The Global Fund is committed to reporting results and impact, and we make data available on the Global Fund website, in reports, information papers and numerous other formats. Everyone in the Global Fund partnership contributes to our collective efforts against HIV, TB and malaria, and it is critically important that we measure and report our joint progress as effectively as possible.
The Global Fund uses the official disease burden and impact estimates developed and published by our technical partners, including WHO, UNAIDS, Stop TB and the RBM Partnership to End Malaria, as the basis for measuring results and impact. We do not create our own disease burden and impact estimates. Technical partners generate disease burden and impact estimates in consultation with countries using state-of-the-art models and widely accepted data sources, such as routine surveillance, population-based surveys and vital registration systems.
The Global Fund’s results are calculated using the data for HIV, TB and malaria in countries where we invest in a given year. This means our results are different from the global figures presented in the WHO and UNAIDS reports, which include all data from all countries worldwide.
The “lives saved” figure in the Global Fund’s results is calculated in conjunction with technical partners using the most advanced modeling methods currently available, yielding sophisticated estimates, not scientifically exact figures. The number of lives saved in a given country in a particular year is estimated by subtracting the actual number of deaths from the number of deaths that would have occurred in a scenario where key disease interventions did not take place. For example, in a country where studies show that 70 percent of smear-positive TB patients will die in the absence of treatment, if 1,000 smear-positive TB patients were treated in a particular year, yet only 100 people were recorded as dying from TB, the model can conclude that 600 lives were saved. Without treatment, 700 would have died.
The Global Fund reports full national results for the countries where we invest, rather than reporting solely on the specific projects or interventions we fund. This reflects a core principle of the Global Fund: that we support national health programs and strategies to achieve national goals. By reporting full national results, we can show the impact of the programs we support together with all partners, and demonstrate where countries are on the trajectory toward achieving 2030 targets to end the epidemics.
The rationale for reporting national results is that the ultimate test of whether the Global Fund partnership is working is whether countries are on track to achieving the SDG 3 target of ending the epidemics by 2030. By taking this approach, we avoid the danger of celebrating the achievements of the specific projects or interventions the Global Fund supports in circumstances where the country as a whole is making insufficient progress, or even sliding backwards. Furthermore, reporting national results avoids any misleading efforts to attribute shares of results to different actors. Most of the programs and interventions we support involve a mix of domestic resourcing and Global Fund investments, and many involve other external donors. Attributing results to different partners in a common program inevitably involves arbitrary assumptions and ignores the inherently interconnected nature of public health interventions. For example, consider a national HIV treatment program where the Global Fund procures the antiretrovirals and community outreach, PEPFAR funds clinical delivery and laboratory testing, and the domestic government supports the supply chain and underlying infrastructure. What matters are the results delivered by the program as whole, not some assumption-driven allocation of these results across the partners. In fact, where domestic governments, bilateral partners, technical partners and the Global Fund all contribute to a program, they can and should cite the same results.
By focusing on national results, we stay focused on the big picture, and ensure the Global Fund’s interventions are designed to maximize our contribution to the achievement of each country’s overall goals for the three diseases.
While we focus our results reporting on national results, we also monitor and report on the performance of specific programs and interventions funded by Global Fund grants to ensure we are delivering value for money. The Global Fund’s strategic performance framework [ download in English ] encompasses the reporting of specific key performance indicators (KPIs) to our Board on a range of metrics covering areas directly attributable to the performance of Global Fund investments, such as the performance of individual programs against agreed grant milestones and targets, the alignment of funding with national programs, absorption rates, fulfillment of co-financing requirements, performance of principal recipients, effectiveness of reprogramming, supply chain metrics, and procurement savings. The Global Fund also provides more country-specific financial and programmatic information to complement our regular reporting on national results and overall KPIs, so stakeholders can see how Global Fund investments work alongside the investments of governments and other partners in high impact countries. These Country Results Profiles for high impact countries are available on the relevant country pages on the Global Fund’s Grant Portfolio.
This approach to reporting the results and impact of the Global Fund partnership has been developed by the partnership itself, and continues to be refined by the Board, technical partners, and other stakeholders.
