Submission to IDC VfM enquiry: Malaria No More UK

Enhancing Value for Money in FCDO Programming

This inquiry into value for money (‘VfM’) reflects the need for FCDO to maximise the impact of ODA spending, especially given fiscal pressures and increasing domestic diversions of aid funds. This submission from Malaria No More UK (MNMUK) addresses key areas of the inquiry, including the FCDO’s definition of VfM, its monitoring and oversight mechanisms, and alignment with financial instruments and delivery models.

Defining value for money in the context of FCDO

The FCDO has not published an updated VfM framework since its 2020 merger with the Department for International Development (‘DFID’). DFID’s 2011 framework defined VfM as “maximising the impact of each pound spent to improve poor people’s lives,” emphasising efficiency, equity, and transparency.[1] However, the FCDO’s current approach appears less aligned to these priorities, with a stronger focus on diplomatic and geopolitical considerations, according to the Centre for Global Development.[2]

VfM should prioritise measurable outcomes, such as lives saved, illnesses prevented, and economic returns generated. DfID placed a high priority on preventing death and illness,[3] and Malaria No More UK believe that economic returns are also a key element of measuring progress. Investing in malaria elimination, for example, delivers exceptional value for money by generating health, economic, and social benefits. Malaria control and prevention reduce the burden on health systems, and every dollar spent on malaria yields returns through increased productivity, improved educational outcomes, and strengthened economies in affected regions.[4]

Malaria No More UK believes that one of the most cost-effective and greatest returns on investment is through investment in global health multilaterals, such as Gavi, the Vaccine Alliance (Gavi) and The Global Fund to Fight Aids, Tuberculosis and Malaria (The Global Fund). These multilaterals raise funds from governments and private donors, pool resources at scale, and negotiate with suppliers to reduce prices, ensuring that life-saving interventions reach those who need them most at the lowest possible cost. The Global Fund partnership has reduced the combined mortality rate from AIDS, tuberculosis (TB), and malaria by over 50%, saving more than 50 million lives since 2002. Since 2000, Gavi has supported the vaccination of over 1 billion children, preventing more than 17 million future deaths.[5]

The Global Fund’s Strategic Initiatives fund highlights how health outcomes can align with VfM principles, producing scalable, sustainable results.[6] For instance, its Breaking Down Barriers (‘BDB’) initiative, which focuses on reducing human rights-related barriers to health services, exemplifies how aligning health outcomes with VfM principles can yield scalable, sustainable results, particularly in addressing malaria. Since 2017, the initiative has supported countries in reducing human rights and gender-related barriers to health services, empowering communities to access malaria care. Efforts include training healthcare providers, engaging traditional leaders, and strengthening legal support systems. Progress assessments highlight increased access to malaria services, reduced stigma, and improved collaboration, showing that addressing human rights barriers and barriers to gender equity enhances the impact of health interventions.[7]

Similarly, the Global Fund’s innovative performance-based funding model aligns health and financial goals, holding recipients accountable while incentivising high-impact interventions.[8] Under this model, countries receive funding in phases, with continued support contingent on achieving pre-agreed performance targets, such as reducing malaria cases or expanding access to treatment. This level of coordination and focus on results ensures that funding is maximised, and health outcomes, such as malaria reduction, are achieved more effectively. By supporting these institutions, the UK can ensure that its foreign aid continues to deliver tangible, long-lasting benefits while maintaining VfM through shared responsibility and expertise.

Moreover, Gavi’s immunisation initiatives have demonstrated exceptional returns on investment, with a $54 return for every $1 spent.[9] Similarly, The Global Fund partnership has yielded exceptional economic returns since 2002; disbursements from the fund of $63bn are estimated to have generated health gains with a monetised intrinsic value of $1.2trn, and direct productivity gains of $400bn.[10] Additionally, thanks in part to UK funding, The Global Fund has saved over 65 million lives since 2002.[11] Indeed, at the last replenishment of The Global Fund, UK aid was estimated to save over one million lives from HIV, TB and malaria.[12] Moreover, research by Malaria No More UK indicates that the elimination of malaria could yield significant economic returns for the United Kingdom as well as endemic countries including an estimated $127 billion boost to GDP in malaria-endemic countries across Africa by 2030, underscoring both regional and global economic benefits.[13] Between G7 countries and key African countries alone, there could be a boost of $3.9bn to export trade over this period.[14]

