30x30 Health Systems Initiative Midterm Evaluation

CCIH 30×30 Health Systems Initiative Midterm Evaluation

1. Introduction

The 30×30 Health Systems Initiative, launched by CCIH in 2019, aims to strengthen 30 global health systems within which faith-based health services operate by 2030. The initiative focuses on improving the six World Health Organization (WHO) health system building blocks: health workforce, leadership and governance, service delivery, access to essential medicines, health information systems, and financing. Additionally, CCIH includes “community services” as an additional building block, recognizing its critical role in health system strengthening.

As of September 2024, there have been 46 total commitments, of which 37 are active commitments to the 30×30 initiative, focusing on one or more health system building blocks. This initiative seeks to increase global attention to faith-based health services, enhance resource mobilization, and strengthen partnerships among FBOs and other sectors. The ultimate goal is to achieve improved health outcomes through more robust, and resilient health systems.

As envisaged during the conceptual stage and to understand the progress, a midterm evaluation was conducted between May-October, 2024. The specific objectives of the midterm evaluation were to assess progress, identify gaps and challenges, and make necessary mid-course adjustments to achieve the intended objectives and goals of the 30X30 health system initiative. In addition, the midterm evaluation aimed at documenting and disseminating the lessons learned and key recommendations to enhance future advocacy efforts.

The evaluation is broken down into the following sections:

• Objectives
• Methods
• Results and Discussion
• Quantitative Results
• Qualitative Results
• Limitations
• Recommendations
• Conclusion
• Annex 1: Key Informant Interview Guide

Objectives

The goal of the midterm evaluation is to assess the progress, gaps, and challenges of the 30×30 health system initiatives which would facilitate mid-course corrections or re-strategizing the activities towards achieving the goal of the 30×30 health system initiative.

The specific objectives were to:

• Assess the progress in terms of achieving the goals and objectives of the initiative and the factors associated with the progress
• Assess the strengths and weaknesses, and their associated factors and explore the potential opportunities for improving the effectiveness of the initiative
• Identify and document the best practices and strategies adopted by the commitment makers and lessons learned
• Recommend strategies and specific activities to facilitate mid-course corrections and adaptations to improve the effectiveness of the 30×30 health initiative toward achieving its goals and objectives.

Addressing these objectives, the evaluation aims to offer actionable knowledge that will strengthen FBO role in global health and contribute to the long-term sustainability of the 30×30 initiative.

2. Methods

The evaluation employed a mixed-methods approach which included both quantitative and qualitative data collection and analysis from primary and secondary data sources.

The secondary data analysis included the quantitative and qualitative data submitted by all the commitment makers since the inception of the 30X30 health system initiative. The secondary data analysis focused on assessing the achievements of the commitment makers adopting the socio-ecological model, focusing on individuals, institutions, communities, and health systems. The common indicators or activities from different commitment makers were grouped and presented as collective output/outcome of the 30X30 health system initiative. For example, at the individual level, the key indicators were the number of training programs, the number of individuals trained, people reached through community health programs, inpatient, and outpatient services etc. At the institution level, the indicators were the number of institutions supported etc. At the community level, the indicators were community health initiatives implemented etc. At the system level, the number of partnerships developed etc. All the past five years of data were downloaded from the 30×30 database, analyzed and presented as trends over the years and total achievement. The cumulative figures presented in this report were calculated by totaling the absolute value of annual data. Therefore, for some cumulative results, there is a possibility that the same person or group could have been counted more than once if they were reached over multiple years. However, further in-depth analysis indicated that the vast majority of the cumulative figures represent unique instances.

The primary data collection was done through 13 key informant interviews (KIIs), among the leaders of the commitment-making institutions, CCIH leadership, technical experts, and interns who supported the initiative. For the qualitative data collection, commitment makers of Year 1 to Year 3 (from 37 active commitment makers) across 36 countries were considered as these commitment makers would have more to share compared to the new commitment makers. The participants were conveniently selected to ensure geographic representation (across Sub-Saharan Africa, Asia, LAC, and global networks) and ensured representation from all the health system blocks.

These KIIs were conducted using an interview guide that focused on capturing the views of the participants on the objectives, activities, strengths, benefits, challenges, gaps, and possible opportunities for improvement of the 30X30 health system initiative. Thematic analysis was done with the support of Atlas.ti software. A deductive approach was adopted for analysis to identify themes. The additional themes and patterns that appeared during the interviews were documented and presented as findings.

Additionally, the interview data will be securely transcribed and stored, with measures in place to protect participant privacy and ensure the reliability and consistency of the analysis process.

