Evaluation of the Small 
Grants Program 
Performed by IHSS 
Project: A Consolidated 
Report 
Prepared for: 
IHSS Project funded by USAID 
Prepare by: 
Ghaith J. Al-Eyd, MD, M.Sc. 
Namir G. Al-Tawil, MD, PhD 
IHSS Project 
Baghdad, Iraq 
May 2004 
2
Table of Contents 
1. Introduction………………………………………………………... 3 
2. Objectives and Approaches……………………………………….. 5 
3. Results…………………………………………………………….. 7 
4. Tables and Figures………………………………………………... 8 
5. Conclusions………………………………………………………. 14 
6. Appendices ……………………………………………………….. 15 
3
1. Introduction 
The Iraq Health System Strengthening Project (IHSSP) provided rapid response grants 
for both local and international NGOs to address the specific health needs of the Iraqi 
people. 
In order to assure that the grant is being best used for the expected results, the 
consolidated work plan of IHSSP as approved by USAID specified that IHSSP should 
“design and implement a grants monitoring and evaluation (M&E) program that includes 
internal M & E, performance-related payment, and collaborative review of grant 
achievements before final payment is made”. 
M&E, both internal and external, can serve as an important tool to increase grant 
performance, through its inspection mechanism as well as provision of necessary 
technical assistance. This is particularly true for those grantees whose experiences are 
limited and who lack financial management systems. 
The framework of M&E of the small grants is presented in Figure 1. It provides general 
guidance for the project specific M&E as well as the overall M&E of the small grant 
program. 
As shown in the Figure, the overall objectives, including a general objective to provide 
rapid response grant to address the specific health needs of the Iraqi people and the 
associated numerous sub-objectives as specified in Box 1. 
These objectives are to be achieved through supporting various projects. Each of the 
project funded by the small grant program has it’s own proposed activities, the 
implementation of which are to achieve the project specific objectives as they are 
proposed in the grant application. The achievements of the project specific objectives will 
mean the attainment of the program objectives. 
The performance of the project (for both midterm and end-of-project) can be monitored 
and evaluated according to whether or not and how well the grantees implemented their 
proposed activities, and the direction and level of attainment of the proposed objectives. 
The performance of the small grant program can be evaluated according to the results of 
M&E of the specific projects as well as an overall and cross-project analysis the grants. 
A total of 35 grants’ projects have been proposed and then approved, but unfortunately 
only 28 grants have been implemented and evaluated completely. There was an 
incorrigible cut in the total small grants budget that interrupted some of the approved 
grants. 
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Figure 1. The framework for M&E of the small grants 
Project n 
Project objective 1 
Project objective 2 
Project objective 3 
Project objective 1 
Project objective 2 
Project objective 3 
•
•
•
•
•
•
•
Small 
Grant 
Program 
Objectives 
Project 1 
Project 2 
Project 3 
Project 1 
Project 4 
Project 5 
Project 6 
Project 7 
Project 8 
Project 9 
Project 10
Project 11
Project n 
SMALL GRANT 
PROGRAM
SMALL 
PROJECTS
 PROJECT 
OBJECTIVES
•
•
•
•
•
•
•
Project activity 1
Project activity 2
Project activities
Project activity 4
Project activities
Project activity 5
Project activity 
Project activity n
Project 1 
Project activity 1
Project activity 2
Project activities
Project activity 4
Project activities
Project activity 5
Project activity 
Project activity n
 PROJECT 
ACTIVITIES
Box1. Objectives of the Small Grants 
A small grant is designed and implemented to quickly and visibly contribute to one or more of the 
following objectives: 
1. Speed up the reconstruction and re-equipment of medical facilities and health sector infrastructure – 
priority will be given to those facilities that support primary health care, particularly, care focused on 
women and children; 
2. Support service providers and community initiatives to restore and maintain health services in areas 
and facilities disrupted by the conflict; 
3. Enhance IHSSP efforts and roll out project results to more facilities, regions, and communities of 
Iraq to contribute to the following important goals: 
3.1 restore and modernize primary health services, particularly, women’s and children’s care; 
3.2 reconstitute health financing and administration; 
3.3 modernize disease surveillance and health reporting; 
3.4 reconnect Iraqi health providers with international standards and best practices through 
modernized clinical training and care management; 
3.5 develop health and management data systems to provide policy- and decision-makers with the 
evidence of health needs and health sector performance; 
3.6 increase participation of the Iraqi communities and families in the matters of health, 
particularly disease prevention and health promotion; 
3.7 help health system leaders of Iraq develop a broader look on the present and future of the Iraqi 
health care sector; 
3.8 foster health care and policy research; 
3.9 support for professional associations such as doctors, nurses, pharmacists, lab technicians, 
public health and allied health sciences. 
