TRP provides comments on requests submitted to the Global Fund in the first two windows of 2017-2019
The Technical Review Panel (TRP) has prepared a report on the funding requests it reviewed in Windows 1 and 2 of the 2017-2019 allocation period. The report was divided into three parts: general observations, technical observations, and the review process. This article summarizes the first part, general observations. A separate article on the TRP’s technical observations will be included in a future issue of GFO.
In the first part of the TRP report, general observations, the TRP commented on (a) areas where improvements are required; (b) differentiated funding requests; and (c) matching funds.
AREAS WHERE IMPROVEMENTS ARE REQUIRED
The TRP said that the majority of the funding requests are strategically focused and technically sound, but that there are some common areas where further improvement is required.
Address the how
About two-thirds of the funding requests lacked sufficient information on how the barriers and gaps identified in the requests would be addressed, and how targets would be attained, the TRP observed. It recommended that applicants explain how the proposed interventions will contribute to achieving the targets and how the proposed strategies, priorities, interventions and budget are all aligned. Where appropriate, the TRP added, timelines should be spelled out.
Optimize the use of data
While there was an increase in the availability, quality and use of data in funding requests, the TRP said, there were some gaps in the availability of specific data, such as the size of key populations; policy and legal barriers to access for key populations; and breakdowns of gender and age data.
In general, the TRP said, applicants failed to adequately analyze and interpret available data, particularly program data. HIV requests tended to be overly reliant on modelling, it said.
The TRP recommended that applicants use multiple sources of available data and that they tailor proposed interventions to specific needs. For example, the TRP said, applicants should acknowledge poor epidemiological outcomes in funding requests, attempt to identify the reasons and develop appropriate responses. The TRP also recommended that applicants use, and make decisions based on, both national and local health management information systems.
The TRP also recommended that partners support countries to compile quality program data.
Improve how RSSH requests are handled
The TRP said it is challenging to carry out a comprehensive review of both disease-specific and health-systems funding requests when they are not submitted at the same time. By the same token, the TRP said, submitting the requests at different times makes it difficult for countries to coherently plan their responses.
Whenever possible, the TRP said, disease-specific and RSSH requests should be submitted simultaneously. However, if they are submitted separately, the TRP said, applicants should indicate how disease-specific interventions are supporting health systems, and vice versa.
The TRP also recommended that one or more persons with RSSH expertise be included in country coordinating mechanisms to facilitate the development of health systems requests.
TRP members observed that countries did not always submit prioritized above-allocation requests (PAARs) with their funding applications. The TRP also noted that PAAR applications did not always include enough information, or the right information, to allow for a proper review of these requests. For example, the TRP said, often applicants did not provide the epidemiological context or a rationale for the choice of strategic interventions proposed. Also, it said, many applicants neglected to specify how the additional interventions would accelerate the achievement of the strategic objectives and targets described in the within-allocation portion of the funding requests.
In addition, TRP members said the division of interventions between the within-allocation requests and the PAARs was not always optimal; essential interventions that should have been in the within-allocation request were in the PAAR instead.
The TRP observed that some requests would benefit from improvements in presentation and readability. It said that some requests included clear references to supporting documents that included page numbers, but they did not do so consistently.
The TRP said that, ideally, references to supporting documents should include a hyperlink to specific passages in the documents.
DIFFERENTIATED FUNDING REQUESTS
The TRP said that the differentiated application process is a positive development, but some fine tuning is required. In Windows 1 and 2, 72 program continuation requests, 38 tailored requests and 35 full review requests were assessed.
Program continuation requests
The TRP said that program continuation was broadly successful as an application approach. Only three of 72 program continuation requests were asked to resubmit using a different approach.
The TRP said that the eligibility criteria for submitting a program continuation request were sound – well-performing grants, together with the absence of major changes in allocation size, funding landscape, epidemiology, identified needs and normative guidance. The TRP considers the program continuation modality most appropriate for grants that recently started implementation.
The TRP said that, for the most part, the Applicant Self-Assessment and the Secretariat Briefing Note were sufficient to make decisions on program continuation requests. However, the TRP said that it missed having a modular-level budget, especially when the allocation was significantly reduced. The absence of a budget made it hard to judge how the country prioritizes interventions, the TRP said; consequently, the TRP had to rely on information provided by the country teams.
