The Global Fund is one of the more transparent global health institutions despite dropping 6 places in the International Aid Transparency Initiative (IATI) ranking for the periods 2012 – 2014. It affords the public considerable access to data on grant funding flows and programme results. Such transparency reflects the Fund's responsibility to its donors, who together contribute around $4 billion annually to the response to AIDS, tuberculosis and malaria in more than 110 countries.
The Fund is consistently improving how it publishes live grant data via its online database, publishing within two weeks of each disbursement: a best practice according to IATI. Information on funding allocations, spending, other grant details and more granular data is provided from the Fund’s data site (API).
But even this database does not go far enough in providing the critical country-level data that watchdogs and civil society need to ensure that every dollar invested in the health response is spent the way it should be.
It would be extremely useful for independent trackers to have access to complete grant data on disbursements and expenditures per principal recipient, sub-recipient or other implementing partner, per broad activity. Also useful would be a subset of good quality indicators provided online by the Fund for all components to better assess grant performance.
It is unfortunate that the Fund's commitment to transparency has failed to translate at country level among implementing countries. There is an entrenched resistance, it seems, to calls from country-level watchdogs like Aidspan and its partners for PRs and SRs to open their records completely. This makes it difficult for analysts to understand the viability and impact of supported activities.
Currently, data are aggregated to PR level, related to disbursements and expenditure and data on high level programmatic indicators and progress achieved against set targets. Tracking program indicators for outputs, for instance, is still messy as many indicators reported via the Fund's data portal are inconsistent, duplicative, incomplete and unreliable.
Yet those data surely do exist as all implementers are required to report these results via their M&E frameworks. Also, planned disbursements are linked to proper reporting of these achievements against pre-set targets.
Beyond this issue of access, much of the data that exists remains un-analyzed, partly because it is not easy to use in the current format and partly because explanations of what is presented and for what period remains unclear. There also exists the problem of the skill gap around data analysis by many country-level actors.
Gaps in data and the limited use of existing data have consequences. For one, these can prevent beneficiaries from accessing health services that are, thanks to investments from the Global Fund and other donors, heavily subsidized or free. Unarmed with the knowledge that the life-saving drugs that they may need are available for free, many will opt against seeking treatment because of the fear that those drugs will cost more than they can afford. A lack of information also means that beneficiaries will assume they have no recourse, no way to hold providers of health services accountable for the services that they should provide.
Second, lack of data makes it difficult to ascertain true impact of supported programs and limits future strategic and resource planning at country and community levels. It limits the depth of analysis possible by local organizations to track the flow and use of health resources; to compare costs of services offered and commodities procured; and to assess efficiency and effectiveness of supported programs. Such studies could limit waste and cost inconsistencies, and enhance value for money.
Limiting independent critique of the Global Fund systems at country level cripples the Fund’s vision of ensuring sustainable health systems and minimizing waste and loss due to poor planning, prioritization and fraud. It limits the ways to question the reporting of results to the Fund -- which allows disbursements of grant funds to continue unfettered.
The above have both short- and long-term consequences for the overall health of a population. In the short-term, they throw up barriers that limit to access to services. In the longer-term they prevent strategic planning and identification of national priorities to achieve durable health outcomes.
As Rwanda's Finance Minister Ronald Nkusi noted in 2012, "if you cannot get your hands on the information, you cannot effectively quantify what you are going to do, what you are going to receive, and what you are going to spend".
The easiest way to resolve this problem is for the Fund to require implementers to make these data available, to throw open their databases to the kind of scrutiny that the Fund itself is allowing. Countries would then be mandated to make their SR- and implementer-level data accessible, to allow interested parties the ability to link the funds disbursed to the results recorded at all levels.
By supporting such openness, the Fund would legitimize its efforts to assess and evaluate the value for money of the programs it supports, empowering watchdogs and other stakeholders as guardians against inefficiency, fraud and corruption. In doing so, the Fund would be able to ensure that every dollar it invests is yielding the best possible result.
It is important, however, to emphasize, that sole responsibility does not rest with the Global Fund: it rests, first and foremost, with implementing countries themselves. In agreeing to take donor funds, countries should also make sure those funds are used as effectively as possible and allow scrutiny from independent entities. Second, it rests with country-level users who could, but don’t, make use of readily available data for initial analyses. This poses a challenge when requests are made to the Fund or its implementers for even more information.
Public systems perform better and are more productive when they are responsive to the public. When such data are made easily accessible, it creates incentives to effect positive change at policy and community levels.