By request of the Bureau for Global Health (GH), Integra documented and analyzed the cross-bureau budget process and provided recommendations aimed at improving transparency, evaluation, accounting control, and performance of that process. The assessment involved analyses of funding and spending within the cross-bureau budget. Data sources included bureau- and office-level fiscal data and reports; program descriptions; staffing data; interviews; observations; and anecdotes, among others. The team completed a comprehensive desk review of documents provided by GH leadership and interviews with approximately 70 key staff at the decision-making and operational levels in GH and regional Bureaus. The team found that as congressional appropriations to GH are highly directed to specific health interventions (or program areas), the Bureau created an internal system to “tax” the program area directives to generate funds for administrative support costs and for cross-cutting health activities (“global common goods”). This system is somewhat contentious within GH and not entirely transparent. The team recommended steps to both increase the supply of funds for the cross-bureau budget (CBB) and 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. Different components of the CBB are treated differently; there are no clear priorities for determining CBB investments; and not all aspects of the CBB formulation and review process are transparent.