Three essays form this thesis which addresses the effectiveness of interventions aimed at attaining two health Millennium Development Goals (MDG) set by the United Nations: a 2/3rds reduction by 2015 of 1990 child mortality rates (MDG4) and 3/4th reduction of 1990 maternal mortality rates by the same date (MDG5). The first chapter assesses the relative efficiency of 85 countries at using these interventions for the reduction of child and maternal mortality. It teases out the extent to which mortality reduction is a result of the interventions themselves as opposed to the context in which they are implemented. A three step procedure which includes Data Envelopment Analysis indicates that efficiency is mainly driven by context. Chapter 2 addresses the association between the 2000-2008 rates of change of interventions and the rate of change of mortality. It uses finite mixture modeling to take account of the possibility that there may be underlying heterogeneity in the mortality reduction functions of the 32 sub-Saharan African countries studied. Results support this hypothesis and show that an intervention may exhibit increasing returns to scale in some countries and decreasing returns to scale in others. Chapter 3 assesses the link between interventions and mortality rates and examines cost minimizing scenarios for attaining MDG4 and MDG5 in 27 sub-Saharan African countries. Lagged data on interventions predicts mortality rates (by OLS) to take into account the potential reverse causality between the two. Results indicate that achieving MDG mortality targets at the least possible cost invariably requires very substantive increases in medical human resources, yet training physicians has not been the main objective of public health organizations. Furthermore, improving the context in which interventions are implemented - increasing female literacy or effectiveness of political stability- allows countries to reach mortality targets with substantially lower levels of interventions (including, much lower levels of physician density).

The need for donor funding has increased significantly over the last decade. Without donor funding millions of people wouldn’t be alive today. Thanks either to research finding a cure, successful treatment, funds donated for food, aid toward building infrastructure, or giving people the opportunity to further their education. Donor funding thus facilitates a better future. A literature review was conducted to give background on the health sector and how these funds were distributed, ethical clearance, different types of reporting, the role project managers pays in a project and the sustainability of projects. Expenses in different countries were evaluated by gathering data from the internet, while two international funded projects are also used to state how funders divide their line items into different categories. The empirical study used a qualitative research approach by collecting and analysing data obtained from the MDG 2010 report and other freely available data on the web. The main findings from this thesis are: *The Millennium Development Goals (MDG’s) influence donor funding as it gives donors a guide towards funding needs. Donors are also influenced by their own preferences or what poses a burden to them individually. *The different types of reporting required for funding received, delay a project and the bureaucratic structures thereof are a hindrance. *Ethical clearance plays a fundamental role in the outcome of a project, as without ethical clearance a project cannot commence. *The objectives of a project play a critical role when applying for funding. This can change the focus of a project. *Expenses differ from country to country and funders need to take this into account when giving funding to recipient countries. *Project Managers and community involvement plays a critical role in ensuring sustainability of projects. THE SUSTAINABILITY OF DONOR FUNDED PROJECTS IN THE HEALTH SECTOR *The MDG’s are not on track and aid are focus on singular goals instead of multiple goals, to ensure an overall improved result. There is a major gap between needed funds and given funds. A single injection of funds will not be the solution to our health problem; different sectors need to collaborate together as we are facing a multi-dimensional problem. Trade and reform must also form part of this aid, ensuring a sustainable progression in the life’s of people. Donor funded projects may have a sustainable future, when taking in account the abovementioned findings. With the world trend in reporting changing rapidly, cost and management accountants as well as financial accountants and project managers have to equip them to adhere to the new way of reporting, namely integrated and sustainability reporting. South Africa is way behind and needs to catch up fast if they want to stay competitive in the “global donor funding market”. The limitations in this study were that not all expenses were evaluated and only 15 countries were looked at. An indebt look was taken into Africa with the empirical review, while Asia is also combating poor health issues. Some African countries like Sierra