A new publication from Aidspan reviews a published academic study on the factors influencing the performance of Global Fund-supported tuberculosis (TB) grants. The review was written for Aidspan by Dr David McCoy.

The aim of the reviewed study, which was conducted by Itamar Katz and several other employees of the Global Fund, was to examine the association between various grant and country-related characteristics and the “performance” of TB grants (where performance was measured in terms of the percentage attainment of the targets that were set for a list of nine major TB output indicators).

The study found that grants were reaching, on average, 89% of the targets that had been set for the main TB output indicators. However, the performance scores changed over time, averaging about 60% in the first 15 months; increasing to about 95% in the period leading up the Phase 2 evaluation; and then stabilising until near the end of the grant, when performance results began to exceed targets.

Using regression analyses, the study identified a number of country and grant-related characteristics that were significantly associated with the performance score of the studied grants.

Such a study is potentially useful in helping the Global Fund identify the factors that influence grant performance. However, in his review, McCoy argues that the study did not evaluate the performance of TB programmes. Rather, it evaluated target-achievement, which does not necessarily indicate good performance “because the targets that were set may have been too low; conversely, the under-achievement of targets may not indicate poor performance” if those targets were ambitious. McCoy also discusses the limitations that may have arisen as a result of the study using a methodology that measures performance through a single composite score.

The Global Fund is, in many ways, leading the international health community in measuring and improving grant performance and should be commended for this, says McCoy. However, McCoy adds that “grant performance measurement is devilishly difficult” and that “more work is required to develop the methodology and enhance the validity of performance ratings and scores.” This is discussed further by McCoy in his review.

McCoy adds that more work is also needed to improve the setting of targets. “For the Global Fund to be an effective performance-based funding agency, it must be able to be confident that targets have been set appropriately. But at present, it does not seem as though the Global Fund is adequately confident of the appropriateness of the targets set in their final grant agreements,” McCoy said.

For those interested in Global Fund TB grant performance, McCoy’s review provides an opportunity to learn about this important study and to think about the on-going challenges of target-setting and performance measurement.

“Aidspan Review of a Study by I. Katz et al on Factors Influencing Performance of Global Fund-Supported TB Grants” is available on the Aidspan website here.