Stakeholders' opinions and expectations of the Global Fund and their potential economic implications

Abstract

Objective To analyze stakeholder opinions and expectations of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to discuss their potential economic and financial implications. Design The Global Fund commissioned an independent study, the “360° Stakeholder Assessment,” to canvas feedback on the organization’s reputation and performance with an on-line survey of 909 respondents representing major stakeholders worldwide. We created a proxy for expectations based on categorical responses for specific Global Fund attributes’ importance to the stakeholders, and current perceived performance. Methods Using multivariate regression, we analyzed 23 unfulfilled expectations related to: resource mobilization; impact measurement; harmonization and inclusion; effectiveness of the Global Fund partner environment; and portfolio characteristics. The independent variables are personal- and regional-level characteristics that affect expectations. Results The largest unfulfilled expectations relate to: mobilization of private sector resources; efficiency in disbursing funds; and assurance that people affected by the three diseases are reached. Stakeholders involved with the Fund through the Country Coordinating Mechanisms, those working in multilateral organizations, and persons living with HIV are more likely to have unfulfilled expectations. In contrast, higher levels of involvement with the Fund correlate with fulfilled expectations. Stakeholders living in sub-Saharan Africa were less likely to have their expectations met. Conclusions Stakeholders unfulfilled expectations result largely from factors external to them, but also from factors over which they have influence. In particular, attributes related to partnership score poorly even though stakeholders have influence in that area. Joint efforts to address perceived performance gaps may improve future performance, and positively influence investment levels and economic viability.

Negative health system effects of Global Fund's investments in AIDS, tuberculosis and malaria from 2002 to 2009: systematic review

“…Seven of the quantitative studies were descriptive and did not use any explicit statistical methods to analyse their data. The remaining nine quantitative studies used a variety of study designs: one study was an uncontrolled before–after study, 23 one uncontrolled study reported data before and during implementation, 24 one study utilized time-series data, 25 two were cohort studies, 26 , 27 two were cross-sectional studies, 28 , 29 one study used Global Fund grant data for modelling 30 and one study modelled economic costs of a national insecticide-treated bed net (ITN) voucher scheme. 31 Only one of the six qualitative studies used an explicitly defined qualitative method of analysis.…”

“…Five studies did not target a specific disease, but were addressing wider issues such as countries’ absorptive capacity, 30 Global Fund's performance-based funding approach, 40 Global Fund-supported programmes’ contribution to international health targets, 41 an innovative financing scheme used by the Global Fund (Debt2Health Conversion Scheme) 37 or analysing stakeholder opinions and expectations using the Global Fund 360° Stakeholder Survey. 29 …”

“… 28 Five studies used aggregate data from several countries worldwide, related to overall health systems. 29 , 30 , 40 , 41 , 45 Two studies reported interventions targeted at community levels. Of these, one reported results at clinic level 38 and the other at community level.…”

“…Five of the studies used and analysed data directly related to the Global Fund, either because the Global Fund-financed programme collected the data or the data collection was commissioned by the Global Fund. 29 , 30 , 40 , 41 , 45 One study was designed to explore stakeholder experiences with Global Fund's impact at local level. 32 The Global Fund was often reported to support national disease programmes, but without clearly specifying the role of funding, recipients of the funding, range of interventions that were implemented using the Global Fund funding and other sources of funding.…”

“…One study analysed several unfulfilled stakeholder expectations and found that the second largest group of unfulfilled expectations were related to impact. 29 These unfulfilled expectations were related to interventions being able to reach target populations, health systems being strengthened through disease-specific approaches and effectiveness of performance-based funding. The authors did not provide explanations as to why they perceived these expectations as unfulfilled, but they found that the more respondents involved with the Global Fund, the fewer unfulfilled expectations stakeholders had.…”