At the end of June 2017, the Technical Review Panel (TRP) met to assess funding requests submitted to the Global Fund in Window 2 (23 May 2017). In this window, the TRP reviewed 54 funding requests, including 22 full reviews, 31 tailored requests and one iteration request. No program continuation requests were submitted in Window 2. Of the 54 applications reviewed, 49 (91%) were recommended for grant-making (Figure 1). Tailored requests were more likely to be recommended for grant-making than full reviews. The 49 applications recommended for grant-making translate to $3.6 billion in allocation funding recommended for grant-making, representing more than a third (35%) of total funding for the 2017-2019 cycle. Funding requests recommended for grant-making by the TRP in Windows 1 and 2 together account for 80% of total 2017-2019 funding. An additional $1.7 billion was requested for prioritized above-allocation requests (PAAR) in Window 2. This represents 47% of the amount requested within allocation, in line with the Global Fund’s guidance that the PAAR should be ambitious and represent at least 30-50% of the allocation amount. Five of the funding requests submitted in Window 2 were sent back to countries for iteration (re-submission).

Figure 1: Technical Review Panel recommendations for Window 2 submissions

Along with the main funding request, 23 matching funds applications were also reviewed in Window 2, totaling $125.8 million. Almost half of this amount ($57 million) was for finding missing TB cases. Of these 23 matching funds requests, 19 were recommended for grant-making. As of the end of Window 2, 45% of total matching funds available ($356 million) have been approved for grant-making by the TRP. Having reviewed this large batch of matching funds applications for finding missing TB cases, the TRP concluded that there was significant room for improvement in this catalytic funding area. The TRP said that countries with TB matching funds requests could improve by using bold approaches to addressing the major gaps in finding missing cases. Specifically, the TRP said, countries should provide more analysis of where and why TB cases are being missed, and should propose targeted interventions to population groups and in geographic locations where missing cases are likely to be. In a survey of TRP members, the majority (87%) found the funding requests to be strategically focused and technically sound. While most (88.6%) TRP members believed that funding requests were aligned with national priorities as expressed in national strategic plans, fewer felt that the requests addressed gender-related and human rights-related barriers to services (58.5% and 54.7%, respectively). Slightly less than two thirds (62.2%) of members believed that requests demonstrated a strategic focus on resilient and sustainable systems for health (RSSH). The TRP’s main reflections from Window 2 submissions included the following:

• The differentiated application approach is a positive development.
• The overall application quality is good, but there are specific areas for improvement.
• Countries are not using their available data in an optimal way.
• RSSH applications need to be clearer about how they will improve delivery of interventions contained in the disease modules.

While acknowledging the merits of the differentiated application process, the TRP articulated several areas where tailored requests could improve. Specifically, regarding funding requests tailored to material change, the TRP voiced concern that applicants do not always make it clear which aspect of funding requests constitute the material change. With respect to funding requests tailored to challenging operating environments (COEs), applicants did not always adequately address how the applicant will respond to the specific challenge stemming from the COE. The TRP also noted that many proposals are still missing the “how?” aspect – i.e. missing a clear plan of action for implementation. In addition, as with Window 1, the TRP reiterated that interventions for key populations continue to be poorly articulated or completely absent from funding requests. Missing information on key population size estimates and legal environment assessments are an underlying issue. Another consistent TRP reflection from Window 1 was the need for more community systems strengthening. After Window 1, the TRP remarked that community system strengthening was hardly addressed, though countries were requesting extensive funding for community health workers. Similarly, after Window 2, the TRP noted that funding requests continue to focus more on community system support (e.g. salaries for community health workers) rather than on community system strengthening (e.g. building capacity of key populations networks). They recommended applicants include systems strengthening and strengthening capacity of community organizations to provide an interface with government at different levels. Building resilient and sustainable systems for health is one of the top-line objectives in the Global Fund’s strategy for 2017-2022. Another top-line strategic objective is to promote and protect human rights and gender equality. Among the TRP’s Window 2 lessons learned related to this objective is that people in closed settings (prisoners) were not widely addressed in HIV, TB and malaria funding requests. This is despite prisoners being elevated in the new modular framework (see GFO article). Further, while the TRP noted progress in addressing gender-based violence (GBV) in general, GBV against men who have sex with men, transgender people and other key populations was not addressed. Last, although applicants prioritized reaching adolescents and young women, the TRP noted that these interventions “lacked targeting.” In terms of sustainability and transition, the TRP noted that the quality of value-for-money and sustainability analysis varied across funding requests. Acknowledging the volatile funding landscape for external and domestic resources in many countries, the TRP said countries need to build stronger narratives on how proposed interventions contribute to sustainability of disease outcomes. Better use of costing data and cost-effectiveness studies in the sustainably section of funding requests was suggested. For Window 3 submissions (28 August 2017), the TRP is anticipating a relatively small batch of applications (24 in total; nine full review and 15 tailored) (Figure 2). Window 4 (January 2018) will be a larger submission wave, with 54 applications expected (three full reviews, 19 tailored applications and 32 program continuation). Seven tailored funding requests are expected in Window 5 (date not yet set).

Figure 2: Number of applications submitted/anticipated for window 1-5, by application type

Aidspan will seek to continue reporting on the TRP debriefs for the upcoming submission windows. For Aidspan’s previous reporting on the TRP’s Window 1 debrief, see GFO articles here, here and here. Information in this article was sourced from the TRP’s debrief presentation from Window 2 reviews, a copy of which is on file with the author. To obtain a copy of the slide deck, please contact gemma.oberth@gmail.com.