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SummaryThe Debt2Health Conversion Scheme of the Global Fund to Fight AIDS, Tuberculosis and Malaria is used to reassess a range of recent initiatives that propose debt relief in exchange for spending in the health sector. The experience with debt swaps in the mid 1990s was far from positive, and recent improved insight in the economics of debt relief suggests extreme caution. We argue that the recent spade of debt swap proposals, even if targeting countries and debt titles that fall outside current major international debt relief mechanisms, share most of the design faults of previous initiatives. Proposals such as Debt2Health do not constitute efficient vehicles to increase net transfers to poor countries, to reduce the economic disadvantages of indebtedness, or to strengthen public health systems of partner countries. For debt relief to constitute a valuable mechanism to provide aid, it should be designed as a large-scale and comprehensive operation, with spending earmarked to broad country-established priorities, and reinforce rather than undermine national implementation systems.

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Donor agencies rely to varying degrees on desk reviews by headquarter staff for the selection, monitoring and evaluation of projects initiated by nongovernmental organizations (NGOs). If information provided in the various documents submitted by NGOs is inadequate or incomplete then the reliability of desk reviews as a management tool for allocation of project funding becomes questionable. A study of European Union funding of NGO projects compared findings from a desk evaluation of a structured sample of 30 projects with those from a field assessment of the same projects. The findings show that a field assessment on the basis of more complete information from a wider range of stakeholders leads to a markedly lower scoring on most of the standard criteria of project evaluation. An important policy implication is that ex ante screening, monitoring and evaluation on the basis of project documents are an ineffective management tool for donor agencies if not backed up by substantive follow-up in the field. This article places such management tools in the wider context of principal-agent relations.K E Y WO R D S : aid management; desk project review; field assessment; NGO co-funding; principal-agent relationship Evaluation