4. Other objectives that target important and effective solutions in the health care sector of Iraq.
5
2. Objectives 
 
The general objective of this report is to provide an overall evaluation of the effectiveness 
of small grants program, and to provide necessary information that can be used in 
preparation of the final report of the IHSS project. Specifically, the report is to: 
a. Check if the activities have been performed as they were designed (timing, 
quantity, and quality). 
b. Assessing whether the grants have been implemented towards the achievement of 
designed objectives. 
c. Assessing whether the objectives of the grant have been achieved. 
d. Estimating the social benefits of the small grant program (e.g. the number of 
people hired, improvement in capacity, the number of direct beneficiaries, the 
quantity of services, and effects on health). 
3. Approaches 
Project-specific and small grant program M&E have been conducted with close 
collaboration between M&E team and the small grant program (I-HELP). While in 
principle, the M&E will be external (external of internal), the two teams are on the 
common ground in their objectives to improve the performance of the grants and the 
program as a whole. During the process of designing and implementation of this M&E 
work, attitude of “inspections” and “criticisms” has been avoided, but rather the two 
teams have maintained frequent dialogues and worked together to seek strategies and take 
actions for the benefits of project and program performance. Achievements have been 
documented as much as possible, problems have been identified, and recommendations 
for performance improvement have been provided. 
Grantees have been informed that they have to accept external M&E on their 
performance, including process and results before the contract is signed. 
M&E Tools & Strategy: 
1- Midterm M&E have been conducted at end of first half of the project 
implementation period. Ideally, I-HELP have received the progress report from 
the grantee (See appendix 1). 
2- The end-of-project M&E have been done after the submission of the final report 
of a project. However, if the grantees fail to submit final report in time, the end￾of-project M&E should begin as soon as possible after the specified deadline (see 
appendix 2). 
3- I-HELP shared the grant files with M&E team through a mechanism of easy 
access to “mother” files or obtaining a copy of each of the grant files. 
4- M&E team communicated with I-HELP and filled parts of the form and 
questionnaire before visiting the grantees. 
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5- Midterm & end-of-project M&E of the grants included field visits, interviews of 
grantees, interviews of the clients (or beneficiaries) of the grants, observations, 
and checking grant documents. 
6- Upon finalization of the field visit, M&E team submitted the Small Grant 
Midterm and End – of project M&E report to I-HELP team as soon as possible for 
the purpose of development and implementation of performance improvement 
strategies and actions. 
7- All reports and forms have been well managed by M&E team and have been 
accessible to I-HELP staff. 
8- Midterm M&E of the grants will include field visits, interviews of grantees, 
interviews of the clients (or beneficiaries) of the grants, observations, and 
checking grant documents. 
9- Upon finalization of the End-of-project M&E for a grant, M&E team should 
submit the Small Grant End-of-Project report to I-HELP as soon as possible. 
10- Data analysis have been done using SPSS version 9 program, based on all data 
collected (including midterm and end-of-project M&E reports and forms, 
accumulated narratives, and other project files available). In addition, M&E team 
have provided a Workshop Evaluation Questionnaire (See appendix 3) to evaluate 
the workshop directly conducted by I-HELP. This questionnaire forms have been 
analyzed and documented in the consolidated trainings’ report with primary 
health care delivery training workshops. 
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4. Results
A total of 28 projects had been granted with a total budget of $1,162,566.73 . 
Half (50%) of the grants were implemented in Baghdad, where as the others were 
implemented in Mosul, Wassit, Basra, Erbil, Sulaimania, Kirkuk, Thiqar, and Tikrit 
(See table 1, Fig. 2 for details). 
 
Table 2 shows that the duration of one third (32.14%) of the grants ranges from 31 – 60 
days and the duration of 14.29% of the grants was ≥ 121 days. 