Leone and Zimbabwe did not have sufficient data to compare with other countries. From the research conducted, the following topics were identified that require further research: *Why are most projects in Third World countries not sustainable? *What plans are put into action to ensure that the MDG goals are reached? *Investigate what works for First World countries health systems and consider how that can be applied to Third World countries to ensure that they also get the best health care available. *Do donors take into account the different costs of countries when allocating funding to that specific country? *Establishing models to evaluate the sustainability of pilot projects and normal projects. *Establishing a model on how to distribute donor funds across different needs and not only one specific need. / MCom (Management Accountancy), North-West University, Vaal Triangle Campus, 2013

The need for donor funding has increased significantly over the last decade. Without donor funding millions of people wouldn’t be alive today. Thanks either to research finding a cure, successful treatment, funds donated for food, aid toward building infrastructure, or giving people the opportunity to further their education. Donor funding thus facilitates a better future. A literature review was conducted to give background on the health sector and how these funds were distributed, ethical clearance, different types of reporting, the role project managers pays in a project and the sustainability of projects. Expenses in different countries were evaluated by gathering data from the internet, while two international funded projects are also used to state how funders divide their line items into different categories. The empirical study used a qualitative research approach by collecting and analysing data obtained from the MDG 2010 report and other freely available data on the web. The main findings from this thesis are: *The Millennium Development Goals (MDG’s) influence donor funding as it gives donors a guide towards funding needs. Donors are also influenced by their own preferences or what poses a burden to them individually. *The different types of reporting required for funding received, delay a project and the bureaucratic structures thereof are a hindrance. *Ethical clearance plays a fundamental role in the outcome of a project, as without ethical clearance a project cannot commence. *The objectives of a project play a critical role when applying for funding. This can change the focus of a project. *Expenses differ from country to country and funders need to take this into account when giving funding to recipient countries. *Project Managers and community involvement plays a critical role in ensuring sustainability of projects. THE SUSTAINABILITY OF DONOR FUNDED PROJECTS IN THE HEALTH SECTOR *The MDG’s are not on track and aid are focus on singular goals instead of multiple goals, to ensure an overall improved result. There is a major gap between needed funds and given funds. A single injection of funds will not be the solution to our health problem; different sectors need to collaborate together as we are facing a multi-dimensional problem. Trade and reform must also form part of this aid, ensuring a sustainable progression in the life’s of people. Donor funded projects may have a sustainable future, when taking in account the abovementioned findings. With the world trend in reporting changing rapidly, cost and management accountants as well as financial accountants and project managers have to equip them to adhere to the new way of reporting, namely integrated and sustainability reporting. South Africa is way behind and needs to catch up fast if they want to stay competitive in the “global donor funding market”. The limitations in this study were that not all expenses were evaluated and only 15 countries were looked at. An indebt look was taken into Africa with the empirical review, while Asia is also combating poor health issues. Some African countries like Sierra Leone and Zimbabwe did not have sufficient data to compare with other countries. From the research conducted, the following topics were identified that require further research: *Why are most projects in Third World countries not sustainable? *What plans are put into action to ensure that the MDG goals are reached? *Investigate what works for First World countries health systems and consider how that can be applied to Third World countries to ensure that they also get the best health care available. *Do donors take into account the different costs of countries when allocating funding to that specific country? *Establishing models to evaluate the sustainability of pilot projects and normal projects. *Establishing a model on how to distribute donor funds across different needs and not only one specific need. / MCom (Management Accountancy), North-West University, Vaal Triangle Campus, 2013

