Performance-based financing at the Global Fund to Fight AIDS, Tuberculosis and Malaria: an analysis of grant ratings and funding, 2003–12

Abstract

Bill & Melinda Gates Foundation.

On metrics and financing for the Sustainable Development Goals

“…Consistent with the literature (Radelet and Siddiqi, 2007;Fan et al, 2013), each regression model was run separately for three disease categories (HIV/AIDS, including combined TB-HIV proposals, TB, and malaria) yielding a total of 12 panel data regressions. Each regression underwent standard statistical tests for outliers in the data, multicollinearity, normality of residuals, homoscedasticity, linearity, and redundancy of predictors, as recommended by Chatterjee and Hadi (2015).…”

“…A new dataset was generated combining data on funding proposals submitted to the TRP provided by the Global Fund secretariat; TRP recommendations and Board decisions; grants and their performance; and country characteristics consistent with predictors used by previous studies (Lu et al, 2006;Katz et al, 2010;Radelet and Siddiqi, 2007;Fan et al, 2013;Bowser et al, 2014). Proposals rated 1 or 2 by the TRP were manually matched with signed grants from the grants dataset using proposal parameters provided in both datasets, including the proposal name, disease component, country, funding volumes, and the year of submission.…”

“…Macro International (2009), French Ministry of Foreign Affairs (2013, Norwegian Min-istry of Foreign Affairs (2013), DFID (2016)). A substantial scientific literature, predominantly published in The Lancet, has covered different aspects of its business model, such as performance-based funding (Katz et al, 2010;Fan et al, 2013Fan et al, , 2014Glassman et al, 2013), its impact on health systems (Samb et al, 2009;Bowser et al, 2014), involvement of civil society (Harmer et al, 2012;Bridge et al, 2016), drug pricing (Stover et al, 2011;Zelman et al, 2014), its role in fragile countries (Bornemisza et al, 2010), and the promotion of implementation research and management learning (van Kerkhoff andSzlezák, 2006, 2010).…”

“…The need to respond quickly to the global health crisis and to meet high expectations from world leaders, combined with the lack of clarity of how to go about such a scaling up, forced the experts designing the Global Fund to reconsider two tensions and tradeoff that have been well documented in the technical and policy literature on aid (Kharas, 2007;OECD, 2008;Temple, 2010;Chandy and Kharas, 2011), and especially on performance-based aid allocation (Adam et al, 2004;Barder and Birdsall, 2006;Wood, 2008;Fan et al, 2013;Glassman et al, 2013). The first concerns the tension between country ownership and the need to ensure effective use of scarce resources, consistent with medical best practice in the case of health.…”

“…The evidence suggests overall that the Global Fund ensures transparent and sound use of resources (Macro International, 2009;French Ministry of Foreign Affairs, 2013). Independent reviews find evidence for performance-based funding by the Global Fund, but with substantial discretion exercised by the Global Fund secretariat (Radelet and Siddiqi, 2007;Katz et al, 2010;Fan et al, 2013). Low tolerance for corruption and performance-based funding appear to improve program performance (Bass, 2005) [DP 7].…”