The Global Fund to Fight AIDS, Tuberculosis and Malaria was created as a new type of international organisation. Its founders uniquely enfranchised non-state actors on its Board, hoping that decision would attract new resources to combat these diseases. Funding decisions would be evidence-based rather than politically-driven. And, the institution would be deliberately ‘lean’ to promote ‘country-ownership’ of grant proposals and implementation. The Fund’s Board (‘principals’) made deliberate choices to constrain the autonomy of its Secretariat (‘agent’). Delegation was strictly limited. In theory, this was to ensure the Fund remained a catalyst for donor funding, evidence-based decision-making and country-ownership. However, the research adduced for this thesis suggests inadequate delegation opened opportunities for direct donor influence in recipient countries. This thesis assesses three specific dimensions of the Fund’s performance in its first decade. The first concerns whether the Fund successfully mobilised more resources, from more funders and did so more reliably. The second is whether the Fund made initial and continued funding decisions in an identifiable evidence-based way. The third centres on ‘country-ownership:’ whether recipient and donor countries on the Fund’s Board had equal influence and whether grant writing and oversight can be assessed as being recipient country ‘owned.’ Data is aggregated from several sources, including: the Fund’s grant portfolio, individual grant agreements and Board documentation; the U.S. PEPFAR programme; and, the Organisation for Economic Cooperation and Development. The research reveals the Fund likely gave a ‘kick-start’ to resources flowing to its diseases but PEPFAR’s arrival a year later contributed relatively more. Broad-based support did not emerge though the Fund proved relatively more successful in converting pledges to contributions. The Fund made evidence-based decisions for initial and continued funding, but the latter is a less robust conclusion given missing grant performance data. Equal donor and recipient Board representation was insufficient to ensure recipients had influence equal to donors. The Secretariat never developed an in-country presence but donors embedded themselves in-country, through grant oversight mechanisms and providing technical assistance to implementers. Principal-agent theory generally assumes agents have more information than principals, a key source of their authority. In the Fund, that asymmetry was in the principals’ favour. The scant delegation of authority to the Secretariat left donors in a position to exert control at all levels. The Fund was an experiment in global governance but has not yet proven to be a success in establishing a new model for cooperation.

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) offers new approaches and challenges in international aid for health. Little research is available exploring the experiences of individuals and communities working within the confines of GF policies in Latin America. The study fills this gap through a qualitative exploration of local experiences with tuberculosis (TB) services and the GF in Nicaragua. <p>This study sought to examine local stakeholders (administrators, health personnel and persons affected by TB) experiences related to GF policies relevant to TB services in Nicaragua. The study drew from a population health perspective and was informed by an ethnomethodological approach. Key themes focused on TB control, health systems and health rights. Data collection involved contextual analysis, participant observation, in-depth interviews and focus groups. The study involved 6 months of fieldwork in Nicaragua from November 2005-April 2006. Fieldwork was conducted with the support, participation and assistance of the Centre for Health Research and Studies, the Damian Foundation and the National Tuberculosis Control Program. <p>Analysis of findings shows various internal and external challenges in communication/procedural and disbursement/execution aspects of the GF grant. In TB control, participants identified private sector participation, case detection & reduced abandonment as improvements resulting from the GF project, though sustainability was a key concern. In health systems, concerns of efficiency and efficacy in the use of funds were commonly expressed. The focus on human resource development via the GF was considered a strength of the project. Community participation and the reduction of stigma, two facets of health rights, were perceived to have improved through the GF grant; however, remain identified as key issues for improving the context of TB in Nicaragua. The experiences of people working to implement or receiving TB services and GF activities in Nicaragua offer valuable insight into the strengths and challenges of this country-driven approach to aid for health. The GF needs to give more attention to such experiences a resource for improving flexibility and assuring sustainability in program strengthening and human resource development.

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) offers new approaches and challenges in international aid for health. Little research is available exploring the experiences of individuals and communities working within the confines of GF policies in Latin America. The study fills this gap through a qualitative exploration of local experiences with tuberculosis (TB) services and the GF in Nicaragua. <p>This study sought to examine local stakeholders (administrators, health personnel and persons affected by TB) experiences related to GF policies relevant to TB services in Nicaragua. The study drew from a population health perspective and was informed by an ethnomethodological approach. Key themes focused on TB control, health systems and health rights. Data collection involved contextual analysis, participant observation, in-depth interviews and focus groups. The study involved 6 months of fieldwork in Nicaragua from November 2005-April 2006. Fieldwork was conducted with the support, participation and assistance of the Centre for Health Research and Studies, the Damian Foundation and the National Tuberculosis Control Program. <p>Analysis of findings shows various internal and external challenges in communication/procedural and disbursement/execution aspects of the GF grant. In TB control, participants identified private sector participation, case detection & reduced abandonment as improvements resulting from the GF project, though sustainability was a key concern. In health systems, concerns of efficiency and efficacy in the use of funds were commonly expressed. The focus on human resource development via the GF was considered a strength of the project. Community participation and the reduction of stigma, two facets of health rights, were perceived to have improved through the GF grant; however, remain identified as key issues for improving the context of TB in Nicaragua. The experiences of people working to implement or receiving TB services and GF activities in Nicaragua offer valuable insight into the strengths and challenges of this country-driven approach to aid for health. The GF needs to give more attention to such experiences a resource for improving flexibility and assuring sustainability in program strengthening and human resource development.

