Technical Evaluation Reference Group

  • The Five-Year Evaluation

    January 2010

    Under the oversight of the TERG, the Five-Year Evaluation was a major effort to review the functioning and performance of the Global Fund as an institution and a partnership, and to identify areas of strength and weakness that would lead to improving day-to-day operations. The three overarching questions that guided the structure of the evaluation are outlined below. One of the most unique aspects of this evaluation was its attempt to measure impact – that is, to assess the reduction in the burden of HIV, TB and malaria associated with the collective scale-up of prevention and treatment activities by all partners.

    Study Area 1 of the Five-Year Evaluation was completed in November 2007 and examined the organizational efficiency and effectiveness of the Global Fund, its progress to date and critical areas for improvement. Study Area 2, which examined the Global Fund’s partner environment in 16 countries and at the global level was presented to the Board in November 2008. Study Area 3, the Health Impact Evaluation, involved the examination of the collective impact on the burden of AIDS, TB and malaria in 18 countries, and was the most extensive component of the Five-Year Evaluation. The Synthesis Report comprised the final deliverable of the Five-Year Evaluation and provided essential analytical linkages across all three study areas along with a synthesis of findings and recommendations. The final reports on Study Area 3 and the Synthesis Report were presented to the Global Fund Board in May 2009. Each element of the evaluation was designed to generate actionable findings and the Global Fund is committed to learn from and make concrete improvements based on these findings.

    The TERG initiated an objective and collaborative process for the selection of countries to be studied under the Five-Year Evaluation. A total of 16 countries was selected for inclusion in Study Area 2, which focused on the Global Fund partnership environment. A set of 20 countries was selected for study under Study Area 3 Impact Evaluation, with 8 countries engaging in an in-depth analysis including primary data collection and 12 countries where impact analysis was based on secondary data. Country representatives and technical partners met at the Partners in Impact Forum in March 2007 to present and discuss country impact evaluation plans.

    The following important background documents are available to download:

    • Evaluation Brief describing the Five-Year Evaluation
      download
    • Five-Year Evaluation Technical Background Document which guided the design and of the evaluation
      download
    • TERG Framework Document on the Scale & Scope of the Five-Year Evaluation as presented to the Global Fund Board at its 14th Board Meeting
      download
    • List of 25 countries participating in the Five-Year Evaluation
      download
    • Country Selection Process
      download
    • Summary Inception Report for Study Areas 1 & 2 – Global Fund Efficiency and Partnership Environment
      download
    • Inception Report for Study Area 3 – Health Impact
      download

    Key studies that have been completed include:

    Overarching Questions for Five-Year Evaluation

    Study Area 1: Organizational Efficiency

    Does the Global Fund as an organization (Board, Secretariat, TRP, LFAs) through both its policies and operations, reflect the core principles, including:

    1. Acting as a financial instrument rather than implementation agency; and
    2. Furthering country ownership?

    In fulfilling these principles, does the Global Fund as an organization perform in an efficient and effective manner?

    Study Area 2: Partnership Environment

    How effective and efficient is the Global Fund partnership system (1) in supporting HIV, malaria, and TB programs at the global and country level?

    Study Area 3: Health Impact

    What is the Global Fund’s contribution to reducing the burden of the three diseases? What has been the overall reduction on the burden of the three diseases?


    Study Area 1

    Global Fund Organizational Efficiency & Effectiveness

    Summary:

    The purpose of Study Area 1 of the Five-Year Evaluation is to review the Global Fund’s organizational efficiency and effectiveness, its progress to date, and to identify critical areas for improvement. The evaluation finds an organization that has made exceptional and inspiring achievements in a short time and has learned and adapted rapidly. In part due to its success, the evaluation finds critical challenges that the Global Fund needs to tackle in order to realize its full potential and to meet new responsibilities that will be part of its next stage of growth. The TERG Summary Report on Study Area 1 provides an overview of the evaluation, its methodology and findings, and recommendations from TERG to the Board and Secretariat based on the evaluation

    Background:

    The Five-Year Evaluation is an independent, Board-mandated evaluation being conducted under the oversight of theTechnical Evaluation Reference Group (TERG). The TERG presented the results of Study Area 1 to the Board at its 16th meeting in November 2007. The study of the Global Fund’s partner environment in 16 countries (Study Area 2) is ongoing and will be presented to the Board in April 2008. The examination of impact on the three diseases in 20 countries (Study Area 3) is more extensive and will require ongoing efforts at country level throughout the next year, with the final evaluation report synthesizing the findings and recommendations from all three study areas to be presented to the Global Fund Board at its meeting in November 2008.


    Study Area 2

    Results Global Fund Partner Environment at Global & Country Levels

    Summary:

    Study Area 2 of the Five-Year Evaluation describes the complex environment of partnerships at the global and country levels and some of the impact of these relationships on the successful implementation of Global Fund grants. The study found that six years into the implementation of its unique model, the Global Fund has made notable and significant contributions towards its original aims. While recognizing the overall achievements of the Global Fund during its first six years of operation, Study Area 2 highlighted a number of areas where improvements are required in the establishment of more effective partnerships.