As part of the process of developing the Global Fund Strategy 2017-2022 [ download in English | Français ] , there were extensive consultations across the partnership in 2015-2016 about how to best report results and measure impact of Global Fund investments in national programs. The consensus was that full national results are the best way of assessing progress against the targets set out in the Global Fund Strategy 2017-2022 and towards the ultimate goal of ending the epidemics by 2030, and should therefore be the starting point for any assessment of the Global Fund’s performance. Our objective is to ensure the success of the country-led national programs that we are supporting alongside other bilateral and multilateral funders and to complement countries’ own domestic contributions.
In addition, a separate round of consultations took place in 2014, in response to a request by the Board, to address the methodological and policy issues around estimating lives saved. It included leading experts, technical partners and other relevant organizations, including PEPFAR, WHO, UNAIDS, the RBM Partnership to End Malaria, the Stop TB Partnership. The expert group agreed a set of recommendations to enhance the Global Fund’s approach to calculating lives saved, and published a detailed July 2014 meeting report, Expert Panel on Health Impact of Global Fund Investments Geneva [ download in English ] . The Global Fund’s current approach to reporting results and impact and setting targets reflects the implementation of these recommendations, as seen in the service delivery and impact targets in the 2017-2022 strategy.
Furthermore, the Strategic Review 2015 [ download in English ] commissioned by the independent Technical Evaluation and Reference Group (TERG) and then reviewed and endorsed by the Global Fund Board’s Strategy Committee concluded the model used by the Global Fund to assess impact was adjudged to be satisfactory.
To provide ongoing support and guidance, the Global Fund has also established a modelling guidance group consisting of technical partners, including WHO and UNAIDS, and modelling experts from leading academic institutions as well as other partners. This expert group provide continuous advice and technical support on the detailed methodological issues around measuring the impact and efficiency of Global Fund-supported programs, and in addressing the limitations of current approaches.
The Global Fund is committed to being transparent about the data that we use, the methodologies we adopt, the results we report, and the impact that we achieve. We are also eager to explain the reasoning behind the approaches we take, and any limitations we identify. Indeed, the 2016 Aid Transparency Index recognized the Global Fund’s rigorous systems and commitment to transparency, rating the Global Fund in the top five of all international aid organizations. Released by the non-profit Publish What You Fund, the AID Transparency index ranked the Global Fund at the top overall in three of the operational categories – performance, related documents, and basic information.
As discussed above, our disease burden and impact estimates are derived from our technical partners, the approaches taken towards lives saved are based on ongoing guidance with experts, and the choices about which results to focus on have been determined through extensive consultation with the Board and the broader partnership.
To complement reporting on full national results, the Global Fund provides more granular country profiles for high-impact countries – those with the greatest disease burden. These are available on the Grant Portfolio.
The Global Fund also makes available information on the progress of individual grants in open data format, accessible via the Global Fund’s Data Service. Data from our portfolio are available through our application programming interface (API), where data sets and reports are available for download. The API is available on the Data Service.
The Global Fund makes significant investments in strengthening data systems and processes in countries to improve data availability and quality. Approximately 4 percent of the Global Fund’s total investment over the 2018-2020 cycle is expected to be devoted to strengthening data systems and measurement. Moreover, the Global Fund has been supporting national health programs in 30 countries in applying disease transmission models and costing tools to inform the development of national strategic plans and funding requests, and thus to improving allocation of resources and maximize impact. The Global Fund has been also supporting technical partners in institutionalizing assessment of impact as part of the national programs. For example, assessment of impact has now been incorporated into UNAIDS’ capacity building workshops for disease burden estimation.
The first set of estimate of lives saved was published in 2010 in collaboration with WHO and UNAIDS in an article entitled Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007, by R. Komatsu et al., (BMC Inf Dis, 2010. 10: p. 109.)
Additional analyses have also examined many issues involved, including Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund's Approach, by D. McCoy et al., (PLoS Med, 2013. 10(10): p. e1001522) as well as Saving Lives in Health: Global Estimates and Country Measurement, by D. Low-Beer, R. Komatsu, O. Kunii et al, (PLoS Med 10(10): e1001523.)