Africa: The Global Fund Is Generally Performing Well Against Its Key Performance Indicator Targets

analysis

The Global Fund has generally achieved its key performance indicators (KPI), according to the mid-2020 Strategic Performance Report presented to the Board on 11 and 12 November 2020. The organization is on track to meet its resource mobilization, program design, and implementation targets but is unlikely to meet its targets for some program results. However, these results did not factor in the impact of COVID-19 on KPIs. The Global Fund Secretariat will report on this to the Board in May 2021. Some constituencies expressed their concerns about the Secretariat's delay (of nearly one year) in reporting the impact of COVID-19 on KPIs, as it does not promote real-time decision making.

The Global Fund is on track with resource mobilization

The Global Fund uses various KPIs to determine its progress on funding:

KPI 10 determines progress in resource mobilization. The Global Fund has met this KPI. As of March 2020, the organization exceeded its targeted pledges for the Sixth Replenishment by achieving 101 percent of the replenishment target. The organization also met its target on the pledge conversion rate by matching the actual replenishment contributions to the forecasted estimates. The Secretariat will report on domestic investments in programs for HIV, tuberculosis (TB), and malaria (KPI 11) and availability of affordable health technologies (KPI 12) in May 2021.

The organization is yet to schedule the report on KPI 9c that measures domestic investments in key populations and human rights and will propose its target during the May 2021 Board meeting.

The Global Fund's investments are aligned to country needs

The organization uses various KPIs to determine its progress in strategic focus and activities:

KPI 3 determines the alignment of the Global Fund's investments to countries' needs in terms of disease burden and economic capacity. The Global Fund has met this KPI. The mid-2020 alignment was 0.318 against a target of 0.320 or less (the lower the score the better the alignment). This KPI indicates that the organization allocates its funding to countries with greater needs rather than those with the best absorption.

KPI 4 determines investment efficiency measured by gauging how the organization is performing in terms of reducing the cost per life saved or infections averted. The Global Fund is close to meeting this KPI. The organization reduced the cost per life saved or infections averted in 88 percent of the countries it supports against its target of 90 percent.

KPI 6f determines the alignment of funding requests to the National Strategic Plan. The Global Fund surpassed its target of 90 percent for this KPI. The Technical Review Panel (TRP) assessed 35 funding requests submitted in Window 1 of the 2020-2022 allocation period and found all to align with their National Strategic Plan.

KPI 9b measures the progress that the Global Fund has made in grant funding for key populations and human rights activities. The Secretariat proposed to revise KPI 9b indicators and will report on these to the Board in May 2021.

Absorptive capacity and allocation utilization are on track

The Global Fund uses KPI 7 to determine its progress on fund utilization. KPI 7 is divided into KPI 7a and KPI 7b:

KPI 7a measures the utilization of allocated funds. The organization is performing well in terms of this KPI since 97 percent of the disbursed funds for the Fifth Replenishment has been committed as grant expenses against a target of 91-100 percent. However, utilization ranges from 75 percent for health system strengthening grants to 100 percent for HIV/TB grants.

KPI 7b measures the absorptive capacity of grants. The organization exceeded it targets for this KPI: it aimed for country programs to spend 75 percent of grant budgets on service delivery by 2022 and achieved 88 percent for 2017-2019. Absorption varied by disease program, from 82 percent for TB to 90 percent for HIV/TB. It also varied by region, from 77 percent in Asia to 96 percent in South-East Africa.

Underperformance on service delivery and service coverage for key populations

The Global Fund's performance on service delivery is at risk, as it is underperforming on several indicators that track its impact on HIV, TB, and malaria:

KPI 1 measures the Global Fund's performance against its impact targets. The Secretariat will report on this KPI to the Board in May 2021.

KPI 2 measures the Global Fund's performance against service delivery targets. The organization is underperforming on several indicators for this KPI:

For HIV, the mid-2020 results indicate that there are only 19 countries where 80 percent of people living with HIV know their status against a target of 33 countries. The coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) are at 67 percent and 86 percent, respectively, against targets of 78 percent and 96 percent by 2022. Additionally, the Global Fund is off track to achieve its target of 35 countries where 80 percent of people living with HIV start preventive therapy for TB by 2022, as mid-2020 results indicated only eight countries met this target. For TB, the Global Fund's target is for 99 countries to successfully treat 90 percent of TB cases by 2022. However, only 65 countries had met this target by mid-2020. For multi-drug resistant TB, the Global Fund's target is for 33 countries to successfully treat 85 percent of these cases by 2022. However, only six countries have met this target. The Global Fund is thus at risk of not achieving these two targets.

For malaria, the organization's target is for 36 countries to administer at least three doses of antimalarial medication to 70 percent of pregnant women during antenatal care visits by 2022; however, only 18 countries have met this target. Thus, it is off target.

KPI 5 measures the number of countries reporting on coverage of services for key populations. The Global Fund is off track to meet this KPI. The mid-2020 results indicate that only 64% of countries met the target, against a target of 75% countries reporting on coverage of services provided to at least two key populations by 2020.

The Secretariat will report on the following KPIs to the Board in May 2021: KPI 6a on procurement prices, KPI 6b on supply chain, KPI 6c on financial management, transition efforts, and financial systems, and KPI 6d on health management information system (HMIS) coverage to track its efforts to build resilient and sustainable systems for health (RSSH).

The Global Fund uses several KPIs to determine its efforts to promote and protect human rights and gender equality:

KPI 6e measures the number of countries reporting on disaggregated results. The organization exceeded its target that 50 percent of countries would report disaggregated results by 2019. By mid-2020, 65 percent of countries reported age and gender-disaggregated data on all relevant indicators.

KPI 8 measures the Global Fund's performance in reducing new cases of HIV for adolescent girls and young women (AGYW) aged 15-24 years. The organization is unlikely to meet this KPI. The organization aims to reduce new HIV cases among AGYW by 58 percent in 13 priority countries between 2015 and 2022. By 2019, new cases of HIV dropped by 31 percent among the AGYW.

KPI 9c measures domestic funding for human rights and key populations in transition countries. The Secretariat will report on this KPI to the Board in November 2021.

The Board constituencies congratulated the Secretariat on performing well in most of the KPIs, including those related to grant absorption, finding missing people with TB, and people on antiretroviral therapy. However, they expressed concerns for the underperforming KPIs, particularly those for service delivery, gender and age equality, and the provision of services to key populations.

Way forward

The Global Fund is performing well in some KPIs but there are others that it is unlikely to meet. The organization has mitigation plans for underperforming KPIs. The Global Fund will continue to scale up new grants in countries with large ART coverage targets. The organization will work with partners to better align PMTCT to testing services. To improve on targets for multi-drug resistant TB, the Global Fund will invest in oral and shorter treatment regimens. To increase the number of countries where women receive at least three doses of malaria drugs during antenatal care visits, the organization is supporting ongoing research on how to move from facility- to community-based delivery. The Global Fund is instituting several measures to further reduce the number of new cases of HIV among AGYW. This includes establishing new strategic initiatives for this group and the use of innovative HIV prevention technologies.

Board Document GF-B44-15A, Strategic Performance Report mid-2020, will be available shortly at https://www.theglobalfund.org/en/board/meetings/44

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