During the 46th Global Fund Board meeting held on 8 to 10 November 2021, the Technical Review Panel (TRP) updated the Board on its work in 2021. In its report, the TRP indicated that it has reviewed and recommended funding requests representing 98% of allocated funds for the cycle. It has also undertaken and submitted an annual self-assessment of its performance in 2020 to the Strategy Committee (SC) that identified strengths and areas for improvement.

TRP also noted that it has documented the lessons from its review of funding requests in 2020 and produced an advisory paper on lessons learned on resilient and sustainable systems for health (RSSH) in the 2020-2022 allocation cycle.

This article details these updates based on the TRP update presented to the Board for the 46^th Board Meeting. Information also comes from the 2020 TRP Lessons Learned Report, the 2021 TRP Resilient and Sustainable Systems for Health (RSSH) Advisory Report, and the 2020 TRP Performance Assessment and preparation for the next funding cycle.

TRP has recommended for funding 200 funding requests amounting to $12.5 billion

In 2021, TRP reviewed an additional 43 funding requests amounting to $1.2 billion in allocated funds, representing 9% of allocated funds. This brought the total number of funding requests reviewed and recommended for funding to 200, amounting to $12.5 billion in allocated funds and representing 98% of allocated funds for the 2020-2022 cycle.

In March 2021, the TRP produced a report on lessons learned from its virtual review of funding requests in 2020 and across Windows 1 to 3 of the 2020-2022 allocation cycle. TRP based its findings on the review of 157 funding requests amounting to $11.34 billion in allocated funds and nearly 90% of allocated funds for the current allocation cycle.

The TRP noted that funding requests were of high quality. They demonstrated increased attention to areas critical to achieving Global Fund strategic objectives compared to the last cycle, such as human rights, gender, and HIV prevention. The TRP called for intentional action to mitigate the short- and long-term impacts of COVID-19, increased focus on results and impact, and a greater focus on core evidence-based interventions that respond to specific epidemiological contexts.

TRP also reports lessons learned in the review of Strategic Initiatives

TRP also reported on lessons learned in the review of 13 Strategic Initiatives (SIs) in late 2020 and early 2021. From these reviews, the TRP found that, overall, the SIs are well-positioned to deliver against the Global Fund’s Strategy and are well focused on Board-approved areas of investment. However, it identified major concerns with three of the 13 SIs and asked for these to be addressed during grant finalization and implementation. Overall, TRP recommended streamlining SIs to avoid fragmentation, transaction costs, and management issues; improve coordination and alignment at the country level; and ensure strategic allocation between and with the SIs.

TRP also called for a clear overall theory of change, improvements to the SIs’ approach to technical assistance, and engagement of the TRP early on in the SI review process.

TRP has reviewed Global Fund investments in RSSH

For the October 2021 SC meeting, TRP produced an advisory paper on lessons learned on RSS) in the 2020-2022 allocation cycle. The report examined how Global Fund RSSH investments can be optimized to continue strengthening health systems in support of the implementation of HIV, TB, and malaria programs while also strengthening pandemic preparedness and response. It also considered progress against previous reviews, most notably the review of RSSH investments in the 2017-2019 cycle. (The Global Fund Observer (GFO) prepared several articles based on this report outlined under Further reading)

TRP came up with a few observations:

• COVID-19 disruptions to health systems span multiple areas of the health system, including human resources for health, routine surveillance, data capture and reporting, and supply chain management, among others.
• The focus of Global Fund investments continues to be on ‘supporting’ rather than ‘strengthening’ health systems.
• RSSH investments require longer-term commitments and investments than the three-year Global Fund allocation periods.
• Applicants do not consistently use Global Fund RSSH guidance and information notes.
• Implementers are not using RSSH indicators sufficiently to measure health system performance.
• The diversity of views on RSSH among the Global Fund Secretariat, stakeholders, and donors leads to siloed RSSH implementation and confusing messaging. As a result, RSSH investments are overly fragmented and often sacrificed when cuts must be made.

The TRP called for a shift from supporting to strengthening and sustaining health systems by providing greater conceptual clarity, developing a Theory of Change, an accompanying Performance Framework that lays out the rationale for Global Fund investments. It also recommended extended RSSH investments beyond the three-year implementation period, increased involvement of key in-country RSSH, HIV, TB, and malaria stakeholders and experts, and integration of health system strengthening and health security.

