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In 2015, the John D and Catherine T MacArthur Foundation (hereafter Macarthur) announced the end of its Population and Reproductive Health (PRH) grant-making program and began to design strategies for exiting the field. The program ran from 1988 to 2019 and provided US$372 million to civil society organisations. In 2020, the Foundation issued a PRH History and Narrative Assessment (written by Dipa Nag Chowdhury, one of the authors of this paper) that describes the program’s scope and impact based on research and interviews with staff and grantee partners. Here, staff involved in the exiting phase reflect on lessons learned over the program’s lifespan. MacArthur’s PRH program funded sexual and reproductive health and rights (SRHR) policy-related advocacy, research, national and cross-country mobilisation, and thought leadership globally and in four countries: Brazil (1991–2001), India (1994–2019), Mexico (1992–2019), and Nigeria (1994–2019). Grant-making budget ranged from US$12–14M in total annually. The program had three distinct phases – expansion: setting up offices and creating initial strategy (1986–2000); focus on maternal mortality and young people’s reproductive and sexual health and rights (2000–2015); and exit (2015–2019). An international advisory group of experts and advocates designed the overarching program strategy which was adjusted to each country. Cross-country learning included staff discussions of country developments, grants, and trends, and exchange visits for grantee partners that strengthened program cohesion, facilitated change, inspired creativity, fostered relationships among thought leaders, and encouraged learning between local and global work. MacArthur’s program was simultaneously a result and a fomenter of changing paradigms in the field – perhaps most significantly, the shift from population control to women’s health and rights. The program’s name change from World Population Program to Population and Reproductive Health in 1994 showed a readiness to embrace reproductive health concepts while maintaining a connection with population growth concerns. Today, in the context of more diverse voices, a shift toward reproductive justice gathers momentum in some countries, moving further from “population” programs. In line with the rights-based approach, there is significant work emerging on empowerment, agency, and autonomy, particularly regarding reproductive and sexual choices and young people. The PRH program supported projects that advanced these concepts, such as networking, leadership, and advocacy projects for young people. But advances in SRHR are uneven worldwide, and the field has always faced challenges and setbacks. Beyond our program, the field will continue to adapt as people increasingly recognise the impact of other fields on women’s rights and wellbeing, such as the climate crisis; racism, discrimination, power, and colonisation; health emergencies such as COVID-19 and their aftermath; governance; closing civic space; migration; insecurity and violence; and other pressing issues. Within this context, we, staff of the PRH program charged with the unenviable task of bringing it to an end, share here our thoughts about adjusting, implementing, and closing a program in the hope that it may be useful to others. Collectively, our tenure spans from 1999 to 2020. We acknowledge and are grateful for the vision of those who came before us, recognising that our perceptions are influenced by the early days of the program but more heavily weighted to the last 20 years.

CHARLES UNIVERSITY FACULTY OF SOCIAL SCIENCES Institute of Political Studies Department of Political Science Abstract 2020 Kateřina Krestová Abstract A decade ago, the WHO decided to make a commitment of reforming itself. Above all, the funding situation was unsustainable. The main source of WHO's funding is voluntary contributions. Anyhow promising the term voluntary might seem, the reality is more complicated since the majority of these contributions is tightly earmarked towards specific programmes. Implying the WHO is not allowed to use the money where it is needed but it must be spent according to donor's wishes. This makes budgeting highly inflexible, the financing is imbalanced between categories and efficiency of fulfilling WHO's mandate declines. The reform launched in 2010 ought to fix these issues. This thesis evaluates the efficiency of the reform; firstly, total budget patterns are compared. Followingly, the attention is given to a specific category of Noncommunicable diseases due to its most severe underfunding. The analysis was conducted based on extensive datasets never gathered before comparing all types of contributions for every category from 1999 to 2019. Findings indicate unsatisfactory results of the reform; flexible sources have not increased, contrarily earmarked donations have...

