This is a joint post with Jenny Ottenhoff.
It appears that the worst kept secret in Washington is out: Ambassador Goosby is expected to step down as Global AIDS Coordinator later this year. As CGD has done for similar leadership transitions, we are working on a report to examine the future direction of PEPFAR and consider which tasks PEPFAR’s next leader should put near the top of the program’s list of priorities. One preliminary conclusion: Goosby’s successor will certainly face programmatic challenges, but the political ones may prove to be more difficult.
On the programmatic side, Ambassador Goosby did a phenomenal job strengthening the evidence base behind PEPFAR’s work, in part by scaling up cost-effectiveness studies and instituting the first Scientific Advisory Board (both of which should continue). There’s more to do. Goosby’s successor should make more progress on data management and dissemination and take steps to better integrate PEPFAR’s programs with other donor- and country-led activities. He or she should also deploy innovative tools (like performance-based financing) to make programs more efficient, effective, and sustainable.
On the political side, PEPFAR, like all development projects, will continue to face budget pressures. That reality demands getting more value for money out of PEPFAR’s investments. But it also requires maintaining political support in a landscape very different from what previous leaders of PEPFAR have faced.
Take the figure below: The first two graphs show votes in the House of Representatives during PEPFAR’s authorization in 2003 and 2008. The third shows the current composition of the House based on those who have voted in the past. Nearly half of the current members of congress weren’t around for PEPFAR’s past two authorizations and thus don’t have the same knowledge of or commitment to the program.
With so much change in the House, PEPFAR may soon no longer benefit from the congressional authorization that has set the program apart from other US development programs for the past decade and has been responsible, at least in part, for its robust funding. Even if pending legislation to extend the programs authorization another five years is passed, it won’t generate the same level of congressional commitment that a full reauthorization process would.
Predicting the exact effects of changing politics on PEPFAR’s future is not possible, but it is clear that the next Global AIDS Coordinator will have to make the case for PEPFAR and be able to exercise considerable political muscle to maintain the kind of support that has served the program well for so long. It’s a tall order in need of ideas and dialogue. That’s why we have convened members of the policy community to inform a short report that outlines essential and actionable priorities for the next US Global AIDS Coordinator. Watch this space for more in the coming weeks and months.