The Global Fund in Nepal
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) is an international financial instrument that focuses on achievements of targets through investments in the control of these three diseases. It 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 explores how the GFATM strategy is operationalised in the context of Nepal. The institutional entities involved 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. Based on ethnographic observation and interviews, the paper illustrates the operationalizing of this target based funding modality in various parts of Nepal. In doing so, it pays attention to the consequences – both intended and unintended – 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, it illustrates how the attention towards broader impact tends to become secondary to reaching numerical targets.