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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
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.
While PEPFAR and the Global Health Initiative (GHI) have dominated the global health community’s attention over the past few years, the President’s Malaria Initiative (PMI) has largely flown under the radar. Surprisingly little had been written about the PMI; still the few available materials painted a reasonably positive picture. But just this month, the PMI released the results of an external evaluation which confirms what we’ve long suspected: PMI is doing a remarkably good job and generating “value for money” in U.S. global health efforts. Such results are all the more impressive in light of the common criticisms of USAID past and present – that it is ineffective, incompetent, and hampered by a complex and arcane bureaucracy. The PMI is a USAID success story that helps validate its ongoing efforts to reform and rebuild into the U.S.’s premier development agency.
Originally conceived in 2005 as a five-year, $1.2 billion scale-up of America’s malaria control efforts, the PMI was extended and expanded by the 2008 Lantos-Hyde Act, receiving $625 million in funding for FY2011. While its funding pales in comparison to PEPFAR, which received almost $7 billion for the same period, the PMI is among the largest global donors for malaria, aiming to halve the burden of malaria for 70 percent of at-risk populations in sub-Saharan Africa. Led by USAID under a U.S. Global Malaria Coordinator, the PMI is jointly implemented with the Centers for Disease Control (CDC).
The Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) was established very quickly in 2001 in response to a widespread perception that a rapid scale-up in financing was critical in the fight against the three diseases. Since it began operations in January 2002, GFATM has made important progress. It has raised substantial funding and become the world’s largest donor for TB and malaria. 70% of the programs reaching the two-year renewal stage are showing solid results. Rwanda, for example, has put over 4,000 people on ARV treatment, more than double its program target, and GFATM programs in aggregate have financed ARV treatment for 130,000 people to date.