Global Health Group, University of California, San Francisco, USA.
Malar J. 2012 Oct 11;11:344. doi: 10.1186/1475-2875-11-344.
Tremendous progress has been made in the last ten years in reducing morbidity and mortality caused by malaria, in part because of increases in global funding for malaria control and elimination. Today, many countries are striving for malaria elimination. However, a major challenge is the neglect of cross-border and regional initiatives in malaria control and elimination. This paper seeks to better understand Global Fund support for multi-country initiatives.
Documents and proposals were extracted and reviewed from two main sources, the Global Fund website and Aidspan.org. Documents and reports from the Global Fund Technical Review Panel, Board, and Secretariat documents such as guidelines and proposal templates were reviewed to establish the type of policies enacted and guidance provided from the Global Fund on multi-country initiatives and applications. From reviewing this information, the researchers created 29 variables according to eight dimensions to use in a review of Round 10 applications. All Round 10 multi-country applications (for HIV, malaria and tuberculosis) and all malaria multi-country applications (6) from Rounds 1 - 10 were extracted from the Global Fund website. A blind review was conducted of Round 10 applications using the 29 variables as a framework, followed by a review of four of the six successful malaria multi-country grant applications from Rounds 1 - 10.
During Rounds 3 - 10 of the Global Fund, only 5.8% of grants submitted were for multi-country initiatives. Out of 83 multi-country proposals submitted, 25.3% were approved by the Technical Review Panel (TRP) for funding, compared to 44.9% of single-country applications. The majority of approved multi-country applications were for HIV (76.2%), followed by malaria (19.0%), then tuberculosis (4.8%). TRP recommendations resulted in improvements to application forms, although guidance was generally vague. The in-depth review of Round 10 multi-country proposals showed that applicants described their projects in one of two ways: a regional 'network approach' by which benefits are derived from economies of scale or from enhanced opportunities for mutual support and learning or the development of common policies and approaches; or a 'cross-border' approach for enabling activities to be more effectively delivered towards border-crossing populations or vectors. In Round 10, only those with a 'network approach' were recommended for funding. The Global Fund has only ever approved six malaria multi-country applications. Four approved applications stated strong arguments for a multi-country initiative, combining both 'cross-border' and 'network' approaches.
With the cancellation of Round 11 and the proposal that the Global Fund adopt a more targeted and strategic approach to funding, the time is opportune for the Global Fund to develop a clear consensus about the key factors and criteria for funding malaria specific multi-country initiatives. This study found that currently there was a lack of guidance on the key features that a successful multi-country proposal needs to be approved and that applications directed towards the 'network' approach were most successful in Round 10. This type of multi-country proposal may favour other diseases such as HIV, whereas the need for malaria control and elimination is different, focusing on cross-border coordination and delivery of interventions to specific groups. The Global Fund should seek to address these issues and give better guidance to countries and regions and investigate disease-specific calls for multi-country and regional applications.
在过去十年中，由于全球疟疾控制和消除资金的增加，疟疾导致的发病率和死亡率大幅下降。如今，许多国家都在努力消除疟疾。然而，一个主要的挑战是忽视了疟疾控制和消除的跨境和区域举措。本文旨在更好地了解全球基金对多国倡议的支持。
从全球基金网站和 Aidspan.org 两个主要来源提取和审查文件和提案。审查了全球基金技术审查小组、理事会的文件和报告，以及秘书处的文件，如准则和提案模板，以确定全球基金在多国倡议和应用方面颁布的政策类型和提供的指导。通过审查这些信息，研究人员根据八个维度创建了 29 个变量，用于审查第 10 轮申请。从全球基金网站上提取了第 10 轮所有多国申请（艾滋病毒、疟疾和结核病）和第 1-10 轮所有疟疾多国申请（6 个）。使用 29 个变量作为框架对第 10 轮申请进行了盲审，然后对第 1-10 轮 6 个成功的疟疾多国赠款申请中的 4 个进行了审查。
在全球基金第 3-10 轮期间，提交的赠款中只有 5.8%用于多国倡议。在提交的 83 份多国提案中，技术审查小组（TRP）批准了 25.3%用于供资，而单一国家申请的批准比例为 44.9%。获得批准的大多数多国申请是艾滋病毒（76.2%），其次是疟疾（19.0%），然后是结核病（4.8%）。TRP 的建议导致申请表得到改进，尽管指导方针通常很模糊。对第 10 轮多国提案的深入审查表明，申请人以两种方式之一描述其项目：一种是区域“网络方法”，通过这种方法可以从规模经济或相互支持和学习的机会增加中受益，或者发展共同的政策和方法；或者是一种“跨境”方法，以便更有效地向跨境人口或媒介提供活动。在第 10 轮中，只有采用“网络方法”的申请才被推荐供资。全球基金只批准了 6 个疟疾多国申请。四项已批准的申请为多国倡议提出了强有力的论据，结合了“跨境”和“网络”方法。
随着第 11 轮的取消和提议全球基金采用更有针对性和战略性的供资方法，现在正是全球基金就疟疾专项多国倡议的供资关键因素和标准达成明确共识的时候了。本研究发现，目前缺乏关于成功的多国提案需要获得批准的关键特征的指导，并且针对“网络”方法的申请在第 10 轮中最成功。这种类型的多国提案可能有利于艾滋病毒等其他疾病，而疟疾控制和消除的需求则不同，侧重于跨境协调和向特定群体提供干预措施。全球基金应设法解决这些问题，为各国和地区提供更好的指导，并研究针对特定疾病的多国和区域申请呼吁。
