Abstract
Objective/BackgroundThe Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) strives for high value for money, encouraging countries to integrate synergistic services and systems strengthening to maximize investments. The GF needs to show how, and how much, its grants support more than just HIV/AIDS, TB and malaria.Sexual and Reproductive Health (SRH) has been part of HIV/AIDS grants since 2007. Previous studies showed the GF PBF system does not allow resource tracking for SRH integration within HIV/AIDS grants. We present findings from a resource tracking case study using primary data collected at country level.MethodsEthiopia was the study site. We reviewed data from four HIV/AIDS grants from January 2009-June 2011 and categorized SDAs and activities as directly, indirectly, or not related to SRH integration. Data included: GF PBF data; financial, performance, in-depth interview and facility observation data from Ethiopia.ResultsAll HIV/AIDS grants in Ethiopia support SRH integration activities (12-100%). Using activities within SDAs, expenditures directly supporting SRH integration increased from 25% to 66% for the largest HIV/AIDS grant, and from 21% to 34% for the smaller PMTCT-focused grant. Using SDAs to categorize expenditures underestimated direct investments in SRH integration; activity-based categorization is more accurate.The important finding is that primary data collection could not resolve the limitations in using GF GPR data for resource tracking. The remedy is to require existing activity-based budgets and expenditure reports as part of PBF reporting requirements, and make them available in the grant portfolio database. The GF should do this quickly, as it is a serious shortfall in the GF guiding principle of transparency.ConclusionsShowing high value for money is important for maximizing impact and replenishments. The Global Fund should routinely track HIV/AIDs grant expenditures to disease control, service integration, and overall health systems strengthening. The current PBF system will not allow this. Real-time expenditure analysis could be achieved by integrating existing activity-based financial data into the routine PBF system. The GF’s New Funding Model and the 2012-2016 strategy present good opportunities for over-hauling the PBF system to improve transparency and allow the GF to monitor and maximize value for money.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0106-z) contains supplementary material, which is available to authorized users.
Highlights
The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) is a leading financier of global health initiatives
Using activities within Service Delivery Area (SDA), expenditures directly supporting Sexual and Reproductive Health (SRH) integration increased from 25% to 66% for the largest HIV/AIDS grant, and from 21% to 34% for the smaller PMTCT-focused grant
The important finding is that primary data collection could not resolve the limitations in using GF Grant Performance Reports (GPRs) data for resource tracking
Summary
The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) is a leading financier of global health initiatives. In 2012, the GF celebrated its 10th anniversary, and by 2014, had committed more than USD 32 billion to grants in more than 150 countries The majority of these funds support the three disease areas that the GF was launched to address: HIV/AIDS control activities (52%), followed by malaria (29%), and tuberculosis (15%) [1]. GF financial data and reporting systems Budget, disbursement, and expenditure data for GF grants are tracked by the Principal Recipients (PRs), who report to the Local Funding Agent (LFA), who reports to the GF Secretariat Each of these three forms of financial data (budget, disbursement, and expenditure) contains costs at the level of Service Delivery Area (SDA), which are broad categories that contain many distinct activities (e.g., Behavior Change Communication or PMTCT), and may vary from year to year. These are kept by the Secretariat, PR, and LFA, and were made available to the study team not in original
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