This doctoral thesis focuses on the evaluation of the World Bank (WB) performance in delivering development aid to the Least Developed Countries (LDCs). For this purpose, an extensive research was performed to analyze a set of 790 Implementation Completion and Results reports for key economic and financial indicators. Results of this research provide various insights for the appraisal and the results stage of project delivery of the LDCs in different continents. In the final part of the economic and financial analysis the minimum Social Return on Investment (SROI) of the LDCs including all project costs was calculated. This SROI ratio outcome of 1 and 1.06 in the weighted and 1.3 and 1.72 in the unweighted case indicate that projects delivered by the WB have a positive effect on the poor countries. In the second part of this research project the data set of the ICR reports was qualitatively researched for negative ratings according to 3 core assessment categories for the overall project performance: Sustainability, bank performance and borrower performance. As a result the most critical categories respectively risks were outlined. In conclusion, the research analyses and findings support the general demand to provide even more development assistance to poor countries.:Table of Tables and Figures List of Equations List of Abbreviations 1 Introduction 1.1 Introduction to the Topic 1.2 Assessing Poverty Problems and Achieving Economic Growth 1.3 Millennium Development Goals 1.4 Development Aid 2 Research Approach 2.1 Objective 2.2 Structure 2.3 Least Developed Countries 2.4 World Bank 2.5 Data Access and Relevance 2.5.1 Data Basis 2.5.2 Implementation Completion and Results Reports 2.5.3 Project Types 2.6 Term “Performance” 2.7 Study and Research Questions 2.8 Challenges of this Doctoral Thesis 2.9 Contribution of this Thesis 3 Economic and Financial Analysis 3.1 SROI Concept 3.1.1 SROI Definition 3.1.2 SROI Process and Impact Map 3.1.3 Cost-Benefit-Analysis 3.1.4 SROI Calculation 3.2 SROI of World Bank Projects 3.2.1 Purpose of the Cost-Benefit-Analysis 3.2.2 Indicators of the SROI Calculation 3.2.2.1 Net Present Value 3.2.2.2 Capital and Recurring Costs 3.2.2.3 Project Dates and Duration 3.2.2.4 NPV-horizon 3.2.2.5 Discount Rate 3.2.3 Types of NPV-Cost-Ratios 3.2.3.1 Pro-Rata-Capital-Costs Ratio 3.2.3.2 Total-Capital-Costs Ratio 3.2.3.3 Pro-Rata-Capital plus Recurring-Costs Ratio 3.2.3.4 Total-Capital plus Recurring-Costs Ratio 3.2.4 Calculation of the proper SROI Ratio 3.2.5 Portfolio Analysis 3.2.6 Sensitivity Analysis 3.3 Additional Economic and Financial Indicators 3.3.1 Economic Rate of Return 3.3.2 Benefit-Cost-Ratio 3.3.3 Net Benefit 3.3.4 Financial Net Present Value 3.3.5 Financial Rate of Return 4 Results of the Economic and Financial Analysis 4.1 Analysis Approach and Setup 4.2 NPV Outcomes at the Appraisal Stage 4.2.1 Appraisal NPVs of the LDCs 4.2.2 Appraisal NPV Continent Comparison 4.3 NPV Outcomes of the Result Stage 4.3.1 Result NPVs of the LDCs 4.3.2 Result NPV Continent Comparison 4.4 Appraisal vs. Result NPVs 4.4.1 Results of the LDCs 4.4.2 Continent Comparison 4.5 Economic Rate of Return Result Values 4.5.1 Results of the LDCs 4.5.2 Continent Comparison 4.6 Additional Economic and Financial Indicator Result Values 4.6.1 Benefit-Cost-Ratio and Net Benefit 4.6.2 Financial Net Present Value and Financial Rate of Return 4.7 Overall Project Performance 4.7.1 Definition 4.7.2 Overall Project Performance Ratings 4.7.3 Outcome Calculation for Non-Financial Indicator Projects 4.7.4 Verification of Outcomes and Conclusion 4.8 NPV-Cost-Ratios and SROI Calculation 4.8.1 NPV-Cost-Ratios of the ICR Reports 4.8.1.1 Overall Results 4.8.1.2 Continent Comparison 4.8.2 Standardized NPV-Cost-Ratios 4.8.2.1 Overall Results 4.8.2.2 Continent Comparison 4.8.3 Calculating the Minimum SROI Ratio 4.8.3.1 Overall Results of the Capital SROI Ratio 4.8.3.2 Continental Comparison of the Capital SROI Ratio 4.8.3.3 Overall Results of the Minimum SROI Ratio 4.8.3.4 Continental Comparison of the Minimum SROI Ratio 4.8.4 Making Meaning of the Results 4.9 Summary and Conclusion 5 Qualitative Data Analysis 5.1 Content Analysis 5.2 Sustainability 5.2.1 Sustainability Rating Definition 5.2.2 Sustainability Rating Categories 5.3 Bank Performance 5.3.1 Bank Performance Definition 5.3.2 Bank Performance Categories 5.4 Borrower Performance 5.4.1 Borrower Performance Definition 5.4.2 Borrower Performance Categories 6 Results of the Qualitative Data Analysis 6.1 Sustainability 6.1.1 Quantitative Assessment of Sustainability Ratings 6.1.2 Outcome of the Content Analysis 6.1.2.1 Types of Reasons 6.1.2.2 Overall Results 6.1.2.3 Results in Haiti 6.1.2.4 Continent Comparison 6.1.3 Excursus: Positive NPV Projects 6.1.4 Summary and Conclusion 6.2 Bank Performance 6.2.1 Quantitative Assessment of Bank Performance Ratings 6.2.2 Outcome of the Content Analysis 6.2.2.1 Types of Reasons 6.2.2.2 Overall Results 6.2.2.3 Results in Haiti 6.2.2.4 Continent Comparison 6.2.3 Summary and Conclusion 6.3 Borrower Performance 6.3.1 Quantitative Assessment of Borrower Performance Ratings 6.3.2 Outcome of the Content Analysis 6.3.2.1 Types of Reasons 6.3.2.2 Overall Results 6.3.2.3 Results in Haiti 6.3.2.4 Continent Comparison 6.3.3 Summary and Conclusion 7 Overall Summary and Conclusion 8 Critical Acclaim and Recommendations 9 Outlook and Future Research List of Appendices Appendix References