“The Global Fund provides strong leadership for the response to HIV and AIDS, tuberculosis and malaria…. The Fund fully meets the requirements of an effective multilateral organization. It is fit for purpose and able to adapt to future needs.”

This is the conclusion of an institutional assessment conducted by the Multilateral Organisation Performance Assessment Network, or MOPAN, a network of donor countries with a common interest in assessing the effectiveness of multilateral organisations. MOPAN was launched in 2002. Today, MOPAN is made up of 18 donor countries: Australia, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Japan, Luxembourg, The Netherlands, Norway, Republic of Korea, Spain, Sweden, Switzerland, the U.S. and the U.K. Together, they provide 95% of all development funding to multilateral organisations.

“ There is strong evidence of effective and innovative collaborative working in the field, particularly in challenging operating environments.”

The assessment, which focused primarily on the Global Fund’s Secretariat, covered the period from 2014 to mid-2016. Applying what MOPAN calls its 3.0 methodology, the assessment considered five performance areas: four related to organisational effectiveness (strategic management, operational management, relationship management and performance management) and the fifth related to development effectiveness (i.e. results). Global Funds performance was assessed against a framework of 12 key indicators and associated micro-indicators that comprise the standards that characterise an effective multilateral organisation, and that provide an overall view on its performance trajectory. This is the first time that MOPAN has assessed the Global Fund.

MOPAN gave the Global Fund top marks in organizational architecture, operating model, and financial transparency and accountability, and it noted that the Fund performed strongly against all 12 indicators.

According to MOPAN, the Global Fund’s internal restructuring and adoption of the new funding model strengthened its performance. The Fund’s focus on results-based planning, management and reporting are driving efforts to improve country-level data, MOPAN said. “Its increasing emphasis on health systems strengthening (HSS), coupled with its existing strengths in strategic and operational management, should continue to increase the impact of its investments.”

“ The Global Fund is committed both strategically and institutionally to work with, support and integrate its work with country systems.”

MOPAN found that the Global Fund is a learning organisation, and that staff have a reputation for delivering pragmatic solutions. “Innovation is valued.” MOPAN noted, however, that the Global Fund delivers its support through structures “over whom it has limited influence, and which at times suffer from weak capability, particularly in the case of country coordinating mechanisms.”

The assessment identified several key strengths, including the following:

• the Fund has implemented significant organizational restructuring as a result of operational challenges identified by partners;
• the Fund has improved its management of risks;
• the Fund has established vibrant and effective partnerships, especially those that work with civil society and that leverage private sector skills to address operational gaps;
• there are initiatives underway to address gaps in data quality and quantity, such as ring-fenced funds to help countries improve their data systems; and
• country teams are building constructive dialogues with civil society around grant management and implementation.

The review lauded the Global Fund for its strong focus on early identification of operational and financial risks, and said the Global Fund’s leadership is committed to practical implementation of results-based management.

Room for improvement

MOPAN also found that there is room for improvement, particularly in evidence-based results measurement and HSS. With respect to the former, MOPAN said that the Fund should strengthen results management and organizational learning through a formal system to identify and address poorly performing interventions.

Regarding health systems, MOPAN said that the Global Fund has found it difficult to track exactly when and how countries spend the additional domestic investments required to unlock part of the Global Fund’s allocation. More explicit attention should be paid to building sustainability into the design of HSS interventions, MOPAN stated, and ways need to be developed so that even small gains made in HSS can be tracked. “The extent to which country systems are used for Global Fund grants is an important measure.”

HSS interventions have to date had limited success, MOPAN stated. “This reflects the need for political and societal buy-in before this aim can be realised. To make progress in this challenging space will require the Global Fund to seek further innovative advocacy and incentivised approaches.”

(Editor’s note: Under the Global Fund’s new co-financing policy, the required additional domestic investments may be made in health systems or in the disease programs.)

“ An acknowledged area for improvement is ‘the last mile’ – getting medication to ultimate users – and this is a critical focus in the next period, as failure in this space negates gains in all others.

Although there is a significant improvement in the analysis of crosscutting issues, MOPAN observed, this analysis has not consistently carried through from concept note stage into programming and budgeting. MOPAN said that this is a particular issue in relation to key populations. “Staff with responsibility for supporting the integration of cross-cutting issues are thinly stretched over the breadth and depth of Global Fund programmes. A more realistic resource allocation should ensure full integration of these issues throughout the business value chain.”

MOPAN observed that many evaluations are conducted, some by the Global Fund and some by partners. There is good “popular” communication of results “in pamphlet form,” MOPAN said. “However, there is limited availability of full evaluation reports with clearly outlined methodologies reflecting a more systematic and quality assured evaluative approach.”

Other observations by MOPAN included the following:

• Secretariat staff are “somewhat overstretched”;
• ensuring independent verification of results at country level is an ongoing challenge; and
• external partners have diverging views on the effectiveness of Global Fund initiatives to strengthen health systems. Recipient governments feel the new funding model aligns well with national priorities, while implementing agencies and NGOs feel alignment is poor.

The assessment is the latest donor review to commend the Global Fund for its performance, transparency and impact. The 2016 U.K. Government Multilateral Aid Review awarded the Fund the highest possible rating for overall organizational strength (see GFO article). The 2016 Aid Transparency Index recognized the Fund’s rigorous systems and commitment to transparency, rating the Fund in the top five of all international aid organizations (see GFO article).

In 2015-2016, MOPAN assessed 11 other organizations, including UNAIDS, the United Nations Development Programme, the African Development Bank, Gavi and the World Bank. Details of these assessments can be found here. MOPAN does not rank or compare the organizations it assesses.