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Malaria and Reproductive Maternal and Newborn Health (RMNH) Frameworks for Results: Mid Term Review

Evaluation and Lessons Learned
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Executive Summary

In December 2010, the UK government published two Frameworks for Results setting out its commitment to accelerate progress on addressing the international challenges of malaria and Reproductive Maternal and Newborn Health (RMNH). This report presents the findings of the Mid- Term Review (MTR) of the Frameworks.

Overview of the Frameworks

The Frameworks reflected a shift in UK development policy under the Coalition Government elected in May 2010 to a greater focus on results, seeking to direct DFID and other resources to support interventions that have strong international evidence of their effectiveness. The Frameworks are innovative as statements of strategy for DFID in combining a thorough process of evidence review and consultation with the setting of outcome targets directly related to DFID’s activities:

  • The Malaria Framework has the goal of contributing to at least halving deaths in at least ten high-burden countries by 2015 and to sustain and expand gains into the future, through: (1) improving the quality of services to address malaria; (2) increasing access and building demand for these services; (3) supporting innovation and the supply of global public goods; and (4) focusing on impact and results. It is the first complete statement of a UK policy toward malaria, and is closely aligned with the Global Malaria Action Plan (GMAP) agreed in 2008 and most recently revised in 2011, which provides a comprehensive international framework for malaria control.

  • The RMNH Framework aims to save the lives of at least 50,000 women during pregnancy and childbirth and 250,000 newborns by 2015, through (1) empowering women and girls to make reproductive choices; (2) removing barriers that prevent access to services, particularly for the poorest and most at risk; (3) expanding the supply of quality services; and (4) enhancing accountability for results at all levels. It builds on DFID’s earlier strategies to address maternal deaths and promote sexual and reproductive health (SRH).

The development and implementation of the Frameworks has taken place in parallel with other measures to strengthen the focus on results for UK aid and to ensure the achievement of value for money (VfM) and accountability in the use of public funds. These measures included the Bilateral and Multilateral Aid Reviews (BAR and MAR) that took place during 2010, the introduction of the requirement for business cases for all DFID spending, the establishment of the Independent Commission for Aid Impact (ICAI), and the establishment of DFID’s Departmental Results Framework (DRF).

The Mid-Term Review

This MTR takes stock of progress in the implementation of the Frameworks to assess if DFID is on track to achieve the results intended, and to provide advice on any actions required. Specifically, the MTR has addressed the following headline questions for each Framework: - Has the Framework provided an effective strategic instrument to achieve UK government objectives?
- Have adequate resources been used and appropriately applied to achieve these objectives?
- Has the Framework and DFID’s programmes under it been effectively managed in order to achieve UK government objectives?
- Are activities and outputs under the Framework on track to meet its objectives?
- Are outcomes on track to meet the objectives of the Framework?
- To what extent is it possible to measure the impact of the Framework and of DFID’s activities, and how can the measurement of impact be improved?

The audience for this MTR encompasses DFID and other UK government departments and a wider range of stakeholders including DFID’s multilateral and bilateral donor partners and partner governments and civil society in the countries in which DFID is providing assistance under the Frameworks.

The approach of the MTR involved four main analytical steps, based on an overarching conceptual model and outline Theories of Change developed for each Framework: - Setting out the global context for each Framework in terms of trends in international actions, in resources and in key health indicators;
- A compilation and analysis of information on what DFID has done over the Framework period, in terms of spending and evidence on results achieved, in relation to multilateral and bilateral programmes and other DFID activities (such as support to research);
- A more detailed focus on selected bilateral programmes (including country case studies of Ethiopia, India and Nigeria) and the multilateral programme, including case studies of engagement with specific multilateral organisations. These studies sought to review evidence where available along the whole results chain and to examine what DFID has done, and the influence of the Frameworks on what DFID has done, within an understanding of the global and national contexts; and
- Reviewing evidence on the process by which the Frameworks were formulated and developed. Data collection involved document reviews, key informant interviews (KIIs), quantitative data analysis (of data on global outcomes and aid activities and from DFID monitoring and reporting systems), and an online survey of DFID country programmes.