Ethical considerations: Institutional Review Board (IRB) approval for ethical clearance was obtained from the Christian Medical College and Hospital, Vellore, India.

The participants were given complete freedom to voice their opinions in the interest of improving the initiative. Utmost confidentiality and privacy were ensured during the data collection process in order to facilitate free and transparent expression of their opinions/views without any hesitation.

3. Results and Discussion

Quantitative Results

As of September 2024, the 30×30 health initiative had 46 commitments across 40 countries. The sub-Saharan Africa (SSA) region represents the most commitments (28.61%), followed by global operations (11.24%), the Asian region (5.11%), and the Caribbean region (2.4%) as shown in Exhibit 1 below. Since the inception, 9 commitment makers have dropped out of 30×30 due to several reasons such as completion of their project, poor capacity to collate information about their activities, etc.

Exhibit 1 Commitment makers by geographic presence of operations

The activities and focus areas of the commitment makers were classified under health systems building blocks as defined by the World Health Organization, in addition to our additional category of Community Services, which WHO now calls People. We present in Exhibit 2, the number of commitments seeking to address each of the blocks.

Exhibit 2 Commitments by Health System Building Blocks

HW- Health Workforce, SD – Service Delivery, LG – Leadership & Governance, CS – Community Services, ACC – Access to essential medicines and supplies, FIN – Financing, HIS – Health Information Systems

Considering the different number of commitments under each of the health systems building blocks, a common public health framework – the socio-ecological model, is used to examine the commitments at a broader level, thus facilitating the aggregation of indicators. Analysis of the indicators revealed that commitments were made at multiple levels of the socio-ecological model, targeting individuals, institutions, communities, and the health system as a whole.

3.1 Individual level

The commitments targeting the individual level were predominantly related to capacity building on a variety of subject areas and improving access and utilization of health services. The specific activities were training programs and provision of health-related services through health programs including inpatient services and outpatient services.

Training/Capacity Building

Training Programs

In the last five years of the 30×30 initiative, 8,013 training programs were delivered by commitment makers. Training programs largely focused on strengthening the health workforce to improve leadership and governance, service delivery, health information systems, health financing, and community services. These programs were delivered to a wide range of health care professionals including medical officers, nurses, laboratory technicians, pharmacists, community health personnel, and administrators which covered twelve subject areas namely (alphabetically listed):

• Basic/General Health Services
• Clinical Practice
• Document Management
• Equipment Management
• Financial Management
• Leadership and Governance
• Maternal, Newborn and Child Health
• Pharmacy Management/Practice
• Civil Society
• Critical Health Issues
• Emerging Health/Wellbeing Issues
• Surgery

Exhibit 3 Training Programs by Year

Exhibit 4 Number of Training Programs by category (Cumulative of Y1, 2, 3 and 4)

MNCH – Maternal, Child and Neonatal Care.

Personnel Trained

Commitment makers trained personnel intending to strengthen the health workforce in different technical areas. In the last five years of the initiative, 61,169 personnel were trained. Personnel, who belong to various healthcare professional cadres, were trained in a wide range of subject areas as indicated in Exhibit 6 and Exhibit 7.

Exhibit 5 Number of Individuals Trained by Year

Exhibit 6 Number of Personnel Trained by Category (Cumulative of Y1 ,2, 3 and 4)

‘Pharmacy management’ includes Pharmacy practice. QMS – Quality Management System

Exhibit 7 Number of Personnel Trained by Year (part 1)

Number of Personnel Trained by Year (part 2)

People Reached Through Health Programs

Commitment makers delivered various health programs to improve the access and utilization of health services primarily, with a few programs also seeking to strengthen community services. During the first four years of 30×30, around 6 million (n= 5,939,989) people were reached by various health programs. (Exhibit 8). The types of programs covered a range of subject areas, as laid out in Exhibit 9.

Exhibit 8 Number of People Reached through Health Programs by Year

Exhibit 9 Number of People Reached through Health Programs by Year

Inpatient and Outpatient Services

During the last five years of the initiative, 89,365 inpatient and 491,003 outpatient services were provided by two commitment makers. These two commitment makers have a network of health facilities providing out-patient and in-patient services across the country where they work.

Exhibit 10 Number of Inpatient/Outpatient services provided by year

Exhibit 11: Number of combined Inpatient/Outpatient services by a commitment maker provided by year

3.2 Institution-level

At this level, the commitment makers focused on supporting other similar or small institutions who require technical support to improve their capacity, efficiency and effectiveness. It includes health facilities, drug supply organizations and non-profit organizations. Efforts to support institutions were undertaken to strengthen all seven building blocks, with access to essential medicines and supplies being the most popular area, followed by financial management.

