An Evaluation of the World Bank's Trust Fund Portfolio

CHAPTER 3THE RELEVANCE AND EFFECTIVENESS OF TRUST FUND SUPPORT FOR DEVELOPMENTBox 3.3 Well-Integrated Trust-Funded Activities Help Scale Up Country OperationsIn Bangladesh, a large MDTF cofinances the government’s Health, Nutrition, and PopulationSupport Program along with an equivalent amount of funding from IDA. Donors used theMDTF vehicle as a way to provide substantial funding for the program rather than providingdirect budget support (previously used in a health sectorwide approach) due to concerns aboutweak financial management and the potential for misuse of funds. According to donors, thefiduciary risks are reduced by having the Bank serve as a “buffer” and by using the Bank’scomparative strengths in financial and risk management.In Indonesia, an MDTF is supporting the National Program for Community Empowerment,whose direction is set by the government. The MDTF provides cofinancing of IBRD/IDAoperations; grants to recipients, including NGOs, for technical assistance and capacity building;grants to the Bank for analytical and advisory activities and the MDTF office; and grants to theBank to cover supervision and project management costs. According to the government, theMDTF was a quicker way to mobilize resources to expand the program than would have beenpossible through Bank lending or bilateral support.In Rwanda, the global Health Results-Based Financing program financed a pilot test ofperformance-based financing for interventions in child and maternal health at the village level,a critical area of development in Rwanda. The government intends to scale up the programnationwide if the results of the impact evaluation are positive.Sources: Bangladesh, Indonesia, and Rwanda case studies.3.21 Global funds that operate in multiple countries tend to workless well than single-recipient-country funds in adapting to andintegrating with country programs. A contrasting example to thewell-integrated single-country experiences is provided by the GlobalFund’s operations in Rwanda and Benin, where the program’s threediseasefocus does not fully match the countries’ most pressing healthchallenges. According to a senior official in Rwanda, only afterconsiderable delay was the government able to convince the GlobalFund to expand its support to the overall system strengthening thatwas needed. Officials in Benin expressed similar concerns with theGlobal Fund’s targeted support in the absence of an integratedapproach to the needs of the overall health system. 6 This disconnectbetween the “vertical” disease focus and the “horizontal” healthsystem needs occurs in a number of other countries, as documented inrecent independent evaluations of the Global Fund (IEG forthcominga). While the Global Fund has made substantial contributions toscaling up interventions in the prevention and treatment of the threediseases, the overall benefits and sustainability of those achievementsare in doubt where health system capacities are weak (as discussed inbox 3.4).Global fundsthat operate inmultiplecountries workless well thansingle-countryfunds inadapting tocountrysituations andintegrating withcountryprograms andother aidsources.31