Analysis of the Global Fund’s qualitative adjustments from African Constituencies’ perspective
By Dr Litaaba-Akila Djinta, Research Assistant. Centre for Research and Training in Economics and Management Sciences (CERFEG), University of Lomé (Togo)
Executive Summary
This analysis compares the effects of qualitative adjustments to the Formula-Derived Amount. The qualitative adjustments show mixed results in Africa and no specific trends. Many countries with large or small allocations like Mozambique or Gabon received lower final allocations than the Formula-Derived Amounts even for diseases for which they have high prevalence or incidence; and many large or smaller countries like Nigeria or Rwanda gained more resources through the adjustments. Some countries classified as Challenging Operating Environment like Burkina Faso lost some resources while others like Chad gained. Overall, African countries got less resources for TB in this grant cycle compared to the previous one owing to the changes in the Global Disease Split.
Context
The Global Fund’s decisions on allocations to countries follow a two-step process. The first step is to apply the Global Disease Split to funds available for investments. This formula is based on the epidemiology and income category of a country. The second step is “qualitative adjustments” which are refinements to the Formula-Derived Amounts (FDAs) to account for epidemiological, programmatic and other factors insufficiently addressed through the allocation formula. This second step is meant to maximize the impact of Global Fund resources in line with the Global Fund Strategy.
The qualitative adjustment goes through two phases:
Phase 1 consists in adjustments for Key Populations (KPs) for HIV. At this stage, the Global Fund reduces the FDAs of countries with a high prevalence to give to countries with low prevalence but a concentrated epidemic in KPs.
Phase 2 adjusts for key programmatic factors and other contextual considerations such as whether the country is a Challenging Operating Environment (COE), program effectiveness in the previous grant cycle, or the absorption levels.
Data Sources
The data come from the report on qualitative adjustment for 2023-2025 allocation and include all changes made to FDAs through the qualitative adjustment process. The report does not cover all countries’ allocations for the 2023-2025 period. Rather, it covers only those that underwent an adjustment in Phase 1 or 2. The data also set out the final country-component allocation communicated to the country, the total overall funding adjusted from the FDAs (in absolute and percentage terms), and the change in funding from the previous Global Disease Split (in absolute and percentage terms). We also calculated a new Change from Previous Funding in percentage using the previous final allocation for analysis.
Qualitative Adjustment Analysis by Region
In West and Central Africa (WCA), the average final allocation is US$59.65 million compared to US$105.62 million in East and Southern Africa (ESA). About 2% of portfolio allocation changed from previous funding in WCA versus 4 % in ESA (Graphs 1 and 2).
Graph 1 : Average of final Allocation by Region Graph 2 : Change from Previous Funding by region
Source : Global Fund report on qualitative adjustment for 2023-2025 allocation
A further analysis by region and by disease grant shows that, on average, in WCA the final allocation for malaria is higher than that of the other two diseases (TB and HIV/AIDS). In contrast, in ESA the HIV/AIDS grant is higher (Graph 3). This difference is due to the high rate of malaria in WCA and the high rate of HIV/AIDS transmission in ESA region. In WCA, 4.7 million people live with HIV, representing a prevalence of 1.3% while the prevalence in ESA averages at 6.2%. In terms of qualitative adjustment in both regions, considering the calculated mean of the percentage change from previous funding, only TB grants have negative adjustments (Graph 4).
Graph 3 : Average of final Allocation by disease and region Graph 4 : Change from Previous Funding by disease and region
Source : Global Fund report on qualitative adjustment for 2023-2025 allocation
African countries most affected by qualitative adjustments
The analysis by country (Table 1) shows that in WCA, the five countries that benefited most from the adjustments) are Mauritania, Senegal, Cape Verde, Chad and Guinea Bissau. They have the higher percentage change from FDA calculated. Similarly, in ESA, the five countries that benefited most from the qualitative adjustments are Madagascar, Mauritius, Rwanda, Namibia and Comoros.