In total, 11,046 institutions were supported (Exhibit 12) for a range of technical activities as indicated below.

• Data Management
• Funding
• General Supplies
• Human Resource Management
• Leadership & Governance
• Medicines, Medical Supplies and Equipment
• Quality Management Systems (QMS)
• Technical Support
• Water, Hygiene and Sanitation (WASH)
• Community Health Activities
• Financial management
• Hospital management
• Safe Water and electricity
• Service delivery (specifically to vulnerable populations)

Exhibit 12: Total number of Institutional Supports Provided by Year

Exhibit 13: Institutional Support Provided over the Years

3.3 Community-level

Several commitment makers focused their activities at the community level, seeking to strengthen the community services building block of the health system. Community activities included health promotion of general well-being (NCD prevention, maternity care, child immunizations, nutrition promotion), increasing awareness/reducing stigma around communicable diseases, vaccine awareness/provision, and community leadership development.

To achieve this, commitment makers established community groups and church groups and trained them in various health-related areas. For instance, 4,483 church groups involved in health-related community activities over the last five years of the initiative (Exhibit 14), 1,081 community groups were established and 3,522 community groups were trained (Exhibits 15 & 16).

Exhibit 14: Church Groups in Health Activities

Exhibit 15: Community Groups Established

Exhibit 16: Community Groups Trained/Supported

During the last five years of the initiative, 6,793 community-level health programs were conducted (Exhibit 17). In addition, 217,238 households were reached through health programs especially, the WASH program (Exhibit 18).

Exhibit 17: Community-level Programs by Year

Exhibit 18: Households reached through WASH Health Programs (n-217,238)

3.4 Systems-level

At the systems level, commitment makers focused on establishing partnerships and resource mobilization initiatives. These efforts were largely to strengthen leadership and governance, with a few targeting financings, service delivery, and health information systems of the health system blocks. As indicated in Exhibit 19, 293 Partnerships were fostered largely with government, NGOs, and development agencies as depicted in Exhibit 20.

Exhibit 19: Number of Partnerships by Year

Exhibit 20: Types of Partnerships across the Years

Throughout the last five years of the initiative, 105 resource mobilization efforts have addressed the Service Delivery and Health Financing health system building blocks (Exhibit 21).

Exhibit 21: Resource Mobilization Initiatives

Qualitative Results

The qualitative analysis comprehensively assessed the 30×30 Health Systems Initiative, in terms of its relevance, strengths, effectiveness, value addition to faith-based organizations’ efforts to strengthen health systems and the challenges. Each section is structured to reflect participants’ experiences and insights, with direct quotes highlighting essential perspectives. Besides, the analysis aimed at offering a holistic view of the initiative’s impact, identifying areas for improvement, and providing recommendations for enhancing future efforts.

3.5 Relevance of the 30×30 Health System Initiative

The relevance of the 30×30 Health Systems Initiative was underscored by its ability to provide visibility and structure to the critical work being done by faith-based organizations (FBOs) within global health systems. Participants expressed a strong sense of personal and professional commitment, noting that the initiative helped them identify where their efforts fit within a larger framework, making their work more impactful and aligned with global health priorities. The participants appreciated and recognized the initiative for bringing faith-based health services into the spotlight, allowing them to demonstrate their high-impact practices and fostering a sense of unity among participants.

“It helps to highlight the work that faith-based organizations are doing.” – Extended 30×30 Team

This sentiment captures the widespread belief that the 30×30 initiative is crucial for individual organizations and the broader global health community. The participants have also mentioned that the initiative effectively created a platform for faith-based actors to share their experiences, overcome common challenges, and enhance their monitoring and evaluation practices.

The initiative’s relevance lies in its ability to enhance the visibility, effectiveness, and global recognition of faith-based health services, making their contributions more accessible and valued within the international health ecosystem.

3.6 Perceived Effectiveness

The effectiveness of the 30×30 Health Systems Initiative, as perceived by the commitment makers, is evident in its ability to highlight and consolidate the contributions of Christian medical and community health efforts across a diverse range of health systems. The initiative’s impact is seen in how it raises the visibility of faith-based organizations (FBOs), bringing their efforts to the attention of key stakeholders, including policymakers and global health leaders.

