Study Details

Following the Funding for HIV/AIDS: A Comparative Analysis of the Funding Practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia.


Oomman N.  Bernstein M.  Rosenzweig S. 


October 2007



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Center for Global Development (CGD)


HIV/AIDS services; health systems strengthening; governance; funding; civil society.

Study Type

A comparative analysis of PEPFAR, the Global Fund (GF), and the World Banks MAP


To describe bottlenecks and other difficulties in the disbursement of funds; to document the way each of the three donors disbursement systems attempt to build national capacity to fight AIDS; to identify specific ways in which the donor agencies could make the resources move more efficiently.


Desk review of key documents, and interviews with officials from the each of the donors, governments and a purposive sample of recipients of donor aid.


This review compares three donor’s funding practices with respect to their adherence to dimensions of “aid effectiveness” derived from the Paris Declaration: working with the government; building local capacity; flexible funding; selecting appropriate recipients; making the money move; and collecting and sharing data.

  • Working with the host government: governments were least involved in the design and planning of PEPFAR-funded programmes, and had the most limited role in overseeing PEPFAR funds. PEPFAR and MAP required governments to manage their funding using donor-specific procedures whilst GF allowed countries to use existing systems and procedures.
  • Building local capacity: Whilst each of the donors supported capacity-building activities for governments, local civil society and private sector actors, only MAP could systematically demonstrate what share of its resources it dedicated to such activities. However, the impact of donor spending in this area is unknown.
  • Flexible funding: In terms of the types of activities supported by each donor, the Global Funds money was the most flexible and PEPFARs the least. PEPFAR funding was least flexible in allowing recipients to implement comprehensive approaches that combined elements of treatment, prevention and/or care. Overall resources from all three donors appeared disproportionately focused on treatment and care at the expense of prevention.
  • Selecting recipients: PEPFAR prioritised achieving targets, MAP prioritised capacity building and institutional strengthening, whilst GF allowed countries to set their own priorities in choosing recipients. The trade-off was between selecting recipients that could implement programs quickly (but often were international organizations), and selecting local recipients with lower capacity (but potentially more sustained engagement). PEPFAR chose the former, channelling funds primarily to international (mainly U.S.) recipients. All MAP and most GF aid was channelled through local governments.
  • Making the money move: MAP and GF monies that flowed through the public system encountered major bottlenecks that delayed subsequent disbursement. PEPFAR avoided many of these bottlenecks by awarding the bulk of its money to non-governmental groups. The sub-granting process from recipients to sub-recipients was reasonably quick and predictable under PEPFAR, but often slow and unpredictable for MAP and the Global Fund. PEPFAR provided funding once a year to each recipient, making funding more easily available for implementation than the multiple-instalment approach of MAP and GF.
  • Collecting and sharing data: PEPFAR had the most comprehensive financial data capture system but did not publicly share most of its data. The GF publicly disclosed the largest share of its financial data. All three donors could significantly increase the amount of information shared publicly.

Conclusions /

To all of the donors: Jointly coordinate and plan activities to support the National AIDS Plan; assist the government in tracking total national AIDS funds; focus on building and measuring capacity; develop strategies with host governments and other donors to ensure financial sustainability; and strengthen financial data collection and disclosure.

To PEPFAR: Make the government a true partner in PEPFAR programs; increase the flexibility of programming and funding; strengthen capacity-building activities in host countries; adopt two-year cycles for Country Operational Plans; and publicly disclose data.

To GF: Keep the focus on funding gaps; re-examine strategies to build local capacity; simplify procedures for good performers; and publicly disclose additional financial information.

To MAP: Focus resources on building government capacity; increase its focus on prevention; consider aligning its funding procedures with existing government systems to manage and report on funding; increase individual disbursement amounts; and publicly disclose data.

Sponsored by DFID, Danida, Irish Aid