Improved TRP function

The Global Fund has taken some steps to improve the function of the TRP ahead of the next cycle:

• The Strategy Committee has created a Working Group on TRP matters to oversee the revision of the TRP Terms of Reference (TORs) and Recruitment
• The Secretariat commissioned the Office of the Inspector General (OIG) to conduct an advisory review of the TRP model.

The TRP also conducts an annual assessment of its performance and submits it to the Strategy Committee. The TRP assessment is a retrospective self-evaluation of the effectiveness, efficiency, and quality with which the TRP carried out its mandate. TRP presented the findings of the assessment during the 16^th Strategy Committee held in July 2021. The self-assessment covers three components: reviewing funding requests for highest impact and reporting outcomes and lessons learned; its advisory role; and governance.

The self-assessment found that the TRP  fulfilled its mandate despite a challenging global context and set a new record for reviewing funding requests and recommending $11.34 billion in a single year. However, the TRP can further improve differentiated reviews and find ways to improve the costs and time efficiency of reviews in a virtual context. Since the 2017-2019 funding cycle, the TRP has tailored its review approaches, including the level of effort and time and the composition of the review group, to the type of funding requests, including full program reviews, program continuation and tailored funding requests.

OIG Advisory: ‘Evolving the TRP model’

The OIG assessed the adequacy of the TRP’s mandate, structure, governance, and accountability mechanisms to support the delivery of the Global Fund’s strategy. It also assessed the effectiveness and efficiency of processes in place to review funding requests and SIs.

The OIG identified the need to re-assess the TRP’s mandate to ensure that the TRP focused on key impact areas. They proposed that the TRP assesses funding requests based on two criteria: allocation size and performance. Each of the funding requests would follow a differentiated review route which could include:

• TRP review for high allocation and low performing programs;
• No TRP review for high allocation and high performing programs;
• TRP review every six years for some funding requests; and
• Fast-track TRP review for some funding requests.

The TRP identified opportunities to differentiate further among funding request reviews across various dimensions, including the review process steps, review group composition, review timelines, review outcomes in terms of the number of recommendations, and review cost per funding request. (The current review approaches of the TRP are available in this document, The Review Approaches of the Technical Review Panel (TRP)). There is also an opportunity to strengthen governance and oversight by enhancing the TRP internal monitoring mechanisms and the Strategy Committee oversight role.

Next steps

The SC Working Group on TRP matters will consider the findings of the OIG Advisory in the revision of the TRP TORs and Recruitment and the recruitment of new TRP members. The SC will review and approve the revised TORs during the March 2022 meeting and address the recruitment of new TRP members during the September 2022 SC meeting.

According to the TRP update, the recommendations of the TRP Advisory on RSSH will inform and support the Secretariat’s operationalization of the new Global Fund Strategy.

Feedback from the constituencies

The constituencies reiterated the report’s findings that investments in RSSH remain fragmented and unsystematic and that RSSH indicators are used insufficiently. They called for a longer-term approach and an evolution of the Global Fund model. They also called for the Global Fund to fully implement the recommendations put forward by the TRP on RSSH.

The constituencies reiterated the importance of the recommendations from the TRP. However, they noted that only two TRP reports have been made public from the current allocation cycle. The two reports were from Windows 1 and 2. (The Global Fund Observer (GFO) looked at the TRP reports page on the Global Fund website and found four reports on the current allocation cycle, with the most recent being the RSSH advisory report discussed above). The constituencies requested that the Global Fund share the TRP reports as part of its accountability mechanisms. These reports give important direction to the Global Fund Secretariat and assist applicants in preparing strategically focused and technically sound proposals.

Further reading

• GFO 348, Funding requests to Global Fund in next allocation period will need to scale up investments in RSSH, TRP says, 14 January 2019
• GFO 349, TRP identifies gaps in human resources for health interventions in funding requests to the Global Fund, 28 January 2019
• GFO 349, Funding requests to the Global Fund need a stronger focus on integrated service delivery, TRP says, 28 January 2019