“The vision and purpose of this initiative is to provide a snapshot of what Christian medical and community health efforts do/contribute across a wide and diverse range of health systems over a decade.” – Extended 30×30 Team Member

The initiative was particularly perceived to be effective in gathering and analyzing data to produce meaningful interpretations. Many organizations might not have adequate capacity to accomplish otherwise. The commitment makers felt that the data collection mechanism through the online data management system and further analysis were crucial for understanding the impact of the efforts and for presenting concrete evidence of the improvements made in healthcare delivery across various contexts. By documenting and sharing these outcomes, the initiative not only enhanced the strategic focus of the participating organizations but also contributed to a broader understanding of the global impact of faith-based health services.

Furthermore, the initiative fostered a global perspective, allowing for shared learning and collaboration among FBOs from different regions.

“I feel that there is a global impact, and I’m not doing something alone.” – A commitment maker focusing on Health Workforce

This international aspect was found to be highly beneficial, enabling organizations to generalize findings and apply successful strategies across various contexts. The ability to demonstrate global impact was found to be a significant strength of the 30×30 initiative, as it provided a powerful narrative of collective action and measurable outcomes in global health.

Overall, the 30×30 initiative’s effectiveness lies in elevating FBOs’ visibility, enhancing data-driven decision-making, and promoting a global dialogue on the contributions of faith-based health systems.

3.7 Strengths and Advantages

Community Engagement and Empowerment: The initiative successfully engaged community members, leaders, and beneficiaries, fostering active participation and leadership. As noted:

“Communities are formed, they are trained, they’re capable, they’re active, and they’re actively providing engaging communities, not just engaging communities, but also engaging the leadership to the extent that they manage to get an increase in the financing of the community health system in that community.” – A commitment maker focusing on Leadership and Governance

The model also empowered individuals to become advocates for vulnerable groups, such as children with disabilities, without relying on financial incentives.

Framework and Indicator Development: A significant strength, as indicated by the participants, was the use of a well-developed framework and standardized indicators across partner organizations. This consistency allowed for better alignment of goals and benchmarks, ensuring all partners work toward the same objectives. The initiative has also contributed to improving the monitoring and evaluation (M&E) processes of the commitment makers, which are crucial for tracking progress and making data-driven decisions.

“The reporting has helped us to be more thoughtful about some of the work we’re doing and the way we’re talking about it.” – A commitment maker focusing on Leadership and Governance

Capacity Building and Knowledge Sharing: The initiative strongly emphasized capacity building of the participating organizations and the communities they serve.

“This capacity building is a two-way street… with knowledge being shared by commitment makers with each other.” – Extended 30×30 Team

The opportunity to work directly with stakeholders and understand the nuances of data entry and health system strengthening was particularly impactful.

Global Perspective and Collaborative Learning: One of the initiative’s key strengths was its ability to unite various faith-based organizations (FBOs) from different contexts, fostering shared learning and collaboration. This global perspective enriched the initiative’s impact and ensured that best practices could be replicated and applied across various settings. The initiative also provided a safe space for participants to share their experiences, challenges, and emotional struggles which included working in challenging environments with limited resources. Creating a supportive network that is particularly valuable for those working in complex environments.

“We have also found that we have become not just a health care network, but a network of traumatized workers who need each other to know that their experience is other people’s experience and they’re not alone in that.” – A commitment maker focusing on Health Workforce

Advocacy and Visibility: The initiative helped advocate for better interventions and health system improvements by raising FBOs’ visibility and work. This visibility also supported fundraising and advocacy efforts for the communities served. The initiative’s reporting processes have helped consolidate information that can inform ministries and other stakeholders about the challenges these communities face.

Overall, the 30×30 Health Systems Initiative leveraged its strengths in community engagement, capacity building, collaborative learning, and advocacy to create a meaningful and lasting impact on global health systems.

3.8 Utility and Value Addition

The commitment makers emphasized the utility and value addition of being part of a global initiative, particularly for organizations in the nonprofit and faith-based sectors. Key areas of perceived utility and value additions include:

Commitment and Accountability: Participating in such an initiative brought a sense of responsibility and accountability, ensuring that organizations followed through on their promises. This is crucial in the nonprofit sector, where accountability is sometimes lacking. “…being a part of an initiative brings accountability, and it makes people do the work.” – A commitment maker focusing on Health Workforce

Strategic Planning and Measurable Impact: The initiative motivated and drove the organizations to develop strategic plans and set clear goals, leading to more focused and practical work. It also emphasized the importance of measurable impact, with data being a vital tool for improvement. “…what you measure you can make better, where if you don’t measure it you don’t even know what areas need improvement.”- A commitment maker focusing on Health Workforce

Motivation and Collaboration: The 30×30 Health Systems Initiative fostered a sense of teamwork and shared purpose among participants, motivating them to achieve more. It facilitated regular communication and collaboration, enabling organizations to learn from each other and adopt best practices.

