Poor countries with least-developed health systems best able to make rapid use of grants

Boston, MA -- The Global Fund to fight AIDS, tuberculosis, and malaria was launched in 2002 to attract and rapidly disburse money to combat these three diseases. During creation of the fund there was considerable debate about the capacity of developing countries, particularly low-income nations, to spend substantial new resources for health effectively -- referred to as absorptive capacity. To date, the Global Fund has made $4.4 billion in commitments to 128 countries and has disbursed $1.8 billion.

Researchers from Harvard School of Public Health (HSPH), led by Research Associate Chunling Lu, set out to make a quantitative assessment of the countries' implementation of grants using extensive data on grant disbursement available publicly on the Global Fund's website. The authors note that the fund has committed itself to a very high level of transparency in its grant-making and financial disbursements, making this assessment possible.

The researchers' independent analysis of grant use in 86 countries found that, counter to prevailing notions, low-income countries are the most likely to rapidly use grants from the Global Fund. The grants are subject to strict reporting procedures for disbursement, with the fund making payments four times a year based on quarterly achievements defined in grant agreements. Countries with higher incomes or more-developed health systems were more likely to let funded grants languish. Implementation of grants was also strongly related to a country's political stability.

The findings are published in the August 5, 2006 issue of The Lancet.

The study is the first quantitative analysis to explore the effect of certain grant characteristics -- the type of primary recipient, the local fund agent and country attributes -- on grant disbursements, said Catherine Michaud, a co-author and senior research scientist at HSPH. The paper's other authors are Kashif Khan, research assistant; and Christopher Mur

Contact: Robin Herman
Harvard School of Public Health

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