Multilateral organisations like Gavi, The Global Fund, and the World Bank play a crucial role in ensuring VfM by centralising efforts, streamlining operations, and focusing on measurable outcomes. Their collaborative models enable pooling of resources from multiple donors, ensuring efficiency and scalability of interventions. For instance, Gavi’s vaccine partnerships have resulted in significant cost savings through economies of scale and coordinated procurement, providing vaccines at lower costs to countries in need. Its most recent initiative, the African Vaccine Manufacturing Accelerator, will make up to US$1.2 billion available over ten years to support the sustainable growth of Africa’s manufacturing base.[15] This coordinated approach by multilateral organisations not only enhances the value of every dollar spent, but also fosters long-term, sustainable health improvements across the globe.

Investments in malaria research and development (R&D) represent high value for money by driving innovative solutions that deliver measurable health outcomes and long-term economic returns. The UK’s leadership in health R&D has already yielded significant advancements, such as the development of the R21 malaria vaccine by Oxford University’s Jenner Institute, which is now being rolled out across sub-Saharan Africa. This is expected to save millions of lives, particularly among children under five, the population most vulnerable to malaria. By strengthening support for health R&D, the FCDO can maximise its impact on global health while showcasing the UK’s scientific and technical expertise. Strengthening innovation-driven funding for health R&D not only amplifies the UK's contribution to global health but also ensures that the country remains at the forefront of scientific advancements with a lasting impact on the world’s most vulnerable populations – a key mandate of FCDO and formerly DfID.

The post-merger landscape and VfM implications

The merger of DFID and the Foreign and Commonwealth Office (FCO) aimed to streamline UK aid delivery, but it has raised concerns about the impact on VfM. At the time, a group of over 200 UK aid organisations, led by Bond expressed concerns that DFID’s poverty-focused mandate had been replaced by broader diplomatic objectives, which raised concerns of risking underinvestment in transformative, high-impact programmes.[16] More recently, analysis by the Independent Commission for Aid Impact (ICAI) has shown that this shift challenged the ability to maintain focus on poverty reduction and global health outcomes, which are foundational to VfM in development.[17]

Monitoring effectiveness

Effective monitoring of programme delivery and outputs is critical for ensuring VfM. However, according to Bond and its most recent analysis of FCDO accounts, the FCDO faces challenges in achieving consistency across its programming, particularly in the aftermath of the merger.[18] Transparent and data-driven evaluation mechanisms are essential for addressing these gaps.[19]

The FCDO’s oversight mechanisms play a crucial role in ensuring VfM across its ODA budget. However, according to the National Audit Office’s Managing reductions in Official Development Assistance spending, existing processes lack the rigour needed to maximise impact and measure progress against its aims and objectives.[20] Revitalising these mechanisms is critical to addressing inefficiencies and ensuring that funds are used effectively.

According to ICAI, The FCDO’s current funding model, which allocates a growing share of Official Development Assistance (ODA) to cover in-donor refugee costs, has diminished the overall cost-effectiveness of the UK’s aid budget. [21] This shift in priorities could restrict investment in high-impact global programmes, such as malaria elimination, strengthening essential health systems, and increasing access to education for disadvantaged groups. ICAI argue that by prioritising domestic-focused expenditure over addressing critical global challenges, this approach undermines long-term development outcomes, limiting both the UK's ability to lead on global health and the positive impact on partner countries' growth.[22]

Conclusion

The FCDO faces significant challenges in ensuring VfM across its ODA programming. According to ICAI, the absence of an updated VfM framework, coupled with inconsistent monitoring and oversight mechanisms, has limited the department’s ability to deliver measurable outcomes.[23] By adopting a more outcome-focused approach, drawing on lessons from and investing in Gavi and the Global Fund, and revitalising its oversight mechanisms, Malaria No More UK believe the FCDO can enhance its ability to achieve VfM and maximise the impact of UK aid.

Investments in innovation, such as malaria R&D, and targeted financial instruments can further strengthen VfM by delivering long-term benefits for global health and development. As the FCDO navigates fiscal constraints and evolving priorities, a cohesive, impact-driven VfM strategy will be essential for maintaining the UK’s leadership in international development.