“It gives us an assurance that we are realizing something, achieving something together as a team.” – A commitment maker focusing on Health Workforce

However, it’s important to note that commitment makers were divided on this aspect. While some participants felt well-engaged and appreciated the collaborative environment, others felt disconnected and perceived the initiative as being on “autopilot.” As noted in the challenges section, these individuals expressed concerns about the need for more meaningful engagement. The differences highlight the need for more consistent and inclusive communication to ensure all participants feel equally involved and supported in their collaborative efforts.

Visibility and Advocacy: Participating in the initiative increased the visibility of the work done by faith-based organizations, which is often underappreciated in the global health community. The platform was also considered as a robust advocacy tool, helping mobilize resources and effectively represent communities.

In summary, the initiative provided a valuable framework for ensuring accountability, fostering strategic planning, motivating participants, and enhancing collaboration and advocacy. These elements collectively contributed to a more impactful and coordinated approach to addressing global health challenges.

3.9 Weaknesses and Challenges

The key weaknesses or challenges of the 30×30 Health Systems Initiative that might impact its effectiveness and the engagement of participating organizations as perceived by the commitment makers include:

Lack of Engagement: A few commitment makers opined that there could be more and regular engagement from the initiative through regular communication and other activities to achieve the purpose of the initiative. It should not be just limited to data submissions, as highlighted by one participant:

“We’ve been doing what we’ve been doing, and we feel like we’ve only just been asked to submit our progress data. There can be more engagement through regular communication” – A commitment maker focusing on Leadership and Governance

Another participant expressed less engagement in the initiative:

“I feel like it’s mainly reporting. I don’t feel involved in the initiative.” – A commitment maker focusing on Leadership and Governance

Resource Limitations and Infrastructure Issues: Many participating organizations faced resource constraints, particularly in rural or under-resourced areas. These limitations impacted their ability to contribute effectively to the initiative’s goals.

“The challenge for sure is just limited resource availability such as supplies and essential medicines and things like that.”- A commitment maker focusing on Leadership and Governance

In addition, infrastructure issues, such as unreliable power grids, further exacerbate their challenges in meeting and reporting on their original commitments.

Data Collection and Quality Issues: Collecting high-quality data remained a significant barrier, especially in areas with limited resources and capacity for data management.

“There are resource limitations where a lot of clinics might not have access to the Internet regularly or computers or just experience with data management among their staff.” – A Commitment Maker Focusing on Service Delivery

Misalignment between the data collected by community partners and what the initiative requires adds to the challenge.

Operational Challenges in Conflict Zones: Organizations working in conflict zones or areas with political unrest faced extreme challenges that hindered their ability to participate fully in the initiative. Safety, freedom of movement, and supply chain disruptions are typical:

“Safety and freedom of movement is often impossible… we would like to be working across the whole country.” – A Commitment Maker Focusing on Service Delivery

The lack of a functioning government or reliable infrastructure further complicated operations:

“Getting our government paperwork has, because there’s not a functioning government, that’s been a challenge. Everything that we do has been a challenge, basically.” – A commitment maker focusing on Leadership and Governance

These challenges underscore the need for additional engagement with 30×30 commitment makers, requests for financial resources, and an understanding of data quality/reporting issues to ensure the success of the 30×30 Health Systems Initiative.

3.10 Overall Experience

Mixed Value Perception: While some participants found the initiative well-aligned with their organization’s mission and saw it as “business as usual,” others questioned its precise value. This reflects a diversity of experiences, with one participant stating, “We were discussing how participating in the 30×30 may not have any clear value for us.” – A Commitment Maker Focusing on Health Workforce

Structured Guidance and Strategic Focus: Many found the initiative’s structured commitments and clear indicators beneficial, particularly for strengthening the health system. The framework helped organizations focus on specific areas and set clear goals. As one quote highlights:

“Having our clear commitments under each building block has given us… good goalposts for what we’re working towards.”- A Commitment Maker focusing on Leadership and Governance

Challenges with Implementation: Some participants faced initial difficulties, particularly with reporting, due to the lack of established systems. However, these challenges often led to improved processes over time.

“After the first year of reporting, I set up some systems on our end so that I’m tracking throughout the year our numbers so that when it comes to the reporting periods, I already have everything there, and it’s a lot easier.” – A Commitment Maker Focusing on Leadership and Governance

Community and Learning: The initiative also fostered a sense of community, with participants appreciating the supportive relationships built through events like the CCIH Global Conference.

