Strengthening alignment of global programs focused on tuberculosis control: Congruence of proposals to the Global Fund with the Stop TB Strategy

Since 2002 the Global Fund to Fight AIDS, Tuberculosis and Malaria has received five rounds of proposals. With the Millennium Development Goal target of reducing TB prevalence and deaths to 50% of 1990 levels by the year 2015, the World Health Organization (WHO) published The Stop TB Strategy in 2006. The Strategy articulates 6 components and 18 subcomponents for National Tuberculosis Programs (NTPs). Recognizing the need for alignment between the Global Fund and the Stop TB Strategy, an evaluation of proposals to the Global Fund as they relate to the subcomponents of the Strategy was conducted by the WHO Tuberculosis and Health Systems Team of the Stop TB Department.

Narratives of 24 proposals from 20 High Burden Countries (HBC) over the five rounds of proposals were evaluated for their level of congruence to each of the 18 subcomponents of the Strategy. Additionally, five budgets and work plans from four HBC Round-5 proposals were analyzed for budgetary associations to 17 Strategy subcomponents.

Narratives of proposals had high degrees of congruence with subcomponents of the Strategy: 74-83% for Rounds-1 and -2, and 88-89% for Rounds-3, -4, -5. Round-5 work plans and budgets, however, revealed that vital subcomponents that were included in the narrative had no proposed funding. Of the 85 possible associations among five budget proposals across 17 Strategy subcomponents, 37 had no monetary allocations. Three subcomponents (International Standards for Tuberculosis Care; Patient's Charter for Tuberculosis Care; and Research to Develop New Diagnostics, Drugs and Vaccines) had no monetary allocations in any of the Round-5 proposals, two only had one proposal allocating funds, and five subcomponents were allotted monies by only two or three of the five proposals.

These data suggest that while proposal narratives may be congruent with subcomponents of strategies, financial mechanisms associated with particular subcomponents are missing. Adoption of WHOxs Stop TB Department's new "Planning and Budgeting Tool" will assist NTPs in identifying financial needs when developing comprehensive proposals. Evaluation mechanisms described here for TB can be replicated for other disease control priorities to strengthen alignment among programs focusing on specific diseases.