Global Health Policy
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June 04, 2007
Using Global Fund Evaluation Scores to Bolster Grant Oversight
Posted by Michael Bernstein at 10:47 AM
With over 450 programs in more than 130 countries (and counting), the Global Fund certainly has its work cut out for it on monitoring and evaluation (M & E). An article (pdf) published last week in The Lancet by CGD senior fellow Steve Radelet and former CGD staff member Bilal Siddiqi provides some important data that could help the Fund further strengthen its M & E system going forward.
Radelet and Siddiqi's research centers around grant evaluation scores -- ie., scores that are assigned by the Global Fund to each grantee after the first two years of a new grant ("phase one"). Scores are assigned using three criteria: 1) results achieved, 2) country contextual information that may have affected the results, and 3) a series of assessments submitted to the Fund's secretariat by a "Local Fund Agent" (typically an accounting firm like PricewaterhouseCoopers). Radelet and Siddiqi explore the correlation between these evaluation scores and various characteristics of the grant itself (e.g., type of recipient), the health sector (e.g., physicians per capita) and the country (e.g., income level). Among their many interesting findings are:
- Programs implemented by non-governmental recipients receive higher scores than those implemented by the government.
- Evaluation scores are higher in countries with more physicians per capita and high immunization rates.
- Grants in countries with fewer donors or where Global Fund grants are a larger share of donor funding receive higher scores.
Radelet and Siddiqi note that "the results should not be used to influence the distribution of funding, but rather to allocate resources for oversight and risk management." The Global Fund could use the authors' results, for example, to allocate more time and money for oversight of grants that are likely to receive lower evaluation scores.
The Global Fund has demonstrated a commitment to "learning by doing," adjusting its policies and procedures as new data or circumstances arise. A five-year evaluation is being conducted with oversight from the Technical Evaluation Reference Group (TERG), so staff from the Fund are likely to look at the data provided by Radelet and Siddiqi closely to determine how best to use the authors' findings within this overall effort.
Some of Radelet and Siddiqi's suggestions are already being considered, or even adopted, by the Global Fund. Take, for example, their finding that non-governmental recipients seem to perform better than governmental ones. The authors explain:
This result does not suggest that the Global Fund should have a bias against programmes with government recipients, but rather that it should encourage countries to facilitate programmes with non-government actors alongside government programmes.
The Global Fund's Board has recently decided (.pdf) to do exactly that, by adopting a new grant approval process that would encourage grant applications with governmental and non-governmental recipients working in concert (ie., "dual-track financing").
The Fund's willingness to learn from its experiences is an encouraging signal that it will continue to use research such as that by Radelet and Siddiqi to bolster all aspects of its operations.
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Comments
An interesting insight! However, such outcome of such researches should not be dogmatized. Interesting areas that are needed to be explored are:
1. Why government recipients show poor performances?
2. What can be done in this regards?
Avanish Kumar
Senior researcher
Posted by: Avanish Kumar at June 7, 2007 07:40 AM
Why did your account leave off a key finding of the study?:
countries "that have or have had socialist governments also received higher scores."
Is this a deliberate omission?
Posted by: Anne-Emanuelle Birn at June 8, 2007 11:38 AM
Why was one of the most important findings of the study left off the blog?
According to Radelet and Siddiqi in their Lancet article: those countries "that have or have had socialist governments also received higher scores" on grant evaluations.
Kudos to the authors for including the presence/role of socialist governments as a variable in their study.
Too bad the CGD notice omitted this important finding. I urge the CGD to revise the notice of Radelet and Siddiqi's article to include their findings regarding socialist governments. In fairness, the notice should be re-posted to CGD updates and to the wider CGD readership.
--Anne-Emanuelle Birn
Canada Research Chair in International Health
University of Toronto
Posted by: Anne-Emanuelle Birn at June 10, 2007 09:35 PM
Hi Anne,
Thanks for your comment and for reading this important article.
I don't disagree with you that the finding about socialist governments is notable, and I certainly did not omit it from the blog to diminish its importance. As I'm sure you can appreciate, there were many very interesting and important findings in this article, so I thought it would be best to describe a few of these findings in the blog and let readers look at the report themselves to learn about all the findings.
As Radelet and Siddiqi note, their finding on the higher performance of socialist countries does suggest that these countries have "stronger health systems and implementation capacity, even after accounting for the number of physicans and immunisation rate." This means that the Global Fund could consider devoting relatively less money and staff time for oversight of grants in these countries, and in turn, increase resources for oversight forother countries who may be more likely to face implementation challenges.
Posted by: Michael Bernstein at June 15, 2007 05:38 PM