Increased Focus and Expansion: The initiative helped some organizations become more focused and expand their programs. “We thought of a way to strengthen our programming… and we have done so in the last few years, and I would attribute a lot of that to the initiative of CCIH 30×30.” – A Commitment Maker Focusing on Service Delivery

In summary, participants’ experiences with the 30×30 initiative vary widely. Some find it highly valuable for strategic focus and community building, while a few struggle to see clear benefits or face challenges in implementation. However, the initiative generally provided a structured framework that guided organizations in their efforts to strengthen health systems and expand their impact.

4. Limitations

Originally, the midterm evaluation was also supposed to include focus group discussions, but due to schedule challenges, individuals were invited to participate in KIIs instead. Three commitment makers did not submit their annual quantitative data and were unresponsive to follow-up communications so their 2023-2024 data is not included in this analysis. The cumulative figures presented in this report were calculated by totaling the absolute value of annual data. Therefore, for some cumulative results, there is a possibility that the same person or group could have been counted more than once if they were reached over multiple years.

5. Recommendations

The following recommendations were developed based on the results of the quantitative and qualitative analysis of commitment makers.

5.1 Improved Communication and Collaboration

• Visual and Centralized Impact Metrics: There is a strong recommendation for creating a centralized platform, such as a web page, displaying impact metrics surrounded by the logos of collaborating organizations. This visual communication of collective achievements can facilitate better understanding and promote the initiative’s impact easier.
• Regular Networking Opportunities: Participants suggested regular and structured opportunities for networking, collaboration, and sharing best practices, possibly through virtual check-ins, webinars, or forums. A quarterly virtual meeting where organizations can give brief updates and discuss challenges would foster community and collaboration. “Collectively, we have… virtual check-in, a virtual meeting where beforehand, I don’t know, everybody gives a two-minute update like a short update on what they’re working on.” – A Commitment Maker focusing on Health Workforce
• Strengthening Engagement through Strategic Communication: Emphasize the benefits of participating in the initiative, such as council membership, network expansion, and increased visibility, to encourage active involvement from all organizations. Clear and consistent communication about these advantages will help drive engagement and commitment, ensuring the initiative’s success.

5.2 Enhanced Resource Sharing and Capacity Building

• Resource Libraries and Training Opportunities: There’s a call for creating a library of resources, including best practices and training materials, particularly for data quality and health system strengthening. Offering virtual training and workshops, especially on topics like mental health, would help build capacity across participating organizations. “I think having a platform-specific on networking and resource sharing will be very helpful.” – A Commitment Maker Focusing on Leadership and Governance

5.3 Increased Funding and Donor Engagement

• Mobilizing Donor Interest: One suggestion is to mobilize greater donor interest by better showcasing the initiative’s impact and potential. This could involve creating compelling visual presentations of data and organizing joint projects to attract funding. “Is there a way to mobilize donor interest to support organizations to amplify what we’re doing well?” – A commitment maker focusing on Leadership and Governance
• Dedicated Funding for Collaboration: To enhance collaboration, there’s a recommendation for more dedicated funding to support joint projects and initiatives, enabling organizations to work together more effectively. “Joint projects where groups of us are implementing something together, or we’re funded together to do work.” – A Commitment Maker focusing on Leadership and Governance

5.4 Clearer Guidelines and Reporting

• Encouragement and Support: Regular encouragement and support, such as through mentorship or motivational videos, would help keep participants engaged and motivated. This could include ongoing mentoring to help organizations navigate challenges and focus on their goals. “Just feeling more involved than just the reporting aspect, I think, would be beneficial.” – A Commitment Maker Focusing on Leadership and Governance

5.5 Boosting Visibility and Credibility

• Develop a distinctive logo for the initiative. Encourage organizations to feature this logo on their websites and metrics, showcasing the collective impact. This strategy would:
  • Improve SEO Rankings: The widespread logo display would enhance search engine optimization, increasing the initiative’s online presence.
  • Increase Exposure: Displaying the logo across multiple platforms would expand CCIH’s visibility and reinforce its leadership role in the global health community.
• Rebranding for Unity and Impact: To better reflect the initiative’s collective purpose and goals, rebrand the “30×30 Health Systems Initiative” to a name that emphasizes collaboration and global impact, such as “Impact Consortium” or “World Impact Consortium.” This rebranding would unify the participating organizations under a more inclusive and powerful identity, strengthening the initiative’s message and appeal.

5.6 Enhancing Participation through Clear Benefits

Clearly articulate and promote the strategic benefits available to organizations participating in the initiative. These benefits could include:

• Council Membership: Offering a council seat allows organizations to play an active role in decision-making and shaping the initiative’s direction.
• Council Directory Listing: Inclusion in a directory that enhances networking opportunities and cross-collaboration among members.
• Network Expansion: Access to a broader network of like-minded organizations, fostering valuable relationships and knowledge sharing.

