We are interested in understanding what factors to consider when deciding where to put scarce taxpayer dollars to have the biggest impact in health gains. Analysis may include examining trends in U.S. foreign assistance spending on multilaterals v. bilateral programming in health, and would identify factors that would allow us to discern the value of one type of program versus the other (bilateral or multilateral) and/or make recommendations on the balance between multilateral and bilateral funding. Additionally, what are the international donor community trends in terms of bilateral vs. multilateral contributions? Factors to be examined could include establishing international consensus or standards on policy issues, amount of money leveraged, overhead costs of multilateral institutions compared to overhead costs of bilaterally funded agencies, nature of funded programs, transparency of impact/outcomes, and programmatic assessments of results. The result may be a framework of considerations to take into account when choosing the most effective way to reach foreign assistance goals. Finally, it would be of interest to consider whether the findings in the health sector might be generalized to the choice between bilateral and multilateral funding in other sectors.