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Imagine you work for a global health funding agency that supports programs to combat malaria in a rural African community. Each year, you exhaust your budget on bed nets and medication. Still, you're only able to deliver these lifesaving commodities to half the people in need, leaving the other half vulnerable to the deadly disease. With no additional funds available, how would you stretch your resources to save more lives?

With modest changes, global health funders could redirect hundreds of millions of dollars to save even more lives than they save now.

Foreign assistance for health has leveled off after reaching a historic high of $28.2 billion in 2010, due largely to a surge of new funding to fight AIDS, tuberculosis and malaria. But each year over three million people still die from these three diseases and many more suffer from extended periods of sickness.

Governments and funders alike face a moral imperative to ensure any money invested in health reduces the burden of disease among those affected as much as possible. And opportunities exist for them to save more lives with the same amount of money by taking steps to generate better "value for money" from their investments.

What is Value for Money?

Value for money is not about reducing costs or cutting budgets, but rather about maximizing the health impact of every available peso, pound or pula to reduce human suffering and save lives. Or, simply put, getting more health for the money.

Considering value for money is a prerequisite for empowering citizens to hold their leaders and global donors accountable. 
Kalipso Chalkidou
Founding Director, NICE International, UK

This sounds straight forward, but in practice global health funders operate in a complex environment where competing mandates and sometimes perverse incentives can stand between health financing and health impact. Getting more value for money requires reexamining the explicit and implicit incentives facing funders and recipients, and adjusting these in ways that encourage allocation of funds to highly cost-effective interventions that are executed in a cost-effective manner.

To this end, global health funders could make relatively modest changes to the global health funding process. These changes would save hundreds of millions of dollars which could then be reprogrammed to save even more lives.

Getting More Out of the Grant Cycle

There are four common domains within a grant cycle where global health funders can align incentives to get more health for the money: allocation, contracts, costs and spending, and verification. While these domains may seem abstract, decisions in each domain directly affect the availability and quality of services provided to people at-risk or suffering from disease, and ultimately a funder's ability to reduce suffering and save lives.

 

Allocation

How to allocate resources to maximize value for money

Designing Contracts

How to structure agreements to create stronger incentives for value for money

Cost + Spending

How to collect and use cost data for commodities, supply chains and service delivery to leverage value for money

Verification

How to verify performance to generate greater incentives and accountability for value for money

Focus on the Global Fund

Achieving more health for the money is the core business of all global health funders. But the Global Fund to Fight AIDS, TB and Malaria is particularly well positioned to lead and its New Funding Model offers an opportunity for quick and flexible adoption of “value for money” principles and practices.

The Global Fund Board has already identified value for money as a priority, and has taken steps within its New Funding Model to improve the health impact of its funding. But current efforts stop short of realizing their full potential.

This report provides a roadmap for the Global Fund and its partners to systematically implement and evaluate the value for money agenda throughout the grant cycle.