5.7 Improve Data Submission Process for Commitment Makers

In September 2024, four members of the 30×30 team thoroughly reviewed the quantitative data process to address critical issues raised by various commitment makers. The objective of the meeting was to ensure smoother data management and improve the quality of data collection and reporting across the 30×30 initiative. The discussion centered on data entry challenges, validation checks, review/revision of indicators, and improvements for data export, automation, and analysis. One of the primary concerns was the data entry process experienced by commitment makers, which led to inconsistencies and reporting errors. Several solutions were recommended, including:

• Increasing the maximum entry limit to over 1 million per indicator to accommodate large-scale data submissions.
• Hosting a training session or webinar to provide tutorials and troubleshoot common issues, with recorded sessions for future reference.
• Engaging the communications team to review qualitative data submissions, especially success stories, and encouraging interns to develop case studies.
• Adjusting the data submission timeline to a January-December cycle to prevent errors related to incorrect year entries, missing data, or incomplete submissions. Recommend conducting a poll at the 2024 Annual Meeting to confirm whether the January-December reporting timeline works for most participants.
• Limiting data entry windows by opening only the relevant reporting period and disabling other years, thus reducing errors related to incorrect timelines. The system will auto-lock once the reporting period has ended, with 30×30 team members unlocking entries on request.

5.8 Boost Data Utility for CCIH

Review/Revision of Indicators

Several indicators still need to be used or utilized by commitment makers. The team recommended:

• Reviewing unused indicators and either editing them to be more applicable or removing them altogether, and then.
• Working with commitment makers to adjust any of their indicators accordingly.

Data Export – Automation and Analysis

The team discussed moving from manual Excel-based analysis to automated systems to improve data management. The leadership team will develop a strategy to automate the analysis process, reducing user error. The key recommendations include:

• Incorporating all five years of data into the midterm analysis ensures no data, mainly submitted outside of submission periods, is excluded.

The 30×30 extended team reviewed and discussed these recommendations and completed a prioritization exercise to group the recommendations into low, mid, and high cost. This will help the CCIH team decide how to move forward in 2025. These recommendations will be presented to the 30×30 commitment makers at the annual meeting in December as well as the CCIH Board of Directors.

• Tier 1: Low Cost Actions
  • Low LOE needed
    • Emphasize the benefits of participating in the initiative in monthly emails, such as increased visibility, to encourage active involvement from all organizations
    • Add links to each commitment makers website to the 30×30 commitment maker webpage
    • Adjusting the data submission timeline to a January-December cycle to prevent errors related to incorrect year entries, missing data, or incomplete submissions. Recommend conducting a poll at the 2024 Annual Meeting to confirm whether the January-December reporting timeline works for most participants
  • High LOE needed
    • Increase networking and support opportunities
      • Implement regular themed forums or office hours for commitment makers to connect
      • Share 1 minute videos from each commitment maker in email communications
    • Generate organization-level indicator reports to share back with commitment makers. These can be used with donors and for advocacy.
    • Create directory of POCs for 30×30 commitments into the 30×30 database creating opportunity for networking and dialogue
    • Reviewing unused indicators and either editing them to be more applicable or removing them altogether, and then. Working with commitment makers to adjust any of their indicators accordingly.
  • Actions already in progress
    • Increasing the maximum entry limit to over 1 million per indicator to accommodate large-scale data submissions.
    • Engaging the communications team to review qualitative data submissions, especially success stories, and encouraging interns to develop case studies.
    • Limiting data entry windows by opening only the relevant reporting period and disabling other years, thus reducing errors related to incorrect timelines.
    • Data Export – moving from manual Excel-based analysis to automated systems to improve data management.
• Tier 2: Mid Cost Actions
  • Launch the 30×30 impact cohort. Dedicate a webpage to sharing logos and indicators of selected commitment makers. These commitment makers would also become key decision-makers for the 30×30 initiative and included in biannual 30×30 management meetings.
  • Publish 1-2 articles in the CJGH (Report out of midterm eval & commentary/narrative of the initiative). Possibly co-sponsor an issue on FBO contributions to HSS.
• Tier 3: High Cost Actions
  • Create high-quality videos of commitment makers to share with donors and decision-makers. Possibly contract with a group like Chembe Collaborative to produce videos
  • Publish in an academic journal besides CJGH like the Lancet Global Health, Christian Relief, Development, and Advocacy journal, or WHO Bulletin

Overall, the 30×30 team recommends pausing new applications in 2025 to provide sufficient time to implement the prioritized recommendations from the midterm evaluation.

