Integrated Site Visits

Visits to Sub-recipient (SR) facilities or service delivery points are important to ensure that programmatic activities are implemented as intended and to required quality, that funds and physical items provided through the SR agreement are being used and maintained according to the agreement and that record-keeping is up to date. Site visits include access to all items and documentation related to the Global Fund-financed activity, as well as discussions with key SR personnel and grant beneficiaries. Taking into account limited resources for site visits, the Project Management Unit (PMU) prepares the site visit plan using a risk-based approach. Each quarter, the PMU updates its monitoring visit plan based on the findings of previous visits to follow up, specific indicators to validate, the importance of the sites (number of clients/patients), volume of funds and commodities managed by specific SRs and other additional information. It is advisable for the PMU to share a monthly calendar of site visits with the National Programme and encourage the realization of joint visits [1]. The PMU also informs the SR in advance of the planned visit in order to assure the on-site presence of the needed staff and encourage the SR to facilitate access to and discussion to beneficiaries to obtain their feedback on the programme. In case one SR implements the programme in numerous locations or through Sub-sub-recipients (SSRs), it is the SR’s responsibility to plan for field monitoring and supervision visits. Based on the SR’s quarterly site visits calendar, the PMU might decide to join a SR during the SR’s visit in certain challenging sites. The main findings of the site visit should be discussed with the staff in place. A complete monitoring visit report should be shared with the SR and ideally with the national programme.

The Principal Recipient (PR) should prioritize integrated site visits that aim to supervise different aspects (monitoring and evaluation (M&E), health products management, programme, asset management) during one visit. The format of an integrated site visit report includes different sections:

A. An update of the previous visit’s recommendations

Before the visit, the PMU should review the reports of the previous visits and note the recommendations that were not fulfilled in order to follow up during the planned mission. It is good practice for the PR to maintain an Excel file to compile the main recommendations of all visits. Before a new visit, the team should consult the file in order to follow up on the previous recommendations during the planned visit. After undertaking the site visit, the team should update the status of the previous recommendations and provide new ones. This file allows monitoring the challenges and progress over time. At the site, the team should note the actions taken in regard to each recommendation and update its status. The report of the mission will end with new recommendations and timeline.

B. Monitoring and Evaluation

Verification of the availability of data-collection and reporting forms and tools:

For each program, whenever available, the site should use the national forms and tools or, in cases where national tools are not available, prescribed grant-specific tools to collect and report against the indicators. For specific project-related activities, data collection tools should be harmonized in the facilities implementing the same activity.

C. Data quality assessment:

As performance-based funding projects, the disbursements of Global Fund’s projects are tied to the results obtained. Therefore, the quality of data collected and reported are important for programme management.

At site level, the team assesses the percentage of availability, timeliness and completeness of the reports. Using the data sources, the team recounts the data and compares the verified data to the site’s report for each indicator selected.

D. Health product management

The verification of the system to manage health products at site level is part of the activities required to assure the quality of the products that reach the patients. The UNDP Country Office (CO) verifies:

• The availability of procedures for storage and inventory management;
• The availability of the report of the last supervision visits and status of previous recommendations;
• The storage conditions, stock management and security of the pharmacy;
• The availability of up-to-date inventory records, data recording and reporting tools, and evidence of routine reporting
• Stock levels at the moment of the visit and any stock availability issues in the previous period; and
• The comparison between number of patients covered and consumption of health products.

E. Laboratory

The assessment of the laboratory system assures that the system in place guarantees the reliability of laboratory results. In addition to the supervision of the environment in which the services are provided, the UNDP CO verifies:

• The availability of tests procedures and laboratory registers up to date;
• The training of designated laboratory technicians;
• The availability of the report of the last lab supervision visit;
• The availability of up-to-date inventory records, data recording and reporting tools, and evidence of routine reporting;
• The equipment maintenance schedule and evidence that routine servicing and maintenance is being implemented;
• The availability of procedures for storage and inventory management;
• The storage conditions, stock management and security of the laboratory store;
• The stock levels of reagents and consumables at the moment of the visit and any stock availability issues in the previous period; and
• The comparison between number of tests performed and consumption of reagents.

F. Programme quality assessment

The programme assessment’s objective is assuring the quality of services delivered. During the data validation, the team should hold discussions with the service providers responsible for the services related to the selected indicators. The team requests information about service provision organization, the system in place to ensure optimal service quality, and the application of national guidelines. The team also notes the service provider’s thoughts on challenges, the adequacy of resources (human, laboratory, inventory management etc.) and in general, the factors that might have impeded or enhanced service performance.

When possible, it is advisable for the team undertaking the monitoring visit to talk with beneficiaries and inquire about their experience with the provided services: accessibility, waiting time, interaction with service provider, privacy.

At the end of the visit, the team should verify that:

• A copy of the national diagnostic and treatment guidelines are available;
• The algorithms of diagnosis and treatment are posted in the examination rooms;
• There is a procedure for recording adverse effects or quality issues of medicines and diagnostic products; and
• The health staff was trained

For monitoring visits for prevention services, the visit should check the number of times beneficiaries are ‘reached’ and how services are delivered to them. Although outreach workers or health facilities may provide condoms or needles and syringes as part of prevention services, the quality of the services provided may be assessed in terms of the percentage of clients with regular/recurring visits; provision of information about the importance of consistent condom use; the importance of safe injections and the benefits of HIV testing. Another important aspect of monitoring visits is looking at referrals of clients to other services (for example for sexually transmitted infections (STI), testing and counselling or provision of antiretrovirals (ART)).

[1]  In general UNDP encourages joint monitoring visits; however, depending on the environment and sensitivities around key populations, in some instances UNDP will have better access to target beneficiaries without the presence of national disease programme representatives.