 More than two thirds (67.86%) of the grants were implemented in urban areas, 3.57% 
were implemented in rural areas, 7.14% were implemented in suburban areas, and the 
others where implemented in a combination of locations (See table 3 for details). 
Seventy five percent of the grants were sponsored by NGOs and the rest were sponsored 
by a variety of community groups (See table 4, Fig. 3). 
The objectives of more than half (53.57%) of the grants were consistent with one or two 
of the I-HELP objectives (See table 5 for details). 
More than two thirds (67.86%) of the beneficiaries were non medical personnel, and 
70.86% were medical personnel as shown in table 5. 
The majority (92.86%) of the grants succeeded to accomplish their activities and only 
two (7.14%) grants failed to do so (See table 6). 
Regarding security status (table 7), nearly all (96.4%) of the grants had no security 
problems, and one grant had faced a minor security problem that was fixed. 
Total number of staff hired by the projects was1051 persons with a mean of 37 persons 
and a median of 10, ranging from 2-209 persons. Half of the projects hired ≤10 persons 
(See table 8 for details). 
More than half (53.57%) of the grantees were newly created NGOs or community groups 
that will be sustained after the end of I-HELP. While the rest were established 
organizations (See Fig. 4). 
In general, the status of the already established organizations was improved compared 
with their status before, specifically; skills & knowledge, ability to provide technical 
assistance, and general performance of the organization as stated by the organizations 
managers (See table 9 for details). 
All of these grants’ managers were aiming to expand their projects to include more areas 
in the country in the future. 
The majority of the grantees succeeded to implement their projects toward the expected 
results as shown in table 10, where the M&E staff has rated the projects performance 
according to certain selected parameters. 
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Table 1. Grants by governorate 
Governorate Frequency Percentage 
Baghdad 13 46.43 
Baghdad & Wassit 1 3.57 
Basrah 2 7.14 
Erbil 2 7.14 
Ninewa 3 10.71 
Salah al-Din 1 3.57 
Sulaymaniyah & Tameem 1 3.57 
Thi-Qar 1 3.57 
Thi-Qar & Basrah 1 3.57 
Wassit 3 10.71 
Total 28 100.00 
Table 2. Grants by duration 
Table 3. Grants by location 
Project duration 
(days) Frequency Percentage 
≤ 30 4 14.29 
31-60 9 32.14 
61-90 6 21.43 
91-120 5 17.86 
≥121 4 14.29 
Total 28 100.00 
Location of the project Frequency Percentage 
Rural 1 3.57 
Sub-urban 2 7.14 
Urban 19 67.86 
Urban & suburban 4 14.29 
Rural & suburban 1 3.57 
Urban & rural 1 3.57 
Total 28 100.00 
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Table 4. Grants by ownership 
Table 5. Grants by reference to I-HELP objectives 
Table 5. Grants by type of beneficiaries 
Ownership status Frequency Percentage 
NGO 21 75.00 
Community group 7 25.00 
Total 28 100.00 
No. of objectives 
consistent with I￾HELP objectives 
No. of grants Percentage 
1 6 21.43 
2 9 32.14 
3 6 21.43 
4 4 14.29 
5 1 3.57 
7 1 3.57 
8 1 3.57 
Total 28 100.00 
Beneficiaries Frequency Percentage 
Medical personnel 5 17.86 
Non-medical personnel 19 67.86 
Medical & non-medical 4 14.29 
Total 28 100.00 
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Table 6. Grants by accomplishment of activities 
% of accomplished 
activities Frequency Percentage 
75 2 7.14 
100 26 92.86 
Total 28 100.00 
Table 7. Grants by security status 
Table 8. Staff hired by the projects 
No. of staff hired Frequency Percentage 
2 – 5 5 17.86 
6 – 10 9 32.14 
11 – 30 5 17.86 
31 – 100 5 17.86 
101 – 209 4 14.29 
Total 28 100 
Security status Frequency Percentage 
Secured 27 96.43 
Not secured 1 3.57 
Total 28 100.00 
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Table 9. Opinion of the previously established organizations’ managers 
regarding their organization status 
Table 10. Rating of the projects’ performance by M & E staff 
skill and 
knowledge 
improvement 
ability to provide 
technical 
assistance 
better equipped 
organization than 
before 
better 
performance of 
the organization
more staff than 
before for the 
organization 
Opinion of 
organization 
manager 
No. % No. % No. % No. % No. % 
