On World AIDS Day, a Moment for Celebration and Self-Reflection

On World AIDS Day, December 1, we honor the advocates that transformed HIV/AIDS from a death sentence to a chronic disease. These activists bequeathed a golden age of global health—a boom in money and programs that is sustained today, evidenced by the recent reauthorization of PEPFAR. But as UNAIDS recognized last year, we still have miles to go despite this extraordinary mobilization. Even today, 40 percent of people in need still lack lifesaving antiretroviral treatment.

At CGD, we believe that stewardship over these hard-earned global health resources is a solemn and weighty responsibility; to honor the legacy of the early advocates—and effectively serve the men, women, and children whose lives are placed in our hands—it is our collective duty to maximize the impact of every dollar and close the persistent gaps in HIV prevention and treatment. It’s for this reason that our global health program has homed in on the AIDS response over the years, starting with the HIV Monitor, the AIDS Transition, and recent work on More Health for the Money and Next Generation Financing at the Global Fund. Throughout all our work, we also try to honor our own institutional legacy—for example, contributions to USAID’s evaluation policy and the creation of 3iE—with a persistent focus on efficiency and impact.

With a new round of global health replenishments in 2019, we are looking critically at recent claims of impact emerging from global health agencies—some of which we do not believe to be sufficiently backed up by rigorous, transparent evidence. We do so because we believe that a humble, self-critical, and growth-focused orientation—where we as a community hold ourselves accountable to the most rigorous standards—is the best way to honor the activists and people living at risk for or with the disease. It is not our intent to diminish the organizations and individuals working diligently to end the epidemic, but instead to encourage the entire community to up its game by ensuring that we are delivering quality services and health impact for those affected.

Richard Feachem, the founding director of the Global Fund, put it best: “Raise It, Spend It, Prove It.” Many global health organizations do well on “raise it,” most on “spend it,” but few “prove it.” This is the ultimate accountability; not an OIG report on how monies are spent, but instead, the sound and rigorous measurement, verification, and evaluation of impact for real people at risk for and suffering with preventable disease burden. In the coming weeks, you will see a commentary that is critical of recent Global Fund results reporting. But insufficient impact measurement is almost universal across almost all agencies—and it's up to all of us to do better.

We believe that “prove it” is also the best way to raise more money, and the best way to honor the achievements of the HIV/AIDS movement on World AIDS Day.