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Value for Money: An Agenda for Global Health Funding Agencies
As international commitments become more ambitious and aid resources become increasingly constrained, global health funding agencies are seeking to improve the efficiency and impact of their investments. This growing “value for money” (VfM) agenda aims to reduce costs, increase impact per dollar spent and focus investments on the highest impact interventions among the most affected populations.
The Value for Money working group’s final report lays out a number of practical steps within each domain to improve value for money at the Global Fund to Fight AIDS, TB and Malaria. These recommendations are also of relevance to other bilateral and multilateral funders, such as the US President’s Emergency Plan for AIDS Relief and GAVI.
Members and Composition
The Value for Money working group was chaired by Amanda Glassman, director of Global Health Policy and research fellow at CGD. Members of the Working Group were invited to join in a personal capacity and on a voluntary basis, and include experts from the public health sectors in developing and developed countries, technical and funding agencies, advocacy organizations and academia.
Working Group Members
David Barr, Pangaea Global Aids Foundation
Joseph Brunet-Jailly, Institut de recherche pour le développement and Sciences-Po Paris
Kalipso Chalkidou, NICE International
Karl Dehne, UNAIDS
Alan Fairbank, Independent
Victoria Fan, CGD
Amanda Glassman, CGD, Working Group Chair
Kara Hanson, London School of Hygiene and Tropical Medicine
Iain Jones, DFID
Jason Lane, DFID
Bruno Meessen, Institute of Tropical Medicine
Mead Over, CGD
Nancy Padian, Independent
Mark Rilling, USAID
Josh Salomon, Harvard School of Public Health
Nalinee Sangrujee, CDC
Nina Schwalbe, GAVI Alliance
Bernard Schwartlander, UNAIDS
David Serwadda, Makerere University School of Public Health
The global health community has made great strides in addressing AIDS, tuberculosis and malaria: fewer people are contracting these diseases, fewer people are dying from them, and far more people are enrolled in life-saving treatments. Yet to sustain this progress and defeat these three diseases, the global community must find more efficient ways to allocate and structure funding.
This week, the Global Fund partnership will meet in Tokyo to plan for its fifth voluntary replenishment, covering the period 2017-2019. The stakes are high: in an austere budget climate, the Global Fund’s ability to raise the needed resources—and then to spend them effectively over the subsequent three years—will have outsize importance in determining the trajectory of the historic fight against AIDS, tuberculosis, and malaria.
Those who follow CGD will be familiar with our branded meme: “Cash on Delivery” aid, or COD. Many are enthusiastic about COD’s potential to revolutionize aid effectiveness. Yet within some global development organizations, leadership and staff alike express common concerns: is COD practical in the real world? Have you thought about this problem, or that constraint? How would this work in the context of our organization? And if we decided to move forward, how would we design a COD grant?
More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country. In this study we examine the interventions supported by two major international AIDS funders: the Global Fund to Fight AIDS, Tuberculosis, and Malaria (‘Global Fund’) and the President’s Emergency Plan for AIDS Relief (PEPFAR).
This report offers a strategy for the Global Fund to get more health for the money by focusing more on results, maximizing cost-effectiveness, and systematically measuring performance throughout its operations.
Little is known about the President’s Emergency Plan for AIDS Relief (PEPFAR) financial flows within the United States (US) government, to its contractors, and to countries. We track the financial flows of PEPFAR – from donor agencies via intermediaries and finally to prime partners. We reviewed and analyzed publicly available government documents; a Center for Global Development dataset on 477 prime partners receiving PEPFAR funding in FY2008; and a cross-country dataset to predict PEPFAR outlays at the country level. We present patterns in Congressional appropriations to US government implementing agencies; the landscape of prime partners and contractors; and the allocation of PEPFAR funding by disease burden as a measure of country need.
This paper examines opportunities for improved efficiency in malaria control, analyzing the effectiveness of interventions and current trends in spending. Overall, it appears that resources for malaria control are well spent—however, there remain areas for improved efficiency, including (i) improving procurement procedures for bed nets, (ii) developing efficient ways to replace bed nets as they wear out, (iii) reducing overlap of spraying and bed net programs, (iv) expanding the use of rapid diagnostics, and (v) scaling up intermittent presumptive treatment for pregnant women and infants.