IDC Inquiry: The FCDO's approach to value for money – call for evidence
Submission: Action for Global Health Network
Action for Global Health (AfGH) is a network of more than 50 organisations based in the UK and low- and middle-income countries (LMICs) working towards a world where the universal right to health is realised. AfGH acts as the coordinator between the UK government and global health civil society, convening regular meetings and sharing learning from across our network.
The former Department for International Development (DFID)’s approach to value for money (VfM) focused on the 3Es: economy, efficiency, and effectiveness. Various FCDO frameworks also consider equity, making sure that development results are targeted at the poorest and includes sufficient targeting of women and girls. However, in recent years, the UK’s role in advancing global health equity and ensuring value for money has waned as cuts to the overall official development assistance (ODA) budget have impacted the UK’s ODA for health. Post COVID-19, the global development landscape demands a more nuanced, holistic understanding. While the current framework of economy, efficiency and effectiveness provides a foundational approach, it fails to capture the complex and interconnected nature of modern development challenges and the paradigm shift needed to achieve prevention at source.
Additionally, the UK’s response to the global COVID-19 pandemic pivoted UK health spending towards a greater focus on global health security and in-country refugee costs. AfGH research indicated that cuts (from 0.7% of GNI to 0.5%) to programmes, represented an overall cut of global health spending of up to 40%. This was a devastating blow catastrophic to the UK’s pandemic security and the delivery of essential health services globally (severely impacting those marginalised, such as women, elders, children, LGBTQIA+ and disabled persons) for generations.
With cuts as large as these, which caused the overnight closure of multiple programmes, it is questionable whether value for money is achievable in any way. The UK's sudden pivot in these ways has also revealed the fragility of existing VfM frameworks. The current framework of economy, efficiency, and effectiveness must evolve to include the principles of sustainability and resilience, particularly in the face of pandemics and other health crises. Investments in programmes that build long-term health system capacity offer unparalleled value for money, that may not be captured by traditional metrics, by addressing the root causes of inequality and preventing future health emergencies.
The FCDO's definition of value for money should also prioritise measurable outcomes such as lives saved, illnesses prevented and economic returns generated, as evidenced by the success of multilateral health initiatives like Gavi's vaccination programmes and The Global Fund's disease control efforts. These programmes provide a clear demonstration of how targeted investments can deliver outsized health and economic benefits. Refocusing on high-impact global health initiatives like Gavi and The Global Fund will help ensure funds are directed towards transformative, cost-effective programmes that align with the UK's international development objectives.
The merger of the Department for International Development (DFID) and the Foreign and Commonwealth Office (FCO) has been much more than an administrative restructuring – it has been a fundamental reimagining of the UK's global development strategy. This transformation reflects a broader geopolitical shift, moving from traditional aid models to a more integrated approach of diplomatic, security, and development objectives. However, this merger continues to raise critical questions about the potential politicization of aid and the potential compromise of development principles. By merging diplomatic and development mandates, there continues to be a risk of subordinating humanitarian and equity-driven considerations to geopolitical interests.
By merging mandates, the FCDO has created a risk of deprioritising evidence-based programmes in favour of short-term diplomatic gains, undermining the long-term value of investments in health, such as malaria R&D and disease eradication efforts. The absence of a unified definition of value for money in the post-merger FCDO has contributed to fragmented priorities. Re-establishing a framework centred on measurable global health outcomes is essential to safeguard the effectiveness and impact of UK aid.
Monitoring the effectiveness of FCDO programming remains inconsistent since the merger of DFID and the FCO. Given the broader remit post-merger and opportunity this presents for more systems-based approaches to rise to the challenges of tackling complex problems, monitoring and evaluation frameworks need to enable and value activities and impact across sectors, levels (e.g. local vs global) and timescales. While the FCDO employs frameworks like the Global Evaluation and Monitoring Framework Agreement (GEMFA) to improve oversight across thematic areas such as health and climate change, the application of these tools varies significantly by programme and geography. For example, GEMFA provides structured evaluations to ensure spending aligns with strategic objectives, but its scope is often limited to smaller-scale assignments, which may not address systemic challenges across larger investments.
In the face of the complex and interlinked global challenges under the FCDO’s remit, there is a demand for integrated approaches to effectively and efficiently deliver impact. For example, across health sectors such as human and animal health to prevent emergence of zoonotic infectious diseases or to sustainably provide global food security in the face of a changing climate. There is little existing evaluation of the appropriate level of integration and the success of its implementation at various project phases to yield value for money. Such a process evaluation framework as the NEOH framework offers a multi-criteria decision analysis, with both qualitative and quantitative assessments linked to conventional metrics to help inform the potential vs. actualised value for money from any intervention.