The Global Fund to Fight HIV/AIDS, Malaria and TB and U.S President’s Emergency Fund for AIDS Relief (PEPFAR) are global health initiatives (GHIs) that were established in the early 2000s with the mandates to increase global capacity to address HIV and AIDS rapidly. When the two GHIs were created, Namibia was one of the highest recipients of funding from both GHIs. A significant portion of their support to the country went to the Ministry of Health, which was the principal provider of treatment services in the country. Critics have argued, however, that the rise of financial support from the Global Fund and PEPFAR was associated with the creation of new administrative structures and procedures at the country level. This approach raises important questions about the degree to which Namibian health policymakers were able to exercise autonomy in the presence of GHI support. The aim of this thesis is to analyse the implications for institutional capacity and autonomy at the rise and fall of funding from the Global Fund and PEPFAR to the Ministry of Health concerning financial flows; human resources recruitment; and civil society engagement. With a focus on the changing relationship between the Ministry of Health and the two initiatives, the thesis examines the implications for country ownership and health systems capacity in the context of decreasing financial support from the Global Fund and PEPFAR. The field studies for this research was undertaken in 2011- 2012, when the two GHIs had indicated their intentions to scale-down the financial support made available to Namibia. This thesis uses multiple sources of data to qualitatively analyse the influences of Global Fund and PEPFAR support to Namibia from when the two initiatives were first established in 2002 and 2004, respectively, to 2012. A principal source of data was 43 semi-structured interviews conducted in Namibia during a placement with the Directorate of Special Programs in the Ministry of Health in early 2012. For financial flows, both the Global Fund and PEPFAR channelled and managed their funding through funder-specific structures and procedures that were developed and operated in parallel to existing Ministry of Health operations. Both for financial flows and human resources, initial structures and processes created difficulties for the Ministry of Health’s long-term objectives for HIV and AIDS. For civil society engagement, the thesis examined the Ministry of Health’s relationship with the Global Fund. At the rise of funding, the Global Fund required the establishment of a new multi-sector coordination structure for HIV and AIDS. This new structure operated at the same time as the existing national coordination structure and was perceived as having undermined the Ministry of Health’s role as the primary steward of Namibia's response. The Global Fund was also criticised for initially funding civil society organisations without making provisions for sustaining their capacity in the event of funding decline. The findings presented in this thesis indicate that at the rise of financing, the Ministry of Health’s engagement with the two HIV and AIDS GHIs initiatives was governed by the objectives of the two initiatives, rather than the long-term health systems goals of the Namibian Government. Their relationships with Namibia had an adverse impact on the Ministry of Health’s autonomy in making decisions on the national response to HIV and AIDS. The initial operations of the GHIs also had negative implications for Namibia's ability to sustain the health systems capacity they had helped to increase.

