Abstract
In 2014, the United States Agency for International Development (USAID) funded the KNCV Tuberculosis Foundation, Management Sciences for Health and the World Health Organization to implement the five-year Challenge TB (CTB) Activity to support Ethiopia?s National Tuberculosis Program (NTP) in reducing TB incidence and related deaths by providing capacity building and technical assistance to the government, agencies, and health facilities to strengthen program management and service delivery. USAID/Ethiopia contracted Social Impact, Inc. to conduct a performance evaluation to examine Activity effectiveness, intervention challenges, and provide recommendations to guide decisions on future TB activity design and implementation. The evaluation team used mixed methods including document review, secondary data analysis, key informant interviews, and observations to identify findings that addressed USAID?s evaluation questions. The evaluation found that the range and reach of CTB interventions and technical assistance were comprehensive, high quality, and responsive to NTP needs. However, design and implementation challenges impeded efficiency (implementation delays, lack of depth in use of data for decision making), and effectiveness (variability in adherence to standards for case finding, treatment, and community-based interventions). While CTB excelled in supporting the expansion of critical diagnostic services, management of drug-resistant TB, and research, there was evidence of inconsistent practice of active case finding. Further, while capacity building activities were especially robust at zone and woreda level, the expectation of continued support from CTB staff for financial support and overall activity management limits long-term sustainability. The report makes eleven recommendations directed to USAID and the NTP on priorities for future design and implementation.