Five-Year Evaluation of The Global Fund Prof. Rose Leke, Vice-Chair of the Technical Evaluation Reference Group The Global Ministerial Forum on Research for Health Bamako, Mali

2 Origins of the Five-Year Evaluation The Five-Year Evaluation is a major effort to review the functioning and performance of the Global Fund as an institution, a partnership, and its contribution to disease impact, and identify areas of strength and weakness that will lead to improved operations The Global Fund's 2003 Board-approved M&E Strategy called for: …a first major evaluation of the Global Funds overall performance against its goals and principles after at least one full grant funding cycle has been completed (five years)

3 Five-Year Evaluation Study Areas Overarching Question Study Focus and Methodology Institutional Arrangements Grant PerformanceImpact Measurement Organizational Efficiency Partnership System Disease Impact Architecture Business model Governance Resources TA Partner systems National ownership Effects on systems (pos. and neg.) Coverage Reduction of infections, illness & deaths 1 2 3

4 Global representation with focus in 25 countries Study Area 2 Study Area 3 Study Areas 2 + 3

5 Highlights from Study Area 1 Findings The Evaluation finds: An organization that has made rapid and inspiring achievements and has learned and adapted rapidly Critical challenges that the Global Fund needs to meet new responsibilities for its next stage of growth Governance and management systems and processes now in place will not meet the needs of an expanded Global Fund Key recommendations made in the areas of: - Strategy - Partnership - Governance - Organizational Structure - Processes and Grant Management - Mission-critical systems

6 Exceptionally rapid start-up New model for global public- private partnerships Significant levels of funding Inclusion of new constituencies Country led and demand- driven Without a field structure High standards of transparency Performance-based funding Contribution to strengthening health systems After six years the Global Fund has made notable and significant contributions towards its original aims, specifically : But: Several areas identified where the paradigm shift of development assistance is still on going for all partners, and where improvements are required in the establishment of effective partnerships Highlights from Study Area 2 Findings

7 Study Area 3: Health Impact Evaluation Goal: To comprehensively assess the collective impact that the Global Fund and other national and international partners have achieved on reducing the disease burden of HIV, TB and malaria and beyond Methodology: Studies in 10 countries based on secondary analysis of existing data: Benin, Burundi, DRC, Ghana, Kyrgyzstan, Lesotho, Moldova, Mozambique, Rwanda, Vietnam In-depth studies in 8 countries designed to fill data and information gaps through primary data collection, to include significant capacity building: Burkina-Faso, Cambodia, Ethiopia, Haiti, Malawi, Peru, Tanzania, Zambia

8 Impact Evaluation Framework Has funding increased? Amount? Sources? Have access and quality of services improved? Has coverage improved and risk behaviour changed? Have health outcomes improved? Outputs Health Services Delivery Quality Behavioural Interventions & knowledge Outcomes Intervention coverage Behavioural change Outcomes Intervention coverage Behavioural change Impact Morbidity Disease consequences Mortality Impact Morbidity Disease consequences Mortality Process Training & Capacity Building Supplies Guidelines IEC Community mobilization Process Training & Capacity Building Supplies Guidelines IEC Community mobilization Reduced inequity Inputs Funding Global Fund Other int'l Resources Domestic resources Inputs Funding Global Fund Other int'l Resources Domestic resources Contextual factors

9 Development Approach to Health Impact Evaluation Country ownership and alignment through the creation of 17 country-level task forces Capacity strengthening of 47 local institutions & consultants responsible for conducting the evaluation at country level Harmonization through sharing an early draft report with partners for comments; and provision of $3.5 M from PEPFAR for additional capacity building and dissemination 75% of budget spent on activities with direct benefit in- country: provision of tools, financing of local costs, TA, support for report writing

10 Roles and responsibilities The health impact evaluation is a country–driven evaluation The process is coordinated by an impact evaluation task force (IETF) in each country The impact evaluation work plan is built by the country The work is carried-out by local persons/institutions The contractor responsibilities Define the evaluation framework (workplan template and methodology) Provide technical assistance Channel the budgets (contract in-country partners) Organize pooled analysis and modeling activities to generalize findings Produce the final cross-country report The role of the Technical Evaluation Reference Group (TERG) Overseeing the study to ensure its quality and independence

11 Data uses Build upon existing data collection and analysis efforts in countries Utilize information from a wide variety of data sources and fill data gaps where possible Use common methods and instruments across countries Strengthen country capacity and improve foundation for long term M&E Sources of data National record reviews Secondary analysis: household surveys Comprehensive district assessments National Health Accounts

12 Status and Next steps Study Area 1: Organizational efficiency and effectiveness of the Global Fund Final Report available on GF website since November 2007 Study Area 2: Global Fund partnership environment and grant performance Final Report available on GF website since November 2008 Study Area 3: Impact of collective efforts on reduction in disease burden Final Report to be presented to the GF Board in May 2009 Synthesis Report: Synthesizing findings from all three study areas Final Report to be presented to the GF Board in May 2009 Dissemination workshops in countries from March 2009

13 Thank you… TERG MEMBERS EX-OFFICIO MEMBERS Rolf KORTE - ChairJaap BROEKMANS Rose LEKE - Vice ChairPaul DE LAY Atsuko AOYAMABernard NAHLEN David BARRPaulo TEIXEIRA Stefano BERTOZZI Lola DARE Bashirul HAQ Loretta PESCHI

Annex

15 Evaluation Framework

* : Supplementary data collection ClusterCountryHealth Impact Evaluation (SA3)Partnerships (SA2) Eastern Europe & Central AsiaKyrgyzstan Moldova Latin America & CaribbeanHaiti* Honduras Peru* North Africa & Middle EastYemen East Asia & PacificCambodia* Vietnam South AsiaIndia (1) Nepal Sub-Saharan Africa: West & CentralBenin Burkina Faso* DRC Ghana Nigeria Sub-Saharan Africa: EastBurundi Ethiopia* Kenya Rwanda Tanzania* Uganda Sub-Saharan Africa: SouthernMalawi* Mozambique South Africa Zambia* TOTAL (1) India and South Africa did not participated in the Health Impact Evaluation as planed; Lesotho replaced South Africa