Submitted by Guilherme Lopez Ghidetti (guilherme.ghidetti@gmail.com) on 2017-09-04T22:40:46Z No. of bitstreams: 1 Dissertação - Guilherme Ghidetti.pdf: 995353 bytes, checksum: 4373446355579d7219e09a399a6d9851 (MD5) / Rejected by Joana Martorini (joana.martorini@fgv.br), reason: Prezado Guilherme, boa noite. Por gentileza, corrija o nome da escola na capa do seu trabalho para que eu possa aprovar! "Getulio" sem acento. Qualquer dúvida entre em contato pelo e-mail mestradoprofissional@fgv.br ou ligue 3799-7764 Att, on 2017-09-04T23:03:37Z (GMT) / Submitted by Guilherme Lopez Ghidetti (guilherme.ghidetti@gmail.com) on 2017-09-04T23:44:01Z No. of bitstreams: 1 Dissertação - Guilherme Ghidetti.pdf: 924017 bytes, checksum: e4d23b4bb78e47633d5326b5724ebd78 (MD5) / Approved for entry into archive by Joana Martorini (joana.martorini@fgv.br) on 2017-09-05T22:28:24Z (GMT) No. of bitstreams: 1 Dissertação - Guilherme Ghidetti.pdf: 924017 bytes, checksum: e4d23b4bb78e47633d5326b5724ebd78 (MD5) / Made available in DSpace on 2017-09-06T14:33:11Z (GMT). No. of bitstreams: 1 Dissertação - Guilherme Ghidetti.pdf: 924017 bytes, checksum: e4d23b4bb78e47633d5326b5724ebd78 (MD5) Previous issue date: 2017-08-09 / Global financial markets are getting more and more integrated. One must consider this phenomenon’s effects in making investment decisions: a Brazilian investor should not rely just on its own local market when making an investment. Within this background and uncountable investment opportunities across the globe, this paper has the objective to help investment professionals in the decision of where to concentrate efforts and resources to select the best investment funds when building a global stocks portfolio. This study analyses the determinants of mutual fund performance for a sample of 2,223 investments funds focused in stocks, for the period between 2008 and 2015. These funds’ investments guidelines restrict them to invest in one of the following regional blocks: United States, Europe, Asia Pacific ex-Japan and Brazil. Data related to funds’ characteristics, economic and financial development, regional stock markets and respective fund industry characteristics where collected to identify and understand their impact in funds’ ‘alpha’. We conclude that investors must focus their efforts looking for active investment managers in regions with the following characteristics: better access to information, developed stock markers (being by larger participation in the region’s economy or higher trading volumes), lower competition in the fund industry and lower passive investment penetration in the market. Regarding fund’s characteristics, larger funds that are receiving inflows should have investors’ preference. / O mercado financeiro está cada vez mais integrado mundialmente e os efeitos desse fenômeno nas decisões de investimento de alocadores de recursos não podem ser desprezados: um investidor brasileiro não deveria se restringir ao mercado local na sua tomada de decisões. Diante desse cenário e das inúmeras alternativas de investimentos disponíveis ao redor do globo, esse trabalho tem como objetivo auxiliar esses alocadores de recursos na decisão de onde concentrar esforços e recursos para selecionar as melhores opções de fundos de investimento no mercado de ações global. Foi realizado um estudo sobre os determinantes de performance de fundos de investimento a partir de uma amostra de 2.223 fundos de ações, com dados no período entre 2008 e 2015, em frequência anual. Esses fundos seguem mandatos de investimentos focados exclusivamente em cinco blocos regionais: Estados Unidos, Europa, Japão, Ásia Pacífico ex-Japão e Brasil. Coletou-se dados relacionados às características dos fundos, ao desenvolvimento econômico-financeiro e do mercado de ações dessas regiões e características das respectivas indústrias de fundos. A partir desses dados, foi realizada uma análise de dados em painel com a geração de valor dos fundos de investimento, 'alfa', como variável explicada e as variáveis citadas anteriormente como variáveis explicativas. Conclui-se que os investidores devem focar seus esforços em busca de bons gestores ativos em regiões onde o acesso a informação seja bem difundido, o mercado de ações bem desenvolvido, seja por ter uma relevante participação na economia ou por negociar altos volumes de ações, tenha uma indústria de fundos menor e com baixa participação da gestão passiva. Já em relação às características de fundos, fundos maiores e que estejam recebendo fluxo de investimentos positivo devem ter a preferência dos investidores.

This thesis contributes to debates on the role of civil society organizations (CSOs) in global governance by asking if their participation in the global response to HIV/AIDS has been transformative – with transformation conceptualized as change towards a more equitable order. Adopting a critical International Relations approach, and applying qualitative methods, it analyzes how CSOs used the initial failure of biomedical responses to the epidemic to advance a human rights frame, which justified their participation in global governance. This frame complemented conceptions of AIDS exceptionalism, and has recently shifted in response to an increased focus on key populations. CSOs continue to advance the rights frame in global institutions – the focus here being on how they have done so within UNAIDS and the Global Fund to Fight AIDS, Malaria and Tuberculosis. However, rigid bureaucracies and dominant power relationships limit CSOs’ ability to transform these institutions to be more responsive to and representative of those affected by the epidemic. CSOs have further struggled to influence the largest global donors of the HIV/AIDS response – the Global Fund and PEPFAR – to direct greater resources to rights-based initiatives, despite CSO participation in resource mobilization. Though CSO participation has been restricted by donor state power, bureaucratic structures, and changes in the political economy of global health, CSOs have continued to promote potentially transformative alternatives, and so have continued to represent the interests of those most affected by the epidemic. This allows potential for further transformative alternatives.

This thesis contributes to debates on the role of civil society organizations (CSOs) in global governance by asking if their participation in the global response to HIV/AIDS has been transformative – with transformation conceptualized as change towards a more equitable order. Adopting a critical International Relations approach, and applying qualitative methods, it analyzes how CSOs used the initial failure of biomedical responses to the epidemic to advance a human rights frame, which justified their participation in global governance. This frame complemented conceptions of AIDS exceptionalism, and has recently shifted in response to an increased focus on key populations. CSOs continue to advance the rights frame in global institutions – the focus here being on how they have done so within UNAIDS and the Global Fund to Fight AIDS, Malaria and Tuberculosis. However, rigid bureaucracies and dominant power relationships limit CSOs’ ability to transform these institutions to be more responsive to and representative of those affected by the epidemic. CSOs have further struggled to influence the largest global donors of the HIV/AIDS response – the Global Fund and PEPFAR – to direct greater resources to rights-based initiatives, despite CSO participation in resource mobilization. Though CSO participation has been restricted by donor state power, bureaucratic structures, and changes in the political economy of global health, CSOs have continued to promote potentially transformative alternatives, and so have continued to represent the interests of those most affected by the epidemic. This allows potential for further transformative alternatives.