Explaining Variation in Grants by the Global Fund to Fight Aids, Tuberculosis and Malaria: Statistical Insights from a Principal-Agent Perspective

Abstract

Between 2002 and 2010, the Global Fund to Fight AIDS, Tuberculosis and Malaria approved over US $22 billion in grants to developing countries, making it the world's single largest source of funding against these diseases. Yet there is great variation in three key measures of the Fund's institutional output: which applications are approved for funding; the amount of money awarded to approved grants; and the discrepancy between requested and approved grant amounts. The Global Fund's decision-making process provides a role for both public health experts and for political representatives of states, non-state donors, and stakeholders. Based on an original database of grant applications from 2002 to 2010, I demonstrate that the Global Fund has been largely successful in 'depoliticizing' grant approval and grant amounts, which are both dependent on the preferences of independent health experts. However, the political preferences of the Fund's six largest donor states still explain the discrepancy between proposed and approved grant amounts - grants by developing states that are more attractive to donors are also more likely to receive what they asked for, while the opposite can lead to dramatic cuts to proposed budgets.