Center for Global Development, Washington, DC, USA.
Center for Global Development, Washington, DC, USA.
Lancet Glob Health. 2013 Sep;1(3):e161-8. doi: 10.1016/S2214-109X(13)70017-2. Epub 2013 Aug 23.
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.
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.
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.
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.
Bill & Melinda Gates Foundation.
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。
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。
第一阶段的赠款绩效评级与第二阶段有任何支出呈正相关，但第一阶段的评级与第二阶段的支出金额之间没有关联。此外，由于在生成绩效衡量标准时做出了主观和自由裁量的决定，并且基础数据不可用，因此绩效评级无法由外部观察员复制。
全球基金目前的基于绩效的供资系统不能充分将绩效激励传达给接受者，该组织应重新设计该系统，明确将部分资金与独立和稳健衡量的健康覆盖或成果方面的简单绩效衡量标准联系起来。
比尔及梅琳达·盖茨基金会。
