11 July 2004
In an analysis of its first 25 grants in operation for one year, the Global Fund to Fight AIDS, Tuberculosis and Malaria has found that these grants have reached an average of 80% of their targets.
This is the conclusion of “A Force for Change: The Global Fund at 30 Months”, a report to assess progress since the Global Fund’s creation in early 2002, which was launched here today.
“We hope this report is an indication that the innovative ways in which the Global Fund works are beginning to make the impact envisioned at its creation 30 months ago,” said Richard Feachem, Executive Director of the Global Fund. “The systems work and the Global Fund is ready to dramatically expand funding to countries fighting the three pandemics.”
The self-analysis finds that the Global Fund’s strengths include flexibility to correct mistakes, adapt to local conditions and that its performance-based funding system works well. It points to the need to improve the functioning of Country Coordination Mechanisms – country-level partnerships which are responsible for submitting grant proposals and oversee local implementation. These must become more effective and inclusive. The report also stresses that more technical assistance must become available to grants with problems, while administration of well-performing grants could be simplified and fewer but larger disbursements could be made to these grants.
An analysis of 25 of the Global Fund’s 296 grants which have been operation for one year, found that 12 were on target or over-performing, while five were severely behind schedule. The remaining eight programs were slightly behind targets but are likely to catch up in their second year. When performance was averaged across all 25 grants, performance was just over 80 percent of targets.
This average hides some substantial over achievers, such as Honduras which put nearly twice as many people on treatment as planned, and Madagascar, which had distributed well over double the number of insecticide-impregnated bed nets it had planned.
Program performance in the Global Fund is based on targets set by the recipients. Funding disbursement takes place against proven performance vis-à-vis these targets. The analysis shows that well-performing grants received 91 percent of their projected funding after one year, those moderately short of targets had received 58 percent, and those which are substantially underperforming had only received 21 percent.
“The Global Fund has developed a unique financing structure and disbursement system,” says Richard Feachem, the Global Fund’s Executive Director. “These results prove that the system works. A number of issues need improvements, but as a global experiment in development finance, the Global Fund is so far a success.”
In the introduction, the report says “The Global Fund’s first achievement lies in its size and speed of action: since its humble beginnings with a staff of five in the first half of 2002, it now has pledges of US$ 5.4 billion through 2008, and it has committed US$ 3.1 billion to more than 250 two-year programs in nearly 130 countries over four rounds of grant proposals. It is on schedule to disburse nearly US$1 billion to over 200 programs by the end of the year. These sums represent a substantial increase in the overall resources for the three diseases, more than doubling 2002 funding for malaria alone.
“The second significant achievement is the pioneering of a number of innovative structures to ensure country ownership, light and speedy oversight, and performance-based funding. The performance of these structures has been varied, but the conclusion is that they have been valuable innovations which, with ongoing modification, will assist countries in more effective implementation of public health programs beyond those financed by the Global Fund.”
The report acknowledges that grants in the first round of financing, which was approved only three months after the Global Fund’s creation in January 2002, systems for monitoring and evaluation were not yet established and that performance indicators were varied and often based on what was possible to measure rather than what was important.
The effort to measure performance of the year-old grants – all from the first round of financing – is part of a larger endeavor to set consistent and systematic monitoring and evaluation standards and to establish a system of performance management of all Global Fund grants. These systems are needed to ensure that when grants are reviewed after two years, only those who perform well will be granted funding for the remaining period of the grant (typically another three years).
The analysis was conducted for the period from 1 May 2003 until 30 April 2004. In total, the 25 grants in 15 countries have reached 2.3 million people with interventions such as testing, treatment and care, and 340,000 people have been trained. 5,200 people had been reached with antiretroviral therapy in four programs, while 45,000 people have been successfully cured for TB. Nearly 350,000 bed nets have been distributed in three programs.
The results are likely to represent only a small part of the people reached in the more than 150 programs which have begun operation. (Another 150 grants have not yet begun activities. Most of these grants were only approved at the Global Fund's Board meeting in the last week of June.) Since most grants have different starting dates, however, it has not been possible to measure results across the entire Global Fund grant portfolio.
“In development assistance, one year of operation is a very short period to measure results,” says Bernhard Schwartlander, Director for Strategic Information and Evaluation at the Global Fund. “The real impact of our ongoing grants will really only be possible to measure after few years. But we felt compelled to publish these early findings since there is such keen interest in – and great expectations for – the Global Fund.”
While stressing the Global Fund’s innovativeness, the report warns that “those who believe that the Global Fund will overcome all problems which have traditionally beset health efforts in poor countries will be disappointed. The Global Fund simply represents the world community’s best efforts, so far, to facilitate the flows of development assistance for health and to empower developing countries to find effective ways of solving the problems they face.”