Smarter Spending on AIDS: How the Big Funders Can Do Better

An HIV/AIDS Monitor event on Wednesday spotlighted the Monitor's first of seven country-level research papers, "Following the Funding: A Comparative Analysis of the Funding Practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia." The paper examines key questions related to the way these donors send funding to countries - where does the money go? what activities is it used for? does donor funding build local capacity? - and makes recommendations for how each donor can improve their performance.

At the launch itself, panelists devoted a great deal of discussion to the need to build capacity at the country level and within governments; the need to increase the number of local recipient organizations being funded (especially in the Zambian context); and the need for greater dialogue and coordination amongst donors. I found it particularly interesting to think about the potential tradeoffs between these priorities - for example, the panel reasonably noted that coordination is not "free" and that in fact some portion of the resources required to improve it might come at the expense of program implementation.

That said, it is important to recognize the costs imposed by the current lack of coordination on the programs themselves - not just at the top of the pyramid where there are relatively fewer people to engage in an active dialogue, but even more so at the base where money is being channeled to organizations on the ground and questions like access to funding, equity and service delivery come into play.

While the 175+ person turnout for the event was exciting, the real measure of the report's success will be its impact on donor performance - and so it is a very encouraging sign that the panel of high-level representatives from World Bank, Global Fund, and PEPFAR went out of their way to praise the value of the report. More importantly, the donors all shared quite candid reflections on its key findings and promised to closely consider the resulting recommendations, which is another early indication that they, and other stakeholders who were represented in the room, are willing to engage in an active and productive discussion around this topic as it goes forward.