Strongly agree 11 84.62 13 100.00 5 38.46 13 100.00 5 38.46 
Agree 2 15.38 0 0 4 30.77 0 0 5 38.46 
Disagree 0 0 0 0 3 23.08 0 0 2 15.38 
Strongly 
disagree 
0 0 0 0 1 7.69 0 0 1 7.69 
Total 13 100.00 13 100.00 13 100.00 13 100.00 13 100.00
Indicators of Very good Good acceptable Poor Very poor Total 
project 
performance No. % No. % No. % No. % No. % No. % 
activity 
performance 19 67.86 4 14.29 3 10.71 1 3.57 1 3.57 28 100
objective 
achievement 13 46.43 8 28.57 5 17.86 1 3.57 1 3.57 28 100
social benefit 14 50 10 35.71 2 7.14 0 0 2 7.14 28 100
health benefit 16 57.14 7 25 4 14.29 0 0 1 3.57 28 100
capacity 
improvement 8 28.57 14 50 4 14.29 1 3.57 1 3.57 28 100
project 
sustainability 14 50 5 17.86 6 21.43 2 7.14 1 3.57 28 100
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Figure 2 Grants by governorates
Baghdad
45%
Baghdad & Wassit
4%
Basrah
7%
Erbil
7%
Ninewa
10%
Salah al-Din
4%
Sulaymaniyah & Tameem
4%
Thi-Qar
4%
Thi-Qar & Basrah
4%
Wassit
11%
Figure 3 Grants by ownership
NGO
75%
Community group
25%
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Figure 4 Grants by time of organization establishment
Newly created because of the 
project
54%
Established before the project
46%
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5. Conclusions 
- I-HELP succeeded to cover 9 governorates with rapid impact small grants to 
strengthen the health system in urban and rural areas. 
- The grantees were either NGOs or community groups, more than half of them 
were newly created because of I-HELP. 
- Around half of the grants comply with 3 or more of I-HELP objectives. 
- Total number of staff hired by all projects was 1051 Iraqi persons. 
- The majority of the grantees had accomplished their proposed activities. 
- There was an improvement in the skills & knowledge, ability to provide technical 
assistance, and better performance of the previously established organizations as 
stated by their managers. 
- The majority of the grants were evaluated as very good or good by the M&E staff. 
- In general the I-HELP succeeded to achieve it’s objectives in spite of the bad 
challenging conditions. 
15
 Small Grant Midterm M&E Report Form 
GENERAL INFORMATION 
1. Project reference No._____________ 
2. Starting date of the grant: MM_____DD_____YY_____ 
3. Proposed end date of the grant: MM_____DD_____YY_____ 
4. Date of midterm M&E: MM_____DD_____YY_____ 
5. Project title: 
6. Awarded amount ($): 
7. Name of project manager: 
8. Name of organization: 
9. Address: 
10. Phone number of the manager: Office________________; Mobile:________________ 
 Email address:_______________________ 
11. Project implementation location: (1) rural; (2) suburban; (3) urban 
12. Ownership status: (1) Government; (2) NGO with government share; (3) NGO; (4) IO; (5) 
Community Group 
TECHNICAL INFORMATION 
13. Proposed objectives: 
Appendix 1 
16
14. Reference to I-HELP objectives: 
 (1) (2) (3.1) (3.2) (3.3) (3.4) (3.5) (3.6) (3.7) (3.8) (3.9) (4)
15. Proposed beneficiaries: 
16. Proposed quantity of beneficiaries: 
17. Proposed activities and timeline: 
17
18. Number of activities proposed to be finished by midterm: 
19. The number of activities finished by midterm: 
20. Number of activities poorly performed: 
21. Security problem: (1) yes; (2) no. If yes, specify:____________________________________ 
 _________________________________________________________________________________ 
22. Reasons and recommendations for non-performance and delayed performance of activities: 
Name of activity: 
Proposed deadline of performance: The _____ week of MM_________YY_________ 
Status of performance: (1) non-performance; (2) delayed performance 
Reasons: 
Grantee’s plan to fix the problem: 
Recommendations (communicate with grantee): 
Name of activity: 
Proposed deadline of performance: The _____ week of MM_________YY_________ 
Status of performance: (1) non-performance; (2) delayed performance 
Reasons: 
Grantee’s plan to fix the problem: 
18
Recommendations (communicate with grantee): 
Name of activity: 
Proposed deadline of performance: The _____ week of MM_________YY_________ 
Status of performance: (1) non-performance; (2) delayed performance 
Reasons: 
Grantee’s plan to fix the problem: 
Recommendations (communicate with grantee):
