By: Steven Radelet and Bilal Siddiqi
The Lancet, May 26, 2007
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The Global Fund to Fight AIDS, Tuberculosis and Malaria has quickly become one of the world's largest funders of programs fighting the three diseases. Just five years after its founding, the Global Fund had approved proposals worth $6.8 billion for 448 programs in 136 countries, and disbursed over $3 billion. It now contributes two thirds of all donor resources globally to fight TB, half for malaria, and one quarter for HIV/AIDS.
This paper presents a rigorous statistical analysis of the evaluation scores of Global Fund grant programs. We examine the first 140 program grants evaluated by the Global Fund and conduct a multivariate analysis of the association between the evaluation score and various characteristics of the grant itself (e.g., financial size, disease target, type of recipient), the health sector (e.g., physicians per capita, donor concentration) and the country (e.g., income level, governance ratings). We estimate these relationships using an ordered multinomial probit methodology, effectively estimating the probability of a grant receiving a particular evaluation score given an array of characteristics, and how evaluation scores vary in tandem with changes in key characteristics.
We find that (controlling for other factors) programs implemented by civil society/private sector recipients receive higher scores than those implemented by the government. AIDS and TB programs receive higher scores on average than malaria programs. Smaller grants tend to receive higher scores than larger ones, as do grants that were rated more highly at the original proposal stage by the Global Fund's Technical Review Panel perform better. We also find that programs in which the firm KPMG acts as the Global Fund's "Local Fund Agent" (LFA) tend to receive lower scores than programs with other LFAs.
With respect to health sector characteristics, evaluations scores are higher in countries with more physicians per capita and high immunization rates, suggesting that capacity and institutional strength in the health sector have a strong influence on program success. We also find higher scores were the health sector has fewer donors and where Global Fund grants are a larger share of donor funding.
At a country level, we find that lower income countries tend to have higher evaluation scores, suggesting no reason for concern that poor countries cannot achieve strong performance, after controlling for other factors. Countries with larger budget deficits tend to receive lower scores, while countries that currently have or have had socialist governments tend to receive higher scores. In terms of simple averages, programs in so-called "fragile states" tend to receive weaker evaluation scores, but this difference disappears after we control for other explanatory variables (such as the number of physicians per capita). We find no significant relationship between evaluation scores and country governance ratings.
We stress that our results show associations, not causality, and they focus on evaluation scores rather than actual performance of the programmes. Yet they provide some early indications of characteristics that can help the Global Fund identify and monitor programmes that might be at risk. The results should not be used to influence the distribution of funding, but rather to allocate resources for oversight and risk management, and in developing "early warning" indicators to anticipate poorly performing grants.
- For more discussion and to comment on this paper, see CGD's Global Health Policy Blog post, Using Global Fund Evaluation Scores to Bolster Grant Oversight