Objective: To explore grant and country characteristics associated with the performance of tuberculosis (TB) grants supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), which uses performance-based funding of grants.
Methods: We used Global Fund grant data to compute the average programmatic performance of 108 TB grants in 88 countries. Using stepwise regression models, we examined the correlation of grant performance with a range of grant and country characteristics.
Results: Funding duration and funding per estimated smear-positive TB case were positively correlated with grant performance (partial correlations of 0.386-0.416 for the former, 0.200 for the latter). Successful completion of an evaluation of a grant during the second year of funding was linked to higher performance (0.357). Performance was further influenced by the independent organisation hired by the Global Fund to provide ongoing monitoring of the grants (0.197-0.243). Two country-specific factors were significantly correlated with performance: political stability (0.197-0.234) and disease burden (-0.211).
Discussion: Successful evaluation that leads to continued funding predicts higher performance of TB grants, even in challenging settings such as weak health services. However, other contextual factors affect grant performance and should be considered when assessing grants to ensure that countries that have a high disease burden and are politically unstable are not penalized.