Name of activity: 
Proposed deadline of performance: The _____ week of MM_________YY_________ 
Status of performance: (1) non-performance; (2) delayed performance 
Reasons: 
Grantee’s plan to fix the problem: 
19
Recommendations (communicate with grantee): 
Name of activity: 
Proposed deadline of performance: The _____ week of MM_________YY_________ 
Status of performance: (1) non-performance; (2) delayed performance 
Reasons: 
Grantee’s plan to fix the problem: 
Recommendations (communicate with grantee):
23. Reasons and recommendations for poorly performed activities: 
Name of activity: 
Description of the problem: 
Reasons and excuses: 
Recommendations (communicate with grantee):
Name of activity: 
Description of the problem: 
20
Reasons and excuses: 
Recommendations (communicate with grantee):
Name of activity: 
Description of the problem: 
Reasons and excuses: 
Recommendations (communicate with grantee):
Name of activity: 
Description of the problem: 
Reasons and excuses: 
Recommendations (communicate with grantee):
24. Grantee’s opinion of the likelihood of achieving the proposed objectives, plan for 
improvement, and requests for technical assistance 
Objectives For 
sure 
Possible Not 
possible
 
21
Plan for achieving the objectives: 
Request for modifications: 
Requests for technical assistance: 
25. M&E staff’s assessment of the likelihood of achieving the proposed objectives, and 
recommendations: 
Objectives For sure Possible Not 
possible
 
Recommendations and rationale (technical assistance, modification of objectives, re-organization 
of the grant implementation, fine-tuning the grant activities, and termination of the grant): 
26. Technical assistance provided by M&E: 
22
27. Conclusions: 
Name of M&E staff:__________________ 
Signature:______________________ 
Date of report: MM______DD______YY_______ 
23
Small Grant End-of-Project M&E Report Form 
GENERAL INFORMATION 
1. Project reference No._____________
2. Starting date of the grant: MM_____DD_____YY_____ 
3. Proposed end date of the grant: MM_____DD_____YY_____
4. Date of end-of-project M&E: MM_____DD_____YY_____
5. Project title: 
6. Awarded amount ($): 
7. Name of project manager: 
8. Name of organization:
9. Address:
10. Phone number of the manager: Office________________; Mobile:________________ 
 Email address:_______________________
11. Project implementation location: (1) rural; (2) suburban; (3) urban 
12. Ownership status: (1) Government; (2) NGO with government share; (3) NGO; (4) IO; (5) 
Community Group
TECHNICAL INFORMATION 
13. Proposed objectives: 
Appendix 2 
24
14. Reference to I-HELP objectives: 
 (1) (2) (3.1) (3.2) (3.3) (3.4) (3.5) (3.6) (3.7) (3.8) (3.9) (4)
15. Proposed beneficiaries: 
16. Proposed quantity of beneficiaries: 
17. Proposed/revised activities and timeline: 
25
18. Number of activities proposed to be finished by the end of project: 
19. The number of activities finished by the end of the project: 
20. Number of activities poorly performed: 
21. The total number of objectives proposed/revised:
22. The number of objectives achieved:
23. Security problem: (1) yes; (2) no. If yes, specify:____________________________________ 
 _________________________________________________________________________________ 
24. Reasons for non-performed activities:
Name of activity: 
Reasons: 
Name of activity: 
Reasons: 
26
Name of activity: 
Reasons: 
25. Reasons for poorly performed activities: 
Name of activity: 
Description of the problem: 
Reasons and excuses: 
Name of activity: 
Description of the problem: 
Reasons and excuses: 
Name of activity: 
Description of the problem: 
Reasons and excuses: 
26. Grantee’s opinion of the achievement of the proposed/revised objectives:
Objectives Fully 
achieved 
Partially 
achieved
Not 
achieved 
 
27
 
27. M&E staff’ assessment of the achievement of the proposed/revised objectives: 
Objectives Fully 
achieved 
Partially 
achieved
Not 
achieved 
 
28. The proposed number of staff hired: 
29. The number of staff hired by the project: 
30. The total number of the person-months used in the project: (Person-months) 
31. Is your organization newly created because of this project? (1) Yes; (2) No 
If it is newly created, will it be sustained after the completion of this project? (1) Yes; (2) No. 
