Earmarking for global health: benefits and perils of the World Bank’s trust fund model

• Trust funds (non-core voluntary aid) for health projects made up nearly half of the World Bank’s total funding for health and social services in 2012-13 • The Bank has four major types of trust funds: IBRD/IDA bank executed trust funds, IBRD/IDA recipient executed trust funds, financial intermediary funds, and IFC trust funds. These funds have distinct purposes, implementation mechanisms, and accountability frameworks • Benefits of the trust fund system for health include its potential for enhanced flexibility, capitalising on international momentum, measurable project outcomes, and investment in innovative areas or financing mechanisms • Risks of the Bank’s trust fund system for health include its potential for misaligned aid allocation, reduced Bank accountability, and inadequate transparency Over the past 50 years, the World Bank has increasingly relied on resources contributed voluntarily from donors and held separately from its core budget to support projects and activities, particularly for global health. These resources are known as trust funds. In the case of the bank, these trust funds are synonymous with earmarked, extra-budgetary, and “multibi” aid (bilateral aid channelled through multilateral institutions). The absolute number and relative proportion of bank assets held in trust has skyrocketed since the early 1990s. In 2011, the bank was trustee to roughly half of the trust funds for official development assistance (ODA) worldwide, and in 2012-13 about 200 donors contributed $3.7bn to more than 1000 World Bank Group trust funds.