DETAILED ASSESSMENT OF UNRWA PERFORMANCE. 39 KPI 10: Interventions are relevant to the needs and priorities of partner countries and beneficiaries, and the organisation works towards results in areas within its mandate. This KPI centres on the relevance of UNRWA’s engagement given the needs and priorities of its partner countries and its results focus. From a results perspective, UNRWA’s engagement in the region is highly relevant. UNRWA delivers critical support to the refugee population that it directly services, to the host authorities and to the wider development processes of the region. The limited number of evaluations that provide a small window into UNRWA’s work all attest to its high relevance. UNRWA’s progress towards its five strategic outcomes (MTS 2016-21) is key to the immediate and longer-term interests of the Palestine refugee population and to maintaining the fragile stability of the region. The set of services that UNRWA provides is tailored to meet distinct basic needs of the registered refugees. Service provision takes account of the specific conditions in each of the five field of operations, particularly the status of the Palestine refugee population in that jurisdiction, whether Palestine refugees have access to services provided by the host government/authority, and/or whether they have access to public facilities and opportunities. The dramatic increase in refugees in the region as a result of the Syrian crisis has placed a significant burden on Jordan and Lebanon. It also intensifies the well-being challenges facing Palestine refugees in these areas and diverting international political attention from the pursuit of a solution that will allow conclusion of UNRWA’s mandate. There is a limited body of independent evaluation evidence and evidence within UNRWA management results on which to judge the extent to which UNRWA is making a difference in the lives of beneficiaries. UNRWA’s reporting does not routinely differentiate in the refugee population between the “abject poor” and the “absolute poor”. Evaluations to date have tended to focus on the work processes rather than who benefitting. The selected (project-based) evaluations and management results note that performance towards poverty reduction is mixed. KPI 11: Results are delivered efficiently. This KPI looks at the extent to which UNRWA is meeting its own aims and standards on delivering results efficiently. Within the context of UNRWA’s funding shortfalls, cost effectiveness and efficiency are fundamental concerns for all of the Agency’s projects. While no independent evidence is available regarding the cost effectiveness and efficiency of UNRWA’s operations, project-based evaluations highlight the impact that insufficient funding has had, on occasion, on the timeliness of project delivery. Project-level evaluations also cite examples where funding uncertainty has led to inefficient project approaches and inefficient use of funds. However, the evidence does not offer the basis for an overall judgement of the efficiency of UNRWA’s approach. Management reporting provides project-based examples of efforts to increase efficiency and reduce costs. Examples of UNRWA’s health programming initiatives include transitioning all health clinics to the e-Health (electronic medical records) system and the person-centred Family Health Teams, which have the benefit of longer but less frequent visits to primary doctors, limiting hospital visits to only the most vulnerable people and referring others to less-expensive care facilities. Education reform has increased efficiency and reduced costs very substantively through more rigorous management of the Class Formation process. UNRWA has also introduced cash-based programming to support efficiency gains and reduce operational costs associated with in-kind food distributions. However, the evaluation of UNRWA’s transition to the e-card modality in Jordan, Lebanon and the West Bank found that, in reality, intended cost savings had not yet been delivered and that key data on management and overhead costs are unavailable.