Metrics and Health Systems: The Global Fund in Nepal
Kapil Babu Dahal
Ian Harper (University of Edinburgh)
Paper short abstract:
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is a performance based financial instrument. By using the example of Nepal, we assess how the generation of mandatory data has significant effects on how programmes are run.
Paper long abstract:
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) has highlighted investing for impact as its core funding strategy for the period of 2012-2016. As an international financial instrument, it focuses on achievements of targets through investments in these three diseases, as well as on "health system strengthening". It also demands outcome-based evaluation metrics to link disbursement of resources to performance in lieu of achievement of clear and measurable results. All the grants from GFATM have a transparent performance framework and the recipients report their service delivery results against this framework. This paper analyzes how the GFATM strategy is experienced by different stakeholders involved in receiving the GFATM resources in the context of Nepal. These institutional entities are the principal recipients (PRs), which receive funding directly from the GFATM and sub-recipients (SRs), which receive funding from their respective PRs. The PRs (Government bodies and International NGOs) and SRs (mainly INGOs and NGOs) are the main organizations involved in health sector development, either working vertically in one or some of these three disease arenas, or in other areas of health development. The paper shows the empirical realities of operationalizing this target based funding modality in various parts of Nepal. In doing so, it pays attention to the unintended consequences of such funding. It also sheds light on how attempting to reach targets with the predetermined activities is linked to generating quantitative data. In focusing on this, the attention towards broader impact tends to become secondary to reaching numerical targets.
Anthropology of health indicators and statistics