The TRP reiterated an observation that it had made earlier – that a program continuation request is generally not a valid approach for disease components facing a cut in the budget envelope of over 30% because the program continuation approach does not allow countries to clearly describe the impact of the budget reduction and explain how this will be managed.
The TRP also observed that the program continuation approach is not as conducive to the inclusion of innovative ideas as the other approaches. Since program continuation is aimed at portfolios for which a continuation of the current strategy is the best approach, there is no expectation to overly innovate in terms of the strategy, the TRP said. However, there can still be innovation regarding service delivery approaches.
Tailored funding requests come in four varieties: (1) requests based on national strategic plans; (2) requests that contain material change; (3) requests from countries with challenging operating environments; and (4) requests related to transitions.
Requests based on national strategic plans
The TRP observed that it is challenging to assess how national strategic plans link with the overall health system. National strategic plans also often lack clear gap analyses, the TRP said, which makes it difficult to review them as a primary document for a funding request.
The TRP recommended that funding requests using national strategic plans as the primary application document should improve the selection of indicators to better reflect the impact of the investment, clearly describe coverage and financial gaps, and explain how the disease-specific program links to the health system and other disease programs.
Material change requests
Material change requests did not always indicate which aspect of the funding request constitutes the material change, the TRP said.
The TRP said the threshold for material change may need to be reconsidered, as even a 10% reduction in funding for interventions can have substantial consequences that require a refocusing and reprioritization of the program.
The TRP said material change requests should clearly describe the change in context or program, provide the TRP with the budget and a description of the full funding landscape, and explain how the proposed strategies and interventions will lead to improved results.
Challenging operating environment requests
Challenging operating environments include a wide range of contexts, including conflict, post-Ebola, corruption and natural disasters. The TRP said that it may not be appropriate to group this diverse range of contexts in the same category.
The TRP also observed that, often, applicants that submit challenging operating environment requests do not clearly describe the context and the specific challenges they face.
The TRP said that in cases where only part of the country qualifies as a challenging operating environment, applicants should explain how the program will differentiate its approach between the challenging operating environment and non-challenging operating environment areas.
In Windows 1 and 2, there were only two transition requests submitted. The TRP discussed transition requests in Part 2 of its report (technical observations).
Matching funds requests
In Windows 1 and 2, the TRP recommended for approval 29 of 37 matching fund requests equaling $63 million. This represented 47% of the matching funds available for 2017-2019.
The TRP believes that matching funds are a significant opportunity that should be maximized to both catalyze and expand the impact of the allocation, and to pilot innovative approaches and interventions. However, the TRP said, it noted a number of occasions where applicants did not sufficiently seize the opportunity to capitalize on matching funds requests.
The TRP sent some matching funds requests for iteration because they were not evidence-based, or did not innovatively address gaps. For example, some TB matching funds applications missed opportunities to propose innovative approaches to find missing TB cases; or, the applications did not analyze where and among whom missing TB cases occurred and did not propose targeted interventions to address the problem. Similarly, the TRP said that some matching fund requests addressing human rights and gender barriers were often described in broad generic terms, and lacked operational details and any identification of measurable impact.
The TRP said that, often, the matching interventions were not identified within the allocation, or were included in the PAAR instead of in the within-allocation request.
Finally, the TRP observed, often, applications for matching funds request submitted after a program continuation request was submitted lacked clarity on how the matching funds request built on the within-allocation funding. The TRP recommended that matching funds applications be submitted in the same window as the within-allocation request.
The TRP also recommended that applicants avoid presenting non-prioritized lists of interventions in matching funds requests and, instead, present a coherent investment approach with a limited number of interventions intended to achieve high impact.
In addition, the TRP recommended that TB matching funds requests provide more analysis of where the TB missing cases are likely to be and why they are missing, and propose specific, targeted interventions for the identified populations and geographic locations.
Finally, the TRP recommended that the Secretariat develop a monitoring framework to analyze the impact of matching funding across the portfolio.
The TRP report is contained in Board Document GF-B38-12 (Report on the TRP Review Windows 1 and 2) which should be available shortly at www.theglobalfund.org/en/board/meetings/38. [check]. It should also be posted shortly at https://www.theglobalfund.org/en/technical-review-panel/reports/.