The Global Fund is on track to not just meet, but surpassed its target for the number of infections it averted between 2012 and 2016, according to the mid-year KPI results presented to the Board this week. This is one of 10 areas in which he organisation’s targets are on track, but four of the performance measures are below expectation or are at risk of not being met.
The Fund’s goal for the time it takes to disburse funds will not be met, and neither will its aims for the number of human rights complaints identified and resolved by the Secretariat. The number of HIV positive women receiving anti-retrovirals (ARTs) is unlikely to be as high as the Fund wanted, nor will the number of HIV-positive TB patients given ARTs during TB treatment. There is still not enough data available for the organisation to know whether it has met the performance indicator it set to measure Health System Strengthening.
Among the targets that have been achieved, one that stands out is KPI 1, which measures the number of lives saved and infections averted. The target for 2012 -2016 is to save ten million lives. The results show that from 2012 to 2015 the Fund saved 8.5 million lives, which is well on track to meeting this target. The target for new infections averted for the same period is 140 million. To date, 146 million new infections have been averted.
A decline in malaria infections is driving this strong result. The target assumed that the 3% rate of decline seen from 2006 to 2010 would continue, but instead a 4% rate of decline was noted from 2011 to 2015.
The Fund also performed well against the KPI measuring value for money. The organisation had hoped to reduce spending on certain commodities by 7% this year by making use of its purchasing power. The mid-year result shows that spending is down 12.5% saving the Fund $64 million. That will bring this KPI back on track after last year’s underperformance.
Here’s a closer look at the KPIs that are unlikely to be met by the end of the year.
KPI 2 - Quality and coverage of service
This measure gauges how well the organisation is performing in seven service areas. The targets for two of them look unlikely to be met by the end of the year.
The Fund had set a target of getting anti retrovirals to 90% of HIV positive pregnant women to reduce mother-to-child HIV transmission. The 2015 results show that 76% of relevant mother received treatment in 2015, and that projecting this forward to the end of this year will not hit the target. The Board has been told three countries account for one third of the burden in this area and they face clear challenges achieving their targets.
Another area with disappointing results is the percentage of HIV-positive TB patients given anti-retroviral treatment during TB treatment. The aim was to achieve 90% coverage, but the final 2015 figures show just 80%, which projected forward to the end of this year would be 84%.
One country is said to be responsible for this result. The Fund says there retention rates dropped from 77% to 73% percent, which is the result of incomplete reporting. The Fund and PEPFAR are working to improve the data system there.
KPI 5 Health System Strengthening
The target for this measure is at risk of not being met for 2016. It is based on a score that rates service ability and readiness. The aim was to see at least a 5 percentage point improvement in 60% of countries surveyed, but so far data is only available for two countries and they show a 4% and 6% improvement.
Further results from seven countries are expected this year, but just two of these will provide the repeat scores needed to calculate this KPI.
To address this deficiency and proved better data, the Global Fund is providing consultants to support Health Facility Assessments, the first of which was conducted in August. Twelve others are expected to start this year so that better results are available by the middle of next year.
KPI 7 Access to Funding
The Fund has been aware since late last year that it was likely to miss this KPI and has already revised down the target from the original one presented to the Board in November 2015. The intention of this indicator is to measure the organization’s progress towards reaching its 2012-2016 strategic goal of evolving its funding model so that it provides predictable funding opportunities.
The target was for 75% of grants submitted in 2015-2016 to take 10 months from submission of the concept note to receipt of the first disbursement. That was originally set at 8 months. So far just 56% of grants have taken 10 months or less.
To fix this, the Fund is looking to refine its application and review process, and provide some portfolios access to the “program continuation process” Project AIM, which is intended to streamline grant management processes is also expected to improve the Fund’s results in this area.
KPI 12 Human Rights Protection
The Global Fund is seeking to have all human rights complaints made against programs it supports identified through risk management tools, and resolved through Secretariat procedures. The target for this KPI is year-on-year improvement, but for the past two years there have been no qualifying complaints.
Of the 87 allegations received by the Office of the Inspector General, only 7 related to human rights, and none of those met the requirements for a full investigation.
To better understand why complaints have not been received, the OIG will this year assess the mechanisms used to monitor human rights violations. The Secretariat will also commission an independent evaluation of the procedures.
Information in this article comes from the Board paper GF/B36/25 presented at the 36th meeting of the Global Fund Board on 16-17 November 2016 in Montreux, Switzerland. All Board documents will be made public on the Global Fund’s website.