Last week, PEPFAR signed a three-year agreement with the Millennium Challenge Corporation (MCC) to support efforts to promote greater host-country responsibility and ownership in the US global AIDS program. Country ownership has been at the core of MCC’s mission (and structure and governance) since its creation, so it’s exciting to see a formalized agreement that will help facilitate lesson sharing and technical support between the two US development efforts.
Transitioning to a sustainable response is an ongoing challenge facing PEPFAR, and no easy feat considering the program was originally designed as an emergency response. But as we highlighted in a recent report, the MCC model includes three features that could be extremely useful in moving PEPFAR toward a more country-owned approach:
1. First, MCC creates incentives for government commitment as expressed through policy and programmatic performance, where only countries that pass a threshold are eligible for assistance. Similar indicators and thresholds related to HIV/AIDS and TB performance could be established under PEPFAR to incentivize greater country investment and reward progress towards greater coverage.
2. Second, MCC sets up a compact and account in-country, usually with a government-owned project implementation unit that can compete, contract, and supervise programs directly. Such a facility could serve as PEPFAR’s country counterpart, channel Global Fund and other donor funding, and evolve toward a single payer or fund as modeled in countries like Rwanda and Liberia.
3. Finally, MCC is one of the most transparent aid agencies in the world. The agency posts its planning, obligation and spending data as well as procurement activity and reporting online in aggregated and country-based sites that are easy to access and understand. These tools help facilitates better understanding, oversight and collaboration among all stakeholders -- including partner governments -- and would go a long way in helping manage expectations for country-ownership as PEPFAR moves forward.
While specific details of the agreement are not yet public, we do know that PEPFAR funds will be made available to facilitate technical assistance from MCC to help advance country ownership in a yet-to-be-decided set of countries. We’ll be watching to see if any of these “MCC features” are reflected in PEPFAR’s program in the coming years.