Global Fund Grant Programs: An Analysis of Evaluation

The Global Fund to Fight AIDS, Tuberculosis and Malaria has quickly become one of the world's largest funders of health programs. Just five years after its founding, it has approved proposals worth $6.8 billion for 448 programs in 136 countries, and disbursed over $3 billion. In this article, originally published in The Lancet, Steve Radelet and Bilal Siddi analyze the first 140 program grants evaluated by the Global Fund and the association between the programs' evaluation scores and various characteristics of the grants themselves (e.g., financial size, disease target, type of recipient), the health sector (e.g., physicians per capita, donor concentration) and the recipient country (e.g., income level, governance ratings).

Key findings include:

• 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.
• 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.
• Scores are also higher where the health sector has fewer donors and where Global Fund grants are a larger share of donor funding.
• Lower-income countries tend to have higher evaluation scores; countries with larger budget deficits tend to receive lower scores; and countries that currently have or have had socialist governments tend to receive higher scores.

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