Poor countries with least-developed health systems best able to make rapid use of grants
Boston, MA -- The Global Fund to fight AIDS, tuberculosis, and malaria was launched in 2002 to attract and rapidly disburse money to combat these three diseases. During creation of the fund there was considerable debate about the capacity of developing countries, particularly low-income nations, to spend substantial new resources for health effectively -- referred to as absorptive capacity. To date, the Global Fund has made $4.4 billion in commitments to 128 countries and has disbursed $1.8 billion.
Researchers from Harvard School of Public Health (HSPH), led by Research Associate Chunling Lu, set out to make a quantitative assessment of the countries' implementation of grants using extensive data on grant disbursement available publicly on the Global Fund's website. The authors note that the fund has committed itself to a very high level of transparency in its grant-making and financial disbursements, making this assessment possible.
The researchers' independent analysis of grant use in 86 countries found that, counter to prevailing notions, low-income countries are the most likely to rapidly use grants from the Global Fund. The grants are subject to strict reporting procedures for disbursement, with the fund making payments four times a year based on quarterly achievements defined in grant agreements. Countries with higher incomes or more-developed health systems were more likely to let funded grants languish. Implementation of grants was also strongly related to a country's political stability.
The findings are published in the August 5, 2006 issue of The Lancet.
The study is the first quantitative analysis to explore the effect of certain grant characteristics -- the type of primary recipient, the local fund agent and country attributes -- on grant disbursements, said Catherine Michaud, a co-author and senior research scientist at HSPH. The paper's other authors are Kashif Khan, research assistant; and Christopher Murray (senior author), Richard Saltonstall Professor of Population Policy at HSPH, all affiliated with the Harvard Initiative for Global Health.
Countries with low income and low health spending had higher rates of grant use than countries with higher income and more developed health systems. In International dollar terms, which take into account relative purchasing power, going from an income per capita of $1,000 (such as in Mozambique) to $2,000 (such as in Yemen) is associated with approximately a three percentage point reduction in grant execution rate.
Addressing the question of whether selection bias might have been introduced in the Global Fund's application process, the researchers point to the wide range of grant recipients included in their analysis -- particularly the lowest income countries in sub-Saharan Africa (37 countries) -- to argue against this hypothesis.
Another interesting finding was that, compared with government recipients (usually either Ministries of Finance or Ministries of Health), private-sector recipients had a 7.4 percent higher level of grant implementation. Private sector groups in this analysis were faith-based organizations, non-governmental organizations and private entities.
Disbursement of funds or grant implementation is one way to begin to evaluate the impact of the Global Fund, said Michaud, but it will be critical in the future to analyze the effects of these grants on actual prevention and treatment coverage.
This research study was sponsored by the Harvard Initiative for Global Health.
Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: www.hsph.harvard.edu
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