In contrast, the five WCA countries that lost the most resources after the adjustments (Table 2) are Burkina Faso, Mali, Gabon, Congo and Sao Tome and Principe. In ESA, Uganda, Mozambique, South Africa, Zanzibar, and Angola were the countries whose allocations decreased most after the qualitative adjustments.
Note that those are percentage changes but not dollar amounts. Some countries have modest total final allocation like Mauritius US$2.4 Million.
Table 1: Presentation of data of the five countries that benefited most from the adjustments in West and Central Africa and Eastern and Southern Africa (ranked by decreasing % change)
| Region | (A)
Countries |
(B)
Stage 1 adjustment for populations disproportionately affected by HIV (US$ m) |
(C)
Adjustment through Stage 2 (Amount) |
(D)
Final Allocation (US$ m) |
(E)
Previous Allocation (US$ m) |
(F)
Change from Formula-Derived Allocation (Amount) |
(G)
% Change from Formula-Derived Allocation (calculated) |
| Eastern and Southern Africa | Madagascar | 6,3 | 34 | 100,7 | 60,4 | 40,3 | 67% |
| Mauritius | 0,5 | 0 | 2,4 | 1,9 | 0,5 | 26% | |
| Rwanda | -9,9 | 32,7 | 172 | 149,3 | 22,7 | 15% | |
| Namibia | -2,3 | 5,6 | 32,7 | 29,4 | 3,3 | 11% | |
| Comoros | 0,1 | 0 | 1 | 0,9 | 0,1 | 11% | |
| West and Central Africa | Mauritania | 1,3 | 1,7 | 8,5 | 5,5 | 3 | 54% |
| Senegal | 6 | 5 | 31,9 | 20,9 | 11 | 53% | |
| Cabo Verde | 0,2 | 0,6 | 4,2 | 3,3 | 0,9 | 27% | |
| Chad | 1,4 | 9 | 55,5 | 45,1 | 10,4 | 23% | |
| Guinea-Bissau | -1,8 | 6,2 | 27,3 | 22,9 | 4,4 | 19% |
Notes: G=(D-E)/E Source: Global Fund report on qualitative adjustment for 2023-2025 allocation
Table 2: Presentation of data of the five countries that lost the most resources after the adjustments in West and Central Africa and Eastern and Southern Africa for the total grant
| Region | (A)
Countries |
(B)
Stage 1 adjustment for populations disproportionately affected by HIV (US$ m) |
(C)
Adjustment through Stage 2 (Amount) |
(D)
Final Allocation (US$ m) |
(E)
Previous Allocation (US$ m) |
(F)
Change from Formula-Derived Allocation (Amount) |
(G)
% Change from Formula-Derived Allocation (calculated) |
| East and South Africa | Uganda | -31,5 | 0 | 288,5 | 320 | -31,5 | -10% |
| Mozambique | -57,5 | -27,1 | 770,6 | 855,2 | -84,6 | -10% | |
| South Africa | -53,3 | -50 | 536 | 639,3 | -103,3 | -16% | |
| Zanzibar | 0,2 | -6,3 | 10,8 | 16,9 | -6,1 | -36% | |
| Angola | 2,3 | -77,9 | 126 | 201,6 | -75,6 | -38% | |
| West and Central Africa | Burkina Faso | 1,5 | -10,3 | 242,5 | 251,3 | -8,8 | -4% |
| Mali | 1,3 | -13,7 | 179,6 | 192 | -12,4 | -6% | |
| Gabon | -0,3 | -0,2 | 5,8 | 6,3 | -0,5 | -8% | |
| Congo | -3,4 | -6 | 62,5 | 71,9 | -9,4 | -13% | |
| Sao Tome and Principe | 0 | -6,6 | 12,9 | 19,4 | -6,5 | -34% |
Notes: G=(D-E)/E Source: Global Fund report on qualitative adjustment for 2023-2025 allocation
All five countries in ESA lost allocations through qualitative adjustments (Table 3). However, if we consider the countries of WCA, Nigeria and Cameroon gained from the qualitative adjustments, while Burkina Faso, Côte d’Ivoire and Mali saw their allocations decrease.
