Improving the Effectiveness of Health Investments in Developing countries: How is performance-based funding working?
30 June 2005
Alvaro Bermejo, the Alliance’s Executive Director, spoke about the Alliance’s experiences operating in Ukraine at the conference "lmproving the effectiveness of health investments in developing countries: how is performance-based funding working?" from 17 to 19 June 2005.
The conference aimed to address key questions around performance-based funding in health, assessing the strategies and methods that various agencies are adopting to evaluate performance, including:
- What is performance-based funding? How has it been interpreted and implemented by the international development and health communities, respectively?
- How is performance-based funding working in practice, especially with reference to the Global Fund to Fight AIDS, Tuberculosis and Malaria?
- How can efforts toward performance-based funding and the need for greater predictability of aid flows be reconciled?
- What must be done to ensure that performance-based funding is used to improve the effectiveness of health investments in developing countries?
Alvaro presented a case study from Ukraine in the session "What happens when targets are not met? Addressing poor performance". He discussed the background to the Alliance being appointed temporary ‘principal recipient’ of the Global Fund following non-performance in Ukraine, with responsibility to administer funds for the Global Fund programme, ‘Overcoming the HIV/AIDS Epidemic in Ukraine’. Successes in the Ukrainian response now include 1,500 people on anti-retroviral therapy, an anti-retroviral price benchmark in Ukraine, strong stakeholder involvement and ownership, and the foundation for an energetic national response. Alvaro concluded that situations can be turned around in-country, and that it can be done in a way that builds social capital, provided that early warnings are heeded and early action taken.
At the same session, Roger Drew, an independent consultant who has been carrying out real-time analysis of the Alliance’s work as temporary principal recipient of the Global Fund in Ukraine, presented his major findings and lessons learned. Between September 2004 and July 2005, Roger will have made a total of seven trips to Ukraine, tracking key developments and focusing on lessons for policy makers on key themes including:
- selecting a grant steward
- stakeholders and structures
- subcontracting, procurement and onward granting
- service delivery
- strategic information.
Roger concluded that, on the basis of the real-time lesson-learning analysis, “under some circumstances, bold and decisive action to change the grant principal recipient(s) can result in dramatic improvement in performance in delivery of short-term results and may also lay the foundation for more long-term and sustainable success.”
The meeting was organised by Wilton Park - an academically independent and non-profit-making Executive Agency of the British Foreign and Commonwealth Office - in conjunction with the Global Fund, the lnstitute for Global Health, University of California San Francisco and with support from the Bill and Melinda Gates Foundation. Speakers represented a variety of organisations, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, the Office of Development Cooperation Directorate, the International Monetary Fund, and the World Health Organization.
More detailed reports on the real-time lessons learning analysis in Ukraine are available from the International HIV/ADS Alliance in Ukraine’s website.
