基于绩效的融资在全球抗击艾滋病、结核病和疟疾基金：对赠款评级和资金的分析，2003-2012 年。

Performance-based financing at the Global Fund to Fight AIDS, Tuberculosis and Malaria: an analysis of grant ratings and funding, 2003-12.

机构信息

Center for Global Development, Washington, DC, USA.

出版信息

Lancet Glob Health. 2013 Sep;1(3):e161-8. doi: 10.1016/S2214-109X(13)70017-2. Epub 2013 Aug 23.

DOI:10.1016/S2214-109X(13)70017-2

PMID:25104264

Abstract

BACKGROUND

Performance-based financing can be used by global health funding agencies to improve programme performance and thus value for money. The Global Fund to Fight AIDS, Tuberculosis and Malaria was one of the first global-health funders to deploy a performance-based financing system. However, its complex, multistep system for calculating and paying on grant ratings has several components that are subjective and discretionary. We aimed to test the association between grant ratings and disbursements, an indication of the extent to which incentives for performance are transmitted to grant recipients.

METHODS

We obtained publicly available data for 508 Global Fund grants from 2003 to 2012 with performance ratings and corresponding disbursements, merged with other datasets that contained data for relevant country characteristics. We used regression analysis to identify predictors of grant disbursements in phase 2 (typically the latter 3 of 5 years of a grant), using two dependent variables: whether a grant had any phase-2 disbursements, and the phase-2 disbursement amount. In a separate analysis, we also investigated the predictors of grant performance ratings.

FINDINGS

Grant performance rating in phase 1 was positively associated with having any disbursements in phase 2, but no association was seen between phase-1 ratings and phase-2 disbursement amounts. Furthermore, performance ratings are not replicable by external observers, both because subjective and discretionary decisions are made in the generation of performance measures and because the underlying data are not available.

INTERPRETATION

The Global Fund's present performance-based funding system does not adequately convey incentives for performance to recipients, and the organisation should redesign this system to explicitly link a portion of the funds to a simple performance measure in health coverage or outcomes, measured independently and robustly.

FUNDING

Bill & Melinda Gates Foundation.

摘要

背景

绩效融资可以被全球卫生资助机构用来提高项目绩效，从而提高资金的使用效益。全球抗击艾滋病、结核病和疟疾基金是最早采用绩效融资系统的全球卫生资助机构之一。然而，其计算和支付赠款评级的复杂、多步骤系统有几个主观和自由裁量的组成部分。我们旨在测试赠款评级与支出之间的关联，这是激励绩效传递给赠款接受者的程度的一个指标。

方法

我们获得了 2003 年至 2012 年期间 508 份具有绩效评级和相应支出的全球基金赠款的公开可用数据，这些数据与包含相关国家特征数据的其他数据集合并。我们使用回归分析来确定第二阶段（通常是赠款的后 3 年）的赠款支出的预测因素，使用两个因变量：赠款是否有任何第二阶段支出，以及第二阶段支出金额。在单独的分析中，我们还调查了赠款绩效评级的预测因素。