Global Health: Cross-Bureau Budget Analysis

Overview of the Project

The Bureau for Global Health’s (GH’s) cross-bureau budget (CBB) allocates funds to activities that support both Bureau and the Agency goals. The results of these activities cannot be directly attributed to specific health program areas such as HIV/AIDS, tuberculosis, malaria, health security, maternal and child health, family planning and reproductive health, or nutrition. Instead, the CBB is divided into four major components: Mechanisms, Staff, Office Allocations, and Operations.

Integra was asked to provide an assessment of the cross-bureau budget for the Bureau. The assessment focused on the components of the cross-bureau budget, including central mechanisms, staffing, office allocations, and operational costs, and provided recommendations to GH on improving processes for determining the allocation of funding for current and future activities.


In light of recent funding constraints, including a reduction in the contributions to the CBB under the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI), the primary objectives of the assessment were to: (1) review how the CBB is currently formulated and executed; (2) document what is included in the CBB; and (3) provide recommendations.


Our team performed mixed methods analyses using available data while taking into account the needs and objectives provided by GH. The data sources used included bureau- and office-level fiscal data and reports; program descriptions; staffing data; interviews, observations, and anecdotes. A combination of rapid appraisal methods, face-to-face interviews with key informants, and focus group discussions were used to conduct the work.


This assessment reviewed both the formulation and execution of GH’s CBB. Recommendations were made to improve the process ensuring that the Bureau remains responsive and optimally contributes to current and emerging Administration, Agency, and GH priorities. Two competing realities were apparent including: (1) the shrinking pool of funds for the CBB; and (2) the dramatically increased demand for programs that support the Agency’s Journey to Self-Reliance (J2SR) policy, many of which are funded through the CBB.

Integra’s assessment team recommended steps both to increase the supply of funds for the CBB and to reduce demand, while also improving transparency and accountability. The team also found issues with how decisions are made on what to include in the CBB.

CBB Formulation Recommendations

  • Review the Budget’s International Partnership line items to determine if fewer deductions can be made, thus increasing the “adjusted” base used for CBB taxation purposes and enabling adjustments to current allocation rates (all “pass throughs” to other organizations would continue to be deducted);
  • Increase surcharges on all mechanisms to cover central costs;
  • Encourage direct and partial funding of administrative positions by program area offices;
  • Formulate a Bureau-wide strategy that creates a unifying framework for GH (beyond its current three health goals), and defines specific criteria to evaluate proposals for CBB funding;
  • Institute a more rigorous CBB review process with broader participation;
  • Re-structure to clearly differentiate between administrative support and program costs.

CBB Execution Recommendations

  • Ensure that the CBB and cross-cutting activities are appropriately covered during annual portfolio reviews and that commitments to the CBB are made by program area offices; and
  • If internal “fixes” within GH cannot be developed, work with the Agency to determine if “fixes” can be made to the Phoenix accounting system to better handle the late allocation and bundling of CBB funds with non-CBB program area funds.
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