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An Evaluation of the World Bank's Trust Fund Portfolio

An Evaluation of the World Bank's Trust Fund Portfolio

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CHAPTER 3THE RELEVANCE AND EFFECTIVENESS OF TRUST FUND SUPPORT FOR DEVELOPMENTBox 3.4 The Global <strong>Fund</strong> Meets Disease Targets But Not Health System Capacity NeedsA five-year evaluation <strong>of</strong> <strong>the</strong> Global <strong>Fund</strong> has shown that it has made substantialcontributions, on <strong>the</strong> whole, in providing increased funding for <strong>the</strong> scaling up <strong>of</strong>interventions in <strong>the</strong> three disease areas <strong>of</strong> AIDS, tuberculosis, and malaria. Thissupport has contributed to increases in <strong>the</strong> availability <strong>of</strong> services, better coverageacross populations in countries, and reduction in <strong>the</strong> burden <strong>of</strong> disease.Yet <strong>the</strong> evaluation (and a forthcoming IEG Global <strong>Fund</strong> review) also points toweaknesses in <strong>the</strong> sustainability <strong>of</strong> intervention programs at <strong>the</strong> country level, inpart because <strong>of</strong> reduced incentives for country programs to engage in nationalplanning for future resource allocations and <strong>the</strong> Global <strong>Fund</strong>’s inadequate attentionto capacity building, while at <strong>the</strong> same time making heavy demands on existingsector capacities.Experience has varied by country, though sustainability <strong>of</strong> intervention programs isat issue in all countries where <strong>the</strong> Global <strong>Fund</strong> is a significant source <strong>of</strong> finance, andintegration <strong>of</strong> activities is a problem in many. For example, independent evaluationindicates that in Cambodia <strong>the</strong> Global <strong>Fund</strong> has had some success enabled by goodgovernment leadership and a well-functioning government-donor coordinatingmechanism, but has still faced problems with fragmented project units, inadequateintegration into <strong>the</strong> national planning process, and difficulties because <strong>of</strong> weaknessesin national fiduciary systems. In Burkina Faso, <strong>the</strong> Global <strong>Fund</strong> needs to coordinatebetter with o<strong>the</strong>r sources <strong>of</strong> aid to allow for a balanced allocation <strong>of</strong> resources among<strong>the</strong> country’s priorities <strong>of</strong> coping with <strong>the</strong> three Global <strong>Fund</strong> diseases, as well aspressing issues <strong>of</strong> maternal and child health.Sources: Macro International Inc. (2009); IEG (forthcoming a).In post-disasteror post-conflictsituations,multidonor trustfunds have beenused to poolbilateral grantfunding and asan aid platformfor donorsinside andoutside <strong>the</strong>pool.3.22 <strong>Trust</strong>-funded investment financing has also contributed whenit has used financing modalities well adapted to a country’sconditions, and not when it uses a modality prescribed by <strong>the</strong>program ra<strong>the</strong>r than by individual country circumstances.Contrasting uses <strong>of</strong> <strong>the</strong> EFA/FTI trust fund in Benin, Ethiopia, andRwanda illustrate this point (box 3.5).3.23 Responding to post‐disaster or post‐conflict circumstances. In<strong>the</strong>se special country circumstances, trust funds have enabled pooledgrant financing from some <strong>of</strong> <strong>the</strong> active donors and served as aidcoordinatedplatforms for donors inside and outside <strong>the</strong> multidonorfunds. For recipients, this funding has <strong>of</strong>ten been indispensable andhas reduced aid transaction costs for both recipients and donors.<strong>Trust</strong> fund financing has also been <strong>the</strong> sole or predominant source <strong>of</strong>financing for <strong>the</strong> Bank’s engagement, at least in <strong>the</strong> initial phases <strong>of</strong>post-disaster and post-conflict assistance. Most programs haveentailed strong management, though <strong>the</strong>re have been high-pr<strong>of</strong>ileexceptions. 732

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