    Background:

    The Five-Year Evaluation is an independent, Board-mandated evaluation being conducted under the oversight of the Technical Evaluation Reference Group (TERG). Study Area 1 of the Five-Year Evaluation was completed in November 2007 and examined the organizational efficiency and effectiveness of the Global Fund, its progress to date and critical areas for improvement. The study of the Global Fund’s partner environment in 16 countries and at the global level (Study Area 2) was presented to the Board in November 2008. The examination of impact on the three diseases in 18 countries (Study Area 3) is ongoing with data collection and analysis efforts at country level nearing completion. Both the Study Area 3 final report and the final Five-Year Evaluation Synthesis Report, which will synthesize the findings and recommendations from all three study areas, will be reviewed by the Global Fund Board at its meeting in May 2009.

    Five-Year Evaluation Study Area 2: Global Fund Partner Environment


    Study Area 3

    Results Health Impact of Scaling Up Against HIV, Tuberculosis and Malaria

    Summary:

    The Global Fund has made an explicit commitment to making an impact on the three diseases. The overall objective of Study Area 3 - the Health Impact Evaluation - is to comprehensively assess, in selected countries, the collective impact that the Global Fund and other international and national partners have achieved on reducing the disease burden of AIDS, TB and malaria. The study focuses on these national disease control programs in 18 countries and seeks to assess overall progress toward the Millennium Development Goals. The Health Impact Evaluation demonstrates that the rapid increase in funding from all partners has resulted in a major expansion in access to services in these countries and improved coverage of interventions. While the study reveals important improvements, it also highlights the urgent need to strengthen health systems to accelerate scale-up.

    Background:

    The Five-Year Evaluation is an independent, Board-mandated evaluation being conducted under the oversight of the Technical Evaluation Reference Group (TERG). Study Area 1 of the Five-Year Evaluation was completed in November 2007 and examined the organizational efficiency and effectiveness of the Global Fund, its progress to date and critical areas for improvement. The study of the Global Fund’s partner environment in 16 countries and at the global level (Study Area 2) was presented to the Board in November 2008. Study Area 3 is the most extensive component of the Five-Year Evaluation, and involved the examination of impact on the three diseases in 18 countries. Both the Study Area 3 report and the final Five-Year Evaluation Synthesis Report, which synthesizes the findings and recommendations from all three study areas, were presented to the Global Fund Board at its Nineteenth Board Meeting in May 2009.


    Five-Year Evaluation Synthesis Report

    Summary:

    The Synthesis Report comprises the final deliverable of the Five-Year Evaluation and provides essential analytical linkages across all three study areas, along with a synthesis of findings and recommendations.  Overall, the Synthesis Report finds that the Global Fund plays an important role in the global development architecture, and fully merits the continued support and collaboration of the diverse array of development actors involved in the fight against HIV/AIDS, TB, and malaria.  While the report recognizes the commendable successes of the Global Fund to date, it also presents findings and recommendations addressing problems and weaknesses which require serious consideration by the Global Fund and its partners.  The key messages from this report underscore the urgent need to focus on principles of mutual accountability in partnerships, to review and reinforce the performance-based funding system to secure its integrity, and to improve contributions to the fight against the three diseases through health systems strengthening. This final report of the Five-Year Evaluation provides a cohesive and well-integrated basis for a strategic and operational response from the Global Fund.

    Background:

    The Five-Year Evaluation is an independent, Board-mandated evaluation conducted under the oversight of the Technical Evaluation Reference Group (TERG). Study Area 1 of the Five-Year Evaluation was completed in November 2007 and examined the organizational efficiency and effectiveness of the Global Fund, its progress to date and critical areas for improvement. The study of the Global Fund’s partner environment in 16 countries and at the global level (Study Area 2) was presented to the Board in November 2008. Study Area 3 is the most extensive component of the Five-Year Evaluation, and involved the examination of impact on the three diseases in 18 countries. Both the Study Area 3 report and the final Five-Year Evaluation Synthesis Report, which synthesizes the findings and recommendations from all three study areas, were presented to the Global Fund Board at its Nineteenth Board Meeting in May 2009.


    360° Stakeholder Assessment

    Perceptions and opinions of stakeholders of the Global Fund

    The Global Fund places strong emphasis on the involvement of stakeholders from all sectors and all regions in the design, operation and assessment of its work. Accordingly, to prioritize issues for the Five-Year Evaluation, the Global Fund commissioned an independent assessment of stakeholder opinion on the Global Fund. The “360˚ Stakeholder Assessment” was implemented between March and July 2006 to solicit feedback on the organization’s reputation, performance, strengths and weaknesses, and to provide critical insight into diverse stakeholder perspectives. Its results have a formative role in shaping the focus and methodology of the Five-Year Evaluation.

    The assessment consisted of an online opinion survey. Responses were received from over 900 respondents across the world, representing all major stakeholder groups and regions. Overall, the results show that stakeholders generally hold high opinions of the Global Fund’s reputation and performance, and support the approach to the Five-Year Evaluation.