To strengthen value for money assessments, FCDO could draw lessons from multilateral initiatives like Gavi and the Global Fund, which offer robust monitoring and accountability frameworks rooted in transparent, data-driven evaluation. These models emphasise real-time outcome tracking and partnership-based reporting, enabling them to navigate complex delivery ecosystems effectively. Embedding such approaches within FCDO’s oversight mechanisms could foster a more cohesive, standardised monitoring culture post-merger, enhancing the impact of UK aid spending.
Traditional oversight often resembles a top-down and bureaucratic process disconnected from ground realities that focuses on outputs instead of outcomes. We propose an alternative: a participatory, transparent, and dynamic oversight model that:
● Integrates community voices;
● Ensures real-time adaptive management;
● Promotes radical transparency;
● Builds local capacity for self-evaluation.
This approach moves beyond compliance to genuine collaborative development and focuses on outcomes. To implement, it will require adequate resources and training by all stakeholders.
Drawing lessons from models like the Global Fund, the FCDO could enhance participatory oversight by incorporating community voices and building local capacity for self-evaluation. The Global Fund’s Regional Platforms, for example, create opportunities for community-based monitoring, knowledge sharing and capacity building, enabling local groups to better engage in funding mechanisms and oversight processes. These initiatives have improved programme accountability and strengthened collaboration between stakeholders, including civil society organisations, technical partners, and fund managers.
Additionally, expanding cross-departmental collaboration within the UK government could ensure ODA spending aligns with broader foreign policy goals and strengthens transparency. A shift toward real-time adaptive management and radical transparency – similar to the Global Fund’s integration of community-driven insights – can help the FCDO move beyond compliance-driven oversight toward genuine development impact
A key part of the value for money narrative should ensure that those traditionally left behind/marginalised are reached. Simply looking at numbers is not enough; those numbers should be disaggregated so as to see who is benefiting (and, crucially, not benefiting) from interventions. For example, the WHO Global Report on health equity for persons with disabilities highlights the need for data disaggregated by disability as it is only with this data that we can truly see the health inequities faced by persons with disabilities. A lack of data on the impact of public health interventions for persons with disabilities, and poor recording of disability in those accessing and intervention, reinforces the lack of disability inclusion in these settings. If we are to look towards reaching those furthest behind and ensuring value for money in providing equitable access, it is imperative that we collect this data.
The FCDO’s current funding model, which increasingly allocates ODA to in-donor refugee costs, has notably reduced the overall cost-effectiveness of the UK’s aid budget. This diversion limits investments in high-impact, transformative global programmes like malaria elimination, essential health systems strengthening, and education access for disadvantaged groups. Such allocations undermine long-term development outcomes by prioritising short-term, domestic-focused spending over addressing critical global challenges that benefit both the UK and partner countries.
Adopting a ring-fenced funding approach for key global health initiatives, such as Gavi and the Global Fund, would significantly enhance predictability and impact. This strategy aligns with commitments outlined in the UK’s White Paper on International Development, which emphasises a focus on global health, gender equality, and climate resilience. Ensuring these programmes receive protected funding would help rebuild the UK’s position as a leader in international development while maximising the efficiency and effectiveness of its aid spending.
Oxfam’s report, Sick Development, outlined the disparity of philosophies of aid of Finance Delivery partners and the lack of VfM . It demonstrated the need for the UK to lead the way in modelling a more equitable model that reaches the most marginalised. Under this new government, we have a unique opportunity to embark on a critical period of assessment and reflection on the role and delivery of health ODA – particularly in the aftermath of the COVID-19 pandemic, cuts to the ODA budget and reinvigorated movements for racial and gender justice.
As a network organisation, AfGH has held multiple discussions on where we should focus our efforts within the chaotic environment within which we are operating, given the increased burdens and challenges faced by our members, in order to be most effective in creating transformational change. Many of these discussions are relevant to the scope and remit of this inquiry, in terms of why the UK provides ODA and the challenges and opportunities for how ODA is delivered. Moreover, it is vital that we address these discussions in order to deliver positive, long-term change to the use and delivery of ODA.
Development is no longer about individual interventions but creating collaborative, interconnected ecosystems (including with the investment priorities of development banks). FCDO can work with stakeholders like AfGH/members/civil society to:
● Foster genuine partnerships
● Create aligned strategic visions
● Promote knowledge sharing
● Build collective capacity
These components are essential to move beyond transactional partnerships to transformative collaborations and ensure international financing architecture is inclusive, equitable and integrated to provide holistic support to communities that require it, particularly in regards to health.
To enhance alignment, the FCDO should work with its partners to co-create health financing strategies that are adaptable, sustainable, and equity-driven. This includes adopting a long-term, systems-focused approach to health aid, ensuring it complements investment priorities in infrastructure, education, and economic development. Collaborating with BII and MDBs to promote blended financing mechanisms could further scale up impactful programmes while ensuring cost efficiency and local ownership. By integrating health outcomes into their investment models, these partnerships would support inclusive, transformative growth aligned with the Sustainable Development Goals (SDGs).