Tableau 3: Presentation of data by country in West and Central Africa with the highest allocations in the report*
| Region | (A)
Countries |
(B)
Stage 1 adjustment for populations disproportionately affected by HIV (US$ m) |
(C)
Adjustment through Stage 2 (Amount) |
(D)
Final Allocation (US$ m) |
(E)
Previous Allocation (US$ m) |
(F)
Change from Formula-Derived Allocation (Amount) |
(G)
% Change from Formula-Derived Allocation (calculated) |
| West and Central Africa | Nigeria | 36,4 | -15,3 | 779,4 | 758,3 | 21,1 | 3% |
| Cameroon | -16,2 | 20,2 | 271,1 | 267,1 | 4 | 2% | |
| Burkina Faso | 1,5 | -10,3 | 242,5 | 251,3 | -8,8 | -4% | |
| Côte d’Ivoire | 3,1 | 12,3 | 229,1 | 213,7 | 15,4 | 7% | |
| Mali | c1,3 | -13,7 | 179,6 | 192 | -12,4 | -6% | |
| East and South Africa | Mozambique | -57,5 | -27,1 | 770,6 | 855,2 | -84,6 | -10% |
| Tanzania (Uni-ted Republic) | -41,4 | -16,2 | 552,9 | 610,5 | -57,6 | -9% | |
| South Africa | -53,3 | -50 | 536 | 639,3 | -103,3 | -16% | |
| Zimbabwe | -45 | 36,7 | 504,8 | 513,1 | -8,3 | -2% | |
| Ethiopia | 23,8 | -46,5 | 427,6 | 450,3 | -22,7 | -5% |
Source: Global Fund report on qualitative adjustment for 2023-2025 allocation
*Note- Some countries like the Democratic Republic of Congo (DRC) with high allocations are not listed in this report
Factors indicating a Future Increased or Reduced Ability to Absorb Funds
Among the countries included in the report, those with large allocations lost resources after the qualitative adjustments except for Nigeria and Cameroon. The Global Fund listed the reasons to explain gains after qualitative adjustments and the opposite of those reasons to explain reduced adjustments.
Among those factors that could increase or (decrease) the ability to absorb funds in the next grant cycle that the Global Fund Secretariat considered included:
- Emergence from (entering) a period of civil strife or other exceptional events that would have depressed recent historical spending;
- National Strategic Plan and country dialogue discussions demonstrate that the country has a coherent and credible plan to improve past performance or to expand programs; or suggest new or heightened problems of governance and leadership of the program;
- Key populations are not included in country dialogue discussions or program plans;
- Evidence of other major donors planning to reduce funding, leaving gaps in existing programs;
- Clear and feasible plans to unlock grant management bottlenecks, such as a plan to strengthen procurement systems or improve financial systems; or no plans are in place to unlock serious grant management bottlenecks;
- Evidence of greater (reduced) political will to support programs;
- Upward or downward trend of disbursements and expenditure rates over the most recent years; and
- Expected changes in grant implementers that would significantly increase or decrease disbursement and expenditure rates.
Overall, the qualitative adjustments show mixed results in Africa and no specific trends.
Many countries with large or small allocations like South Africa or Gabon received lower final allocations than the Formula-Derived Amounts; many large or smaller countries like Nigeria or Rwanda gained more resources through the adjustments. Some countries classified as Challenging Operating Environment like Burkina Faso lost some resources while others like Chad gained.
References
- Global Fund, 2022; “2023-2025 Allocations: Report on Qualitative Adjustments”, Strategy Committee, GF/SC20/ER03.
- Forster, Timon; Kentikelenis, E. Alexander; Stubbs, H. Thomas; King, P. Lawrence, 2020, “Globalization and Health Equity: The Impact of Structural Adjustment Programs on Developing Countries”, Social Science & Medicine, Vol.267, 112496.
- African Constituency Bureau, 2022, “WCA and ESA Constituencies Approved the Qualitative Adjustment with Comments: Discover Why”.
