budget and USAID reimbursing amounts quarterly for the achievement of predetermined objectives. The project's objectives were to strengthen the health sector's capacity, improve health outcomes, and enhance accountability and transparency. The verification exercise involved the collection of evidence through desk reviews, field visits, interviews, and observations. The exercise focused on six deliverables, including: 1. Updated Risk Mitigation Reviews (RMP) reflecting progress achieved for the quarter, including a review of key audit findings from three counties and central MoH and mitigating measures. 2. Bi-annual Health Management Information System (HMIS) data assurance in 20% of health facilities in the three counties. 3. Report from the Integrated Human Resources Information System (iHRIS) of all healthcare workers in Bong, Lofa, and Nimba, including training on family planning, malaria, WASH, and interpersonal communication. 4. A four-county-wide commodity distribution plan, showing the distribution of essential medicines and malaria commodities from the county and NGO depots to last-mile service delivery points. 5. County EPHS implementation for Bong, Lofa, and Nimba, including timely calculation and payment of service delivery incentives to facilities and healthcare workers. 6. Accelerated Performance Framework (AAP) Performance Report outlining progress in Montserrado, Margibi, Bassa, Nimba, Lofa, and Bong in achieving District Contraceptive Days, misoprostol rollout, and availability and use of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment (IPT). The verification exercise revealed that some deliverables were partially achieved, while others were not achieved. For instance, the RMP deliverable was partially met, with risk mitigation reviews conducted in Nimba, Bong, and Lofa, but the Lofa Finance Officer was absent, and the reviews could not be verified. The HMIS data assurance deliverable was also partially achieved, with 18 out of 104 facilities visited having assurance exercises conducted by the MoH. The iHRIS deliverable was not achieved, with no records of in-service training uploaded for the period under review, except for Bong, which had 19 entries. The commodity distribution plan deliverable was achieved, with all three counties having plans for the quarter and documented waybills of drugs received in counties. The EPHS implementation deliverable was partially achieved, with bonuses paid in all facilities visited in Nimba and one facility in Lofa, but the payments for Lofa were not in compliance with the FARA payment time table. The AAP Performance Report deliverable was achieved, with all 30 facilities having SP for IPT for the period under review, and the facilities having never gone out of stock from the quarter under review. The verification exercise highlighted the need for improved coordination and communication between the HR managers and training staff in the three counties.