The Global Fund: an experiment in global governance

The Global Fund to Fight AIDS, Tuberculosis and Malaria was created as a new type of international organisation. Its founders uniquely enfranchised non-state actors on its Board, hoping that decision would attract new resources to combat these diseases. Funding decisions would be evidence-based rather than politically-driven. And, the institution would be deliberately ‘lean’ to promote ‘country-ownership’ of grant proposals and implementation. The Fund’s Board (‘principals’) made deliberate choices to constrain the autonomy of its Secretariat (‘agent’). Delegation was strictly limited. In theory, this was to ensure the Fund remained a catalyst for donor funding, evidence-based decision-making and country-ownership. However, the research adduced for this thesis suggests inadequate delegation opened opportunities for direct donor influence in recipient countries. This thesis assesses three specific dimensions of the Fund’s performance in its first decade. The first concerns whether the Fund successfully mobilised more resources, from more funders and did so more reliably. The second is whether the Fund made initial and continued funding decisions in an identifiable evidence-based way. The third centres on ‘country-ownership:’ whether recipient and donor countries on the Fund’s Board had equal influence and whether grant writing and oversight can be assessed as being recipient country ‘owned.’ Data is aggregated from several sources, including: the Fund’s grant portfolio, individual grant agreements and Board documentation; the U.S. PEPFAR programme; and, the Organisation for Economic Cooperation and Development. The research reveals the Fund likely gave a ‘kick-start’ to resources flowing to its diseases but PEPFAR’s arrival a year later contributed relatively more. Broad-based support did not emerge though the Fund proved relatively more successful in converting pledges to contributions. The Fund made evidence-based decisions for initial and continued funding, but the latter is a less robust conclusion given ...