Collaboration is one hallmark of a successful development project. It allows for capacity building, knowledge sharing, and improved efficiency in activity implementation. For the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, the End Use Verification (EUV) survey has become an activity that champions collaboration between projects, implementing partners, and field offices.
The EUV is a health facility survey implemented bi-annually in 17 countries to assess the availability of malaria, family planning, and maternal, newborn and child health commodities. In-country stakeholders use information from the survey to make policy and planning decisions and monitor changes over time. Established in 2008, the EUV was designed to collect important supply chain data that was not being captured, was insufficient in quality or lacked geographic reach. According to Philip Kwao, EUV lead in Ghana, there was no network between the country EUV implementers, and the survey was siloed, with changes being made by some countries without information on what other countries were doing. This resulted in no standardized reporting across countries, which is one of the main reasons the survey was updated.
From 2018-2019, GHSC-PSM standardized the survey, sampling approach and report to provide reliable data for improved decision making. These changes culminated in the launch of a EUV toolkit in 2020 for country offices. Using the standardized toolkit, stakeholders can make decisions that represent the survey sampling frame and identify trends over time within and across countries.
“The EUV was taken to the next level and strengthened under GHSC-PSM with additional guidance on sampling, additional modules on reasons for stockouts and warehouse challenges, and most recently the addition of a module on the continuity of care in the context of COVID-19,” said Christie Hershey, Senior Malaria Technical Advisor at PMI who supports the EUV.
Donatien Niyonkuru, who leads the EUV in Burundi and worked on the EUV for over six years, agrees that the updates have strengthened the survey. “As soon as we talk about improvements, we automatically think about the quality of data. Before standardization, the tool was being implemented in many different ways and the tool was not harmonized even within a country. Now, with the updated tool and harmonized sampling approach, we have improved the overall quality — everything is standardized,” he said.
The collaboration between the GHSC-PSM and GHSC-Technical Assistance (GHSC-TA) Francophone Task Order projects made standardizing the survey possible. As the EUV was updated, it was essential to ensure that Anglophone and Francophone countries conducting the survey were equipped with resources and information to understand the standard survey methods and how to align them with their in-country needs.
GHSC-PSM and the GHSC-TA Francophone Task Order monitoring and evaluation teams partnered to translate the EUV toolkit to ensure this alignment and offer the EUV in multiple languages. Their focus was on adapting the toolkit from English to French. This collaboration served as the first step towards capacity building of centrally managed standards across GHSC projects. It was also instrumental in establishing a strong and committed team capable of providing inter-project technical support to country offices.
The collaboration began the project launched the survey toolkit and streamlined processes. However, it has expanded and was strengthened by the teamwork and network built between various stakeholders implementing the standardized survey. “The collaboration goes to the heart of ensuring that standardization is internalized for EUV implementers,” said Kwao. “Now we understand, it’s not just Ghana but everywhere,” he said. So even if you want to make a change in Ghana, [you] want to make sure it’s in line with what others are doing.”
This collaboration took place in two primary ways: south-to-south technical assistance and a working group connecting country offices. To facilitate south-to-south technical assistance between country offices and implementing partners, GHSC-PSM created an EUV community of practice that connects experienced EUV leads that understand all aspects of the survey and have on-the-ground experience working in a variety of supply chain environments, with less experienced EUV countries, which is valuable when training.
In January 2020, two country office EUV leads, Philip Kwao (Ghana) and Tiba Pima (Burkina Faso), co-facilitated a training for USAID IMPACT project staff in Madagascar to implement the updated EUV. Frederic Randriamilanto, the LMIS advisor for USAID IMPACT, found the technical assistance beneficial. He stated, “[Kwao and Pima] were able to provide concrete solutions to the problems encountered and then adapted to reality and country needs on-site.”
The technical assistance not only helped the trainees but was also a learning opportunity for the training facilitators. “Coming from [Francophone] and [Anglophone] countries, I wondered how it [the training] was going to work. But I was really surprised that we had the same experience and requirements,” said Pima. Kwao, who has also provided training and technical assistance on the EUV to Liberia, Guinea and Niger, agreed, saying that it was a valuable experience to lead the training with a colleague because their shared understanding of survey topics and demonstrated the need to follow standard approaches. According to Niyonkuru, who has trained staff in Mali, Benin and Cote d’Ivoire on parts of the EUV survey, providing technical assistance to other countries helped him improve his training delivery.
Through interactions like this, the country offices realized that even though the context may be different, they have a lot of shared experience and knowledge and can learn from one another. To provide a way for field offices to share their expertise and provide timely feedback, GHSC-PSM created the EUV Working Group, comprised of home office and EUV leads from eight country offices. The working group meets monthly to discuss EUV changes, improvements and challenges. These meetings are a unique learning opportunity for attendees.
“[The working group] is a great platform for sharing experiences and learning new ideas,” said Noah Mtonga, Malaria Supply Chain Advisor in Zambia who works on the EUV. “It has proved to be an effective way of bringing issues being faced by the FO and chatting the way forward. It also has provided a platform [on] which we discuss issues and propose change prior to taking the proposal to the larger and external groups.”
In late 2020, Mtonga presented a new set of malaria microscopy questions to the working group for their input. The questions aimed to revise the microscopy questions to understand microscopy use in facilities—information stakeholders in Zambia are interested in collecting due to the country’s policy regarding the service. Mtonga said, “[I] am happy to learn that the need for change was a need not only for Zambia but also for other countries as well.”
The collaboration throughout the EUV standardization was recently highlighted in the EUV Change Board, which brings together the President's Malaria Initiative (PMI), USAID, GHSC-PSM, GHSC-TA Francophone, and country offices to provide input on changes to the survey questions, indicator definitions, and report. The changes to the EUV are slated to be rolled out in early 2021. With these changes, the project hopes to provide stakeholders with a refined report that can be used for decision making in Washington and in the EUV implementing countries.
“[These collaborative efforts and standardized tools have resulted] in standard indicators and reporting across PMI countries,” Hershey said.