Earlier this year, the Global Fund amended its prioritisation criteria for Round 10, giving less weight to technical merit than under the old criteria. This has led to some misconceptions about how the prioritisation criteria would be used for Round 10. The purpose of this article, therefore, is to explain the facts and provide an example of how proposals might be ranked if the criteria need to be invoked. Prioritisation criteria are used to rank proposals recommended for funding by the Technical Review Panel (TRP) when there is not enough money to immediately pay for all of those proposals. The way it works is that the top-ranked proposals are funded first, and the other recommended proposals are funded as more funds become available (in descending order of ranking). The criteria have been invoked in several previous rounds, resulting in delays in the funding of some approved proposals. The delays were up to several months in some instances, but all approved proposals were eventually funded. The new prioritisation criteria consist of a composite index, where scores are allocated for (a) technical merit, (b) disease burden and (c) poverty level. Proposals can earn up to four points in each category, meaning that the maximum score is 12. See Table 1 for details.

Table 1: Description of the composite index

It is important to note that recommended proposals are ranked according to the prioritisation criteria by the Global Fund Secretariat only after (a) the TRP has completed its work, and (b) it is apparent that there is not enough money to immediately fund all recommended proposals. In its deliberations. the TRP looks only at the technical merit of the proposals. The TRP has been specifically instructed not to consider whether the Global Fund will have sufficient funds to pay for a proposal; therefore, the TRP does not ever consider the prioritisation criteria. This means that a country with a high disease burden and a high poverty level is not more likely than others to have its proposal approved. What the rules say is that if the TRP recommends for approval a proposal from Country X, and if Country X has a high disease burden and a high poverty level, and if there is not enough money immediately available to fund all proposals recommended by the TRP - then, the proposal from Country X may receive its funding earlier than proposals from countries with a lower disease burden or poverty level. Thus, all Round 10 proposals that were submitted to the Global Fund will be reviewed by the TRP providing that they met the Fund's eligibility criteria. (Eligibility criteria are different from the prioritisation criteria, even though they both cover some of the same elements.) So, how might the prioritisation criteria come into play in Round 10? Well, the ideal scenario would be that the criteria are not invoked at all because there is sufficient money to pay for all recommended proposals. But if the criteria do have to be invoked, the following hypothetical example, using a small number of proposals (12) to keep it simple, explains how it could work. The proposals in Table 2 are listed in descending order of ranking as per the prioritisation criteria. For this example, we assume that there is only enough money to immediately fund eight of the 12 proposals. The proposals are labelled A through J, in descending order of ranking.

Table 2: Hypothetical example of how the prioritisation criteria might be applied

Under this scenario, the top eight proposals, the ones that are shaded in the table, would be funded immediately. The other four proposals would be funded as more money became available, starting with I and J, and then K, and then L (assuming that sufficient new money comes in). As this scenario shows, it is possible that some proposals scoring 4 in technical merit will be funded later than some proposals scoring only 3 in technical merit. What all this means is that if there is not enough money to immediately fund all proposals recommended by the TRP, the Global Fund Board will immediately approve some of the TRP-recommended proposals, and will approve "in principle" other TRP-recommended proposals, pending funding availability. But what happens if not enough new money comes in to fund those recommended proposals that are approved in principle and not funded immediately? When it launched Round 10, the Global Fund Board said that the amount of money allocated to Round 10 could not exceed the amount of money that donors give to the Fund for use by the end of 2011 (after setting aside money to pay for Phase 2 of grants approved in previous rounds). So, if, by the end of 2011, the Global Fund has not received enough money for use in 2011, then some recommended proposals might not be funded. However, the Board could adopt alternative measures, such as imposing a budget cut on all approved proposals.