The Global Fund’s Technical Review Panel (TRP) has published a 35-page report on the Global Fund website, intended to offer content-related support to countries that are developing their funding requests for the next allocation cycle. The report is based on the panel’s observations made during the 2017-2019 funding cycle, during which 225 country applications and 30 multicountry applications for funding were submitted.
The core of the report, which summarizes key trends and lessons learned, is the TRP’s recommendations regarding funding requests for each of the three diseases and for resilient and sustainable systems for health.
Now that the $14.02 billion total amount available for the Global Fund’s next funding cycle is confirmed (following the Sixth Replenishment pledging conference in October), the Board will allocate funds for 2020-2022 at the upcoming Board meeting in Geneva on November 14-15.
Progress to date
The TRP’s report describes “an overall improvement” in funding requests, noting that a majority of the funding requests were based on disease-specific, costed National Strategic Plans (NSP) or National Health Plans (NHP). The panel also noted some improvements in the use of data to target interventions to key populations, that the applications increasingly addressed health systems concerns, and that “a number of applications” paid greater attention to financial sustainability.
Overview of the 2017-2019 Allocation Cycle
In the ‘overview’ section of the report, the TRP breaks down the number and type of country applications received, in the context of the ‘differentiated approach’ adopted in the 2017-2019 allocation cycle. The differentiated approach was a response to lessons learned in the 2014-2016 allocation period, which the TRP calls “an essential change”. This change enabled “flexible and tailored” country funding requests to match the needs and context of a country. The TRP says that the differentiated approach allows applicants to develop quality applications for funding more efficiently, theoretically freeing up more time and resources on actual grant implementation.
From the differentiated approach flowed three main categories of application material:
- Full review application (of which there were 50 in the 2017-2019 cycle)
- Program Continuation reviews (of which there were 93)
- Tailored reviews (of which there were 82).
This section concludes by explaining how the TRP evaluated grants’ strategic focus, as well as the review criteria the panel used to evaluate the requests’ technical soundness.
The TRP makes recommendations in five areas that “pose some constraints in achieving Global Fund strategic objectives,” the report says.
Overarching concerns and related key messages and priorities
While acknowledging progress, the TRP’s report identified “several areas of critical concern”. In section 3.1 of the report, the TRP sets out detailed context, followed by recommendations, for each of the five areas that “pose some constraints in achieving Global Fund strategic objectives,” the report says. (A large section of the report deals with each of the four strategic objectives, which we do not discuss here.)
These five areas of concern form the core of the report:
- Improve priority setting
- Increase focus on prevention and reducing incidence
- Strengthen cross-cutting resilient and sustainable systems for health (RSSH) programming
- Community systems strengthening
- Sustainability and transition
These issues are interrelated, the report says, but warrant specific, separate recommendations.
Selected observations and recommendations from the TRP report
The richly detailed content under each of the overarching concerns is too lengthy to report on comprehensively here, but we include a sample of some of the TRP’s insights, which help inform the detailed recommendations.
Funding requests reviewed during this period:
- Showed progress in commitments to domestic resource mobilization and sustainability, as well as progress in preparing countries for transition;
- Reflected “the potential fragility of programs maintaining gains” as well as the challenges of scaling up and enhancing program quality;
- Reflected “a shifting role for Global Fund investment”, with Global Fund resources plateauing or decreasing, therefore covering a smaller proportion of countries’ respective disease programs;
- Did not provide “an adequate basis for prioritization of interventions” – it was difficult for the TRP to understand why countries were making particular choices for investment, even in the presence of available data providing strong evidence for program direction and investment strategies;
- Do not “convey a sense of boldness, innovation or ambition in setting targets or designing interventions” to strengthen prevention and thereby reduce disease incidence;
- Mostly did not propose activities for strengthening community systems “that are comprehensive and at sufficient scale to make a difference” or included proposed funding to support communities “to advocate against unsound and inequitable policies, laws and regulations, which are often linked to structural, political and cultural reticence to provide or scale up services for key populations (this especially important in light of recent information about more than 50% of new HIV infections occurring among key populations)
- Showed increasing attention to sustainability and transition, especially in upper middle-income countries and countries with programs in, or near, transition;
- For the area of resilient and sustainable systems for health (RSSH), investments were “largely focused on support activities more in keeping with early stages of health systems development, for example salary support and short-term training (see the TRP’s Report on RSSH investments in the 2017-2019 funding cycle).
Some of the related recommendations, including some for the Global Fund, are:
1. Priority setting:
- The prioritization of interventions and activities to be funded should be improved, and should be based on empirical data that provides a sound basis for assessing contributions to program results;
- Funding requests should be based on national stategies and health plans that identify clear funding priorities (in case available resources cannot support all elements)
- Interventions should contribute to long-term systems strengthening “to the greatest extent possible”.
2. Increase focus on prevention and reducing incidence:
- Funding requests should include a stronger focus on interventions that reduce incidence (such as TB case finding, latent TB infection and comprehensive HIV prevention for adolescents);
- Funding requests should reflect greater ambition in prevention targets;
- To succeed in implementing programs at scale, better understanding is needed of “who is the most vulnerable and why”, to address the core factors around this vulnerability, and to reach vulnerable individuals with prevention, care and treatment services in a compassionate and safe environment.
3. Strengthen cross-cutting RSSH programming:
- Funding requests for RSSH investments in national health systems should be based on stronger country situational analyses that include the public and private sectors, as well as civil society inputs, and should be coordinated and aligned with other partners in order to maximize the effect of combined funding for RSSH;
- Proposes RSSH investments should reflect a shift from health systems support to health systems strengthening, and eventually countries sustaining such investments;
- The Global Fund should update the RSSH modular framework and associated guidance notes to promote more targeted health systems investments in line with national health (and overall development) strategies;
- The Global Fund should strengthen upfront guidance on operational costs and review recurrent/operational costs in future funding requests (especially human resource costs).
4. Community systems strengthening:
- Increase efforts to expand community engagement, especially in addressing critical barriers such as human-rights and gender-related barriers;
- Strengthen community-based health-systems programs in ways that extend coverage to hard-to-reach and marginalized populations.
5. Sustainability and transition:
- Sustainability planning should take place for all countries (except some with a designated ‘challenging operating environment’ classification) so that funding requests focus on financial and programmatic sustainability, greater use of national systems, and on mechanisms to sustain services for key populations well in advance of transition;
- Transition planning should be undertaken early;
- The Global Fund should:
- Further assess co-financing requirements, ensuring that co-financing commodities does not distort program funding away from other items
- Improve expenditure tracking, budget analysis and costing
- Ensure that activities in funding requests reflect the broader context of country-specific Universal Health Coverage and Sustainable Development Goals commitments, expanding efforts to coordinate with other global health partners at the country level, on domestic resource mobilization for health and health systems strengthening.
In addition, the TRP strongly recommended continuing the differentiated approach to funding requests, with some adjustments to be made for the 2020-2022 funding cycle.
|Application window||Submission date||Technical Review Panel review|
|1||23 March 2020||27 April – 2 May 2020|
|2||25 May 2020||29 June – 5 July 2020|
|3||31 August 2020||5-11 October 2020|
Source: The Global Fund