If it is not newly created, go to item 32.
32. Capacity improvement for existing organization:
Statement Strongly 
agree 
Agree Disagree Strongly 
disagreed
The skill and knowledge of your staff are improved 
Your ability to provide technical assistance to another project 
is improved 
 
Your organization is better equipped than before 
Your organization will perform better in the future because of 
this project 
 
You have had more staff than before because of 
implementation of this project 
 
33. Services and beneficiaries: 
The list of services provided Number of beneficiaries/Quantity of services 
1. 
2. 
3. 
4. 
28
34. Did you receive any technical assistance during the implementation of the project? 
 (1) Yes; (2) No. 
 If yes (received), is the technical assistance beneficial for the improvement in your project 
 performance? (1) Yes; (2) No. Explain: 
35. Lessons and experience learned (by staff and program manager): 
36. Lessons and experience learned (by M&E staff): 
37. Explanation by the project manager of the secondary, long-term, expanded effects (eg from 
project region to other regions and to the whole country) of the project: 
29
38. Rating of the project performance by M&E staff: 
Dimensions of performance Evidence-based rating by M&E staff from 1 (very poor) to 5 (very 
good) 
Activity performance 1 2 3 4 5 
Objective achievement 1 2 3 4 5 
Social benefit 1 2 3 4 5 
Health benefit 1 2 3 4 5 
Capacity improvement 1 2 3 4 5 
Project sustainability 1 2 3 4 5 
39. Concluding Remarks by M&E staff (success and failure of the project, and the lesson learned):
Name of M&E staff:__________________ 
Signature:___________________ 
Date of report: MM______DD______YY_______ 
30
Workshop Evaluation Questionnaire 
1. Name of workshop:________________________________ 
2. How old are you? _______years 
3. Your gender? 1) Male 2)Female 
4. Which governorate are you from?_________________ 
5. City where workshop took place?________________ 
6. What is your main profession (check only one)? 
1) Medical doctor 
2) Nurses 
3) Technician 
4) Statistician 
5) Community medicine specialist 
6) Engineer 
7) Business administration 
8) Social scientists 
9) Other (specify): _______________ 
7. What is your administrative position? 
1) Ministry of health officer 
2) Director general of the governorate 
3) Department director of directorate of health 
4) Health center manager 
5) Health clinic manager 
6) Hospital manager 
7) Other 
8) No administrative position 
8. What is the length of this workshop? _____hours/days 
9. What do you think the length of the workshop? 
1) Too short 
2) Short 
3) Just about right 
4) Long 
5) Too long 
10. Is this workshop useful? 
1) Very useful 
2) Useful 
3) Unuseful 
11. How is your improvement in your knowledge and skills? 
1) Major improvement 
2) Minor improvement 
3) No improvement 
12. How will be the impact of the workshop on your work? 
1) Very positive impact 
2) Positive impact 
3) No impact 
13. Would you be willing to participate in additional 
workshops like this? 
1) Very willing to 
2) Willing to 
3) Unwilling to 
4) Very unwilling to 
14. What is your satisfaction with the trainers? 
1) Very satisfied 
2) Satisfied 
3) Unsatisfied 
4) Very unsatisfied 
15. What is your overall satisfaction with the workshop? 
1) Very satisfied 
2) Satisfied 
3) Unsatisfied 
4) Very unsatisfied 
16 . Please provide your recommendations on how we can improve the quality of the workshop 
This anonymous questionnaire is used for evaluating the effectiveness of the workshop and asking you for recommendations for further
improvement of future workshops. It is greatly appreciated if you would be willing to take a few minutes to answer the following 
questions. Thank you very much for cooperation. 
Appendix 3