Through case studies and empirical analysis, scholars have uncovered convincing evidence that individual donors influence lending decisions of international financial institutions (IFIs) such as the World Bank and the Asian Development Bank. Less clear are the mechanisms by which donors exert influence. Potential mechanisms are either formal or informal. Formal influence is through official decisions of the board of executive directors while informal influence covers all other channels. This paper explores the role of informal influence at the Asian Development Bank by examining the flow of funds after loans are approved. Controlling for commitments (loan approvals), are subsequent disbursements linked to the interests of the key shareholders, Japan and the U.S.? I compare these findings with results for the World Bank and consider implications for institutional reforms.

This paper investigates U.S. informal influence in the Inter-American Development Bank (IDB) by testing whether IDB loans disburse faster when the borrowing country is geopolitically or economically important to the U.S. The methodology is similar to that in earlier work on the World Bank and the Asian Development Bank and relies on the governance structure in which formal donor influence ends with loan approval, i.e., prior to loan disbursement. In contrast to findings for the World Bank and the Asian Development Bank, we do not uncover convincing evidence of consistent U.S. informal influence in the Inter-American Development Bank.

In the last few years, numerous econometric studies have unearthed evidence of donor influence over the geographic distribution of funds from international financial institutions (IFIs). Scholars are now beginning to use quantitative methods to delve into the details of donor influence to understand better how IFIs function and to guide institutional reform. The evidence suggests that donors influence both the amount of funds committed (the number and size of loans) and the disbursement of committed funds. This paper advances the literature by applying stochastic frontier analysis to a novel data source to examine factors that affect how quickly World Bank projects proceed from identification to approval, i.e., how long it takes to prepare a project. Accelerated preparation is one explanation for how the World Bank might increase the number of loans to a recipient member country within a fixed time frame, for example in response to that country siding with powerful donor countries on important UN votes or while that country occupies an elected seat on the UN Security Council or the World Bank Executive Board.

Recent scholarship has uncovered convincing evidence of systematic donor influence in international financial institutions such as the World Bank. Less clear is how donors influence international financial institutions’ decisions. Possible avenues are formal and informal: formal influence through official decisions of the Board of Executive Directors and informal influence over decisions not made at the board level. This article explores the role of informal influence at the World Bank by examining the flow of funds after loans are approved. Controlling for commitments (loan approvals), are subsequent disbursements linked to the geopolitical interests of important donors? Since the Board of Executive Directors is formally involved in loan approval but not in disbursement decisions, this provides an interesting case to identify the avenues of influence. The results indicate the scope of reforms needed to bolster the independence of the World Bank.

Background: In Tanzania, decentralisation processes and reforms in the health sector aimed at improving planning and accountability in the sector. As a result, districts were given authority to undertake local planning and set priorities as well as allocate resources fairly to promote the health of a population with varied needs. Nevertheless, priority setting in the health care service has remained a challenge. The study assessed the priority setting processes in the planning of the prevention of mother to child transmission of HIV (PMTCT) programme at the district level in Tanzania. Methods: This qualitative study was conducted in Mbarali district, south-western Tanzania. The study applied indepth interviews and focus group discussions in the data collection. Informants included members of the Council Health Management Team, regional PMTCT managers and health facility providers. Results: Two plans were reported where PMTCT activities could be accommodated; the Comprehensive Council Health Plan and the Regional PMTCT Plan that was donor funded. As donors had their own globally defined priorities, it proved difficult for district and regional managers to accommodate locally defined PMTCT priorities in these plans. As a result few of these were funded. Guidelines and main priority areas of the Ministry of Health and Social Welfare (MoHSW) also impacted on the ability of the districts and regions to act, undermining the effectiveness of the decentralisation policy in the health sector. Conclusion: The challenges in the priority setting processes revealed within the PMTCT initiative indicate substantial weaknesses in implementing the Tanzania decentralisation policy. There is an urgent need to revive the strategies and aims of the decentralisation policy at all levels of the health care system with a view to improving health service delivery. publishedVersion