The Fund's total programmatic spending over the five-year period 2005-09 is expected to be $140.6 million. Of that amount, it is anticipated that 62 percent, or $87.7 million, will be spent as grants, allocated across program areas as follows: 48 percent to promoting a high performance health system, 33 percent to addressing the health care needs of special populations, 13 percent to international health policy and practice, and 6 percent to communications and other continuing programs. The foundation expects to spend approximately 5 percent of its extramural program budget on surveys, which have proven to be useful in informing policy debates and developing programs. Reflecting the foundation's value-added approach to grantmaking, 38 percent of the total budget will be devoted to intramural units engaged in research, program development, and management, collaborations with grantees, and dissemination. This allocation includes $9.4 million to communicate the results of Fund-sponsored work and funds to operate programs directly managed by the foundation.

In all its work, the Fund seeks particularly to target issues that affect vulnerable populations. It also aims to achieve a balance between information-generating and action-oriented activities, and between public- and private-sector work. Other concrete objectives that help guide its grantmaking strategy include keeping its doors open to new talent, working in partnership with other funders, being receptive to new ideas, undertaking appropriate risks, and contributing to the resolution of health care problems in its home base, New York City, while pursuing a national and international agenda.

The Fund regularly reviews its major programs and activities to assess their effectiveness and reexamine their strategies. Every five years the Fund's Board of Directors conducts a special retreat to take stock of the foundation's work over an extended period, assess its institutional capacities, and lay out an agenda for the following five years. The April 2005 retreat assessed the Fund's work over the last five years from a variety of perspectives: the progress in each program made toward goals set out in 2000, with concrete examples of the Fund's impact; a report on the extent to which the Fund is realizing the ambitious communications objectives that are so closely linked to its grantmaking strategy; an assessment of the institutional capacities of the Fund that are the sine qua non for all its programmatic and communications activities; and a synthesis of lessons that have been learned from the Fund's grantmaking experience over an extended period of time.