“Efficiency” and “effectiveness.” These buzz words are mentioned all the time in the context of global health, but we often fail to integrate them into our work, either because we don’t have the time or don’t see them as integral to achieving our goals. This report from the Kaiser Family Foundation documents the plethora of HIV/AIDS donors, displaying the overlap, duplication, and communication challenges that we face with so many cooks in the kitchen; it emphasizes the need to carefully align our work to make it as impactful as possible. The report finds 14 recipient countries had 20 or more HIV/AIDS donors over the three-year study period, and 70 countries had ten or more donors. For example, Uganda, where I am working with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), had a staggering 23 donors. In such a crowded landscape, how do we ensure that our work complements one another’s, rather than detracts from achieving our shared objectives?
No matter my specific role or perspective in the field of global health, I always find myself coming back to this question. I cringe when I hear of donors implementing siloed projects without coordinating with colleagues inside and outside their own organizations, which wastes already scarce time and resources with lifesaving potential. Only a few months into my fellowship, I again find myself examining everything through this lens, and I am impressed by EGPAF’s concerted efforts to make efficiency and effectiveness a reality throughout its work.
I work as a Grants Officer with the Awards and Compliance Team, which monitors EGPAF’s sub-grantees under the USAID-funded Strengthening the TB and HIV/AIDS Response in the Southwestern Region of Uganda (STAR-SW) project. I am well positioned to observe efficiency and effectiveness because our team straddles the project’s programmatic and operational work. In fact, I have already seen the fruits of an impressive initiative undertaken by the Uganda office to reduce significant gaps in coordination between the Programs Team, which manages the technical work on STAR-SW, and the Operations Team, which handles finance and administration. STAR-SW provides grants to 14 organizations throughout the region. Each team used to monitor the sub-grantees independently, so the Operations Team tracked money given to grantees while the Programs Team tracked program outputs, with inadequate collaboration between the two teams to identify which activities produced the greatest value for money and which failed to achieve sufficient results. The teams also visited sub-grantees separately, increasing travel costs and causing unaligned support.
About one year ago, the teams established a joint planning and monitoring process to address this divide. They now make joint weekly travel plans, conduct joint performance reviews of each sub-grantee to ensure that financial resources are aligned to key focus areas, and cooperatively monitor budget performance to verify that money is spent effectively to maximize output. These efforts streamline communication between EGPAF teams and with sub-grantees, allow for more robust monitoring of value for money, and increase overall efficiency and effectiveness because resources are geared toward those activities identified as most impactful.
EGPAF also just announced an internal efficiency and effectiveness initiative to help employees approach their daily work with an eye toward maximizing existing resources and increasing the quality of their work. The Foundation rightfully acknowledges that this will not happen in a matter of weeks or even months, but is rather a long-term, institutional culture shift that needs time to develop. I am really excited to see how this initiative is operationalized and unfolds.
In the decentralized, complex and difficult contexts in which we work, how can we not constantly evaluate whether every dollar we spend and every minute we work contributes to the improvement of someone’s health? As we all move forward over the next year and throughout our careers, I hope we can keep efficiency and effectiveness on our minds. Ask yourself every so often how you or your organization can bring even the slightest bit more efficiency and effectiveness to your work, from simply aligning your field activities with those of your colleagues, to holding high-level meetings between directors of different organizations. In whatever way possible, integrating these principles into our work contributes to resource savings, faster achievement of our shared goals, and ultimately, more lives saved.