The 30×30 team presented the recommendations to the commitment makers at the annual 30×30 meeting for discussion. For the tier 1 actions, the team asked if the data submission timeline should be changed to Jan-Dec. About half of the participants said we should move the timeline and the other half said we should keep the original July-June timeline. We asked what type of networking events, commitment makers would be interested in and almost everyone selected “Forum discussion with commitment makers working on the same health systems strengthening area”. There wasn’t much interest in other types of networking/connection. Commitment makers were also interested in utilizing organization-level indicator reports to share back with commitment makers and a directory of points of contact for 30×30 commitments. For the tier 2 actions, most interest was expressed in publishing 1-2 articles in the CJGH (Report out of midterm eval & commentary/narrative of the initiative). There didn’t seem to be much interest in establishing an impact cohort but that could have been because people didn’t understand the concept. Lastly, for tier 3 – there was more excitement around publishing in another journal than creating high-quality videos.

6. Conclusion

The findings from this evaluation provide valuable insights into the progress of the 30×30 initiative and guide future strategies for achieving its goals. The results show the incredible influence faith based organizations have on all aspects of health systems. The evaluation also helped the 30×30 team identify important program adaptations to make the next half of the program stronger. The following recommendations were established as top priority by commitment makers, the 30×30 team, and CCIH Board of Directors:

• Tier 1: Low Cost Actions
  • Low LOE needed
    • Emphasize the benefits of participating in the initiative in monthly emails, such as increased visibility, to encourage active involvement from all organizations.
    • Add links to each commitment makers website to the 30×30 commitment maker webpage
  • High LOE needed
    • Forum discussion with commitment makers working on the same health systems strengthening area
    • Generate org level indicator reports to share back with commitment makers. These can be used with donors and for advocacy.
    • Create directory of POCs for 30×30 commitments into the 30×30 database creating opportunity for networking and dialogue
• Tier 2: Mid Cost Actions
  • Launch the 30×30 impact cohort. Dedicate a webpage to sharing logos and indicators of selected commitment makers. These commitment makers would also become key decision-makers for the 30×30 initiative and included in biannual 30×30 management meetings.
  • Publish 1-2 articles in the CJGH (Report out of midterm eval & commentary/narrative of the initiative). Possibly co-sponsor an issue on FBO contributions to HSS.
• Tier 3: High Cost Actions
  • Publish in an academic journal besides CJGH like the Lancet Global Health, Christian Relief, Development, and Advocacy journal, or WHO Bulletin

7. Annex 1: Key Informant Interview Guide

• Introduction
  • Thanks very much for your time
  • As you are aware, CCIH’s 30X30 Health System initiative aims to strengthen 30 health systems globally within which faith-based health services operate by 2030. This project is in its 5th year now with 40 active commitment makers from 36 countries. As intended, we are carrying out a mid-term evaluation to assess the progress, gaps, and challenges so that we can undertake mid-course adaptations or re-strategize the activities towards achieving the goal of the 30X30 health system initiative.
  • This discussion today will help us understand your views on the progress we have made so far, the utility being part of the initiative, the gaps, challenges, and your suggestions/ recommendations to make the initiative effective and efficient.
  • I have a list of guiding questions, but please do feel free to provide your views on new aspects and suggest things that will be useful to understand the progress of the project and address the issues and challenges in the implementation of the project.
  • Do you understand the above statement/purpose of this interview? Also, as noted in the informed consent, we will be taking notes and recording our conversation today.

1. As we begin our discussion, please share about your overall experience of being part of the 30X30 Health System Initiative.
   1. This could be both personal experience and organizational
   2. How many years have you been involved in the 30×30 initiative?
   3. What are the key aspects of your 30×30 commitment and what changes have you seen over since you made your commitment?
2. What are the key strengths or benefits of the 30×30 initiative?
   1. These can be related to organizational, implementation, or other aspects of the project
3. What are the key barriers or weaknesses of the 30×30 initiative?
   1. These can be related to organizational, implementation, or other aspects of the project
   2. What struggles have you faced in your communities or within the project that affected your efforts to strengthen your health system?
4. What are your recommendations or suggestions to improve the functioning and implementation of the 30×30 initiative?
5. Do you think that this type of global initiative is necessary and why? If yes, how does it make a difference in your activities to improve population health?
6. Is there anything else important that we have not included in today’s discussion, but would add value to understanding the 30×30 initiative’s progress in strengthening local health systems of your country or region?