1. Factors influencing success rates of tuberculosis proposals for The Global Fund Dr Mohamed Aziz Dr Lindi van Niekerk

3. Despite internationally agreed strategy, expertise available and clear targets still high percentage of proposals are not approved Why??

4. Hypotheses : 1. Unapproved proposals are mainly from non-priority countries (not among 22 high burden TB & 27 high MDR countries 2. Less assistance was given to these countries by technical organizations such as WHO 3. Weak components of proposal might be: TB/HIV, MDR, laboratory strengthening Objectives: 1.Identify epidemiological & geographical characteristics of countries that failed. 2.Identify reasons for failure 3.Identify most common weak TB control components 4.Develop key messages for countries such that outcome of proposal can improve

5. Methods Retrospective case-control analysis of TB Proposals from Round 5 – 8. 2 Groups: Approved vs Non-approved proposals Data on : 1.epidemiological situation, 2.data evaluating the approach, feasibility and sustainability of proposals, 3. data on financial aspects 4.technical assistance received. Data entry and analysis done using SPSS Statistical Analysis software Statistical methods used: Bivariate Chi square analysis, Pearson Correlation & Logistic regression

6. Materials 1.Data from The Global Fund –Country Proposal Unit: TRP reports –Data from Performance, Impact & Effectiveness unit –Full proposals 2.Data from WHO: Technical Assistance

7. Main results 193 tuberculosis proposals reviewed : Round 5 -8 100 proposals approved. ( 54.1%) 25 (40%) 73 24 37 16 18 (72.2%)

8. Country income status ApprovedUnapprovedTOTAL Low Income 66 (54.1%)56 (45.9%)122 Low Middle Income 33 (50%) 66 Upper Middle Income 1 (20%)4 (80%)5 TOTAL193

9. 22 High TB burden Countries Funds requested for 5 year period was $2’432’777’249 (=48.7% of total funding requests) 27 High MDR Countries ApprovedUnapproved TOTAL 22 High Burden 26 ( 52%) 24 ( 48%) 50 Non High Burden 74 (51.7%) 69 (48.3%) 143 100 93 193 ApprovedUnapprovedTOTAL 27 High MDR 36 ( 60%) 24 ( 40%) 60 Non High Burden64 (48.1%) 69 ( 51.9%)133 10093193

10. Comments made by Technical review panel Variables identified and analyzed according to 6 major categories 1.Situation Analysis 2.HIV component 3.MDR component 4.Proposal approach 5.Financial aspects 6.Monitoring and Evaluation

11. Findings of TRP comments Situation Analysis VariableP-value 1.No current Epidemiological Data 2.Inadequate situation analysis 3.Inadequate gap analysis 4.Lessons from previous rounds not applied to current proposal p <0.001 HIV Component Variable P-value 1. Unclear HIV planp < 0.002

12. MDR Component Variable p- value 1. Unclear MDR Plan 2. Lack /inadequate laboratory strengthening p < 0.136 p < 0.001 Proposal Approach Variable p- value 1.Inappropriate approach 2.Lack of National TB Plan strengthening 3.Unclear/ Undetailed strategy 4.Unclear work plan 5.Unrealistic/ unsustainable proposal 6.Lack/ inadequate drug procurement p < 0.001 p < 0.006 p < 0.001 p < 0.006

13. Financial aspects Variable p value 1.Current funding request not linked to previous grants 2.Unclear budget objectives 3.Undetailed cost categories 4.Inadequate financial gap analysis 5.Lack of experience of Principle Recipient p < 0.001 p < 0.001 Monitoring & Evaluation Variable p value 1. Inadequate impact measuring tools 2. Lack of ongoing M & E p < 0.001

14. Technical Assistance provided by WHO p = 0.002 thus technical assistance during proposal preparation played a significant role in proposal approval. ApprovedUnapprovedTotal TA received 95 (56.2%) 74 ( 43.8%) 169 No TA received 5 ( 21.7%) 18 ( 78.3%) 23 192

15. 1. Pearson Correlation: Total (n)Pearson co- efficient significance Financial Aspects1560.6910.001 Proposal Approach1750.6510.001 Situation Analysis1340.6400.001 2. Logistic regression: The regression models had high r-squares (above 0.4). Strongest factors determining proposal outcome

16. In summary 1.Disease burden, income status and country location does not influence proposal approval. 2.19 significant factors determining proposal outcome : major 3 - financial aspects - proposal approach - situation analysis 3. Technical assistance played a major role in determining the success of proposal approval.

17. Conclusion 1.Improve quality of proposals to increase the approval rate by Global Fund TRP. 2.More ambitious proposals such that tuberculosis will be better funded. (>14%) 3.Countries are urged to pay more attention to the, financial aspects,proposal approach & situation/gap analysis during proposal development 4.The Global Fund should improve on proposal guidelines and fact sheets available to countries prior to Round 10.

18. 5. Technical assistance by partner organisations should continue and the quality should be improved during proposal development and implementation of grants. Assistance should be extended to all countries applying to The Global Fund. 6. Similar analysis needs to be performed for the other diseases: HIV & Malaria

19. Acknowledgment Prof Rifat Atun Mary Ann Lansang Itamar Katz Moritz Schwarz Ombeni Mwerinde Estafianos Shargie Andrea Godfrey ( WHO)