This is a joint post with Rachel Silverman.
Through our Value for Money working group, we’ve spent much of the past year immersed in the world of global health funding agencies. With so many new agencies, particularly in the last quarter century (Figure 1), understanding the intricacies of the global health family can be daunting, even for the most devoted observers.
The recent IOM evaluation of PEPFAR made clear that a key challenge for the program moving forward will be to get country governments to effectively assume primary responsibility of AIDS programs in their countries, both in terms of finances and “leadership”. But seeing that most PEPFAR funds are channeled through US-based contractors – and not country governments – it seems impractical to expect countries to be able to take real leadership and accountability for AIDS spending.
The Institute of Medicine, the prestigious health arm of the National Academy of Sciences, has weighed in with a massive report on the President’s Emergency Plan for AIDS Relief (PEPFAR), the multibillion dollar US effort to confront the epidemic in the developing world. The evaluation validates PEPFAR’s enormous reach during its first 10 years and identifies concrete actions that Congress and PEPFAR should take for the program to become more sustainable moving forward.
The Institute of Medicine (IOM) will soon release its much anticipated report evaluating the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR). Conducted at the request of Congress, the forthcoming report should follow up on points raised by a previous IOM report (2007), which provided a “short-term evaluation” of implementation after PEPFAR’s first three years, and which was soon followed by PEPFAR’s Congressional reauthorization in 2008. The new report is expected to broadly assess the cumulative performance of US HIV/AIDS programs, with two main tasks:
Ambassador Eric Goosby has been selected to head the US Department of State’s new Office of Global Health Diplomacy, officially turning the page in the ongoing saga of the program formally known as the Global Health Initiative (GHI). Goosby’s appointment will be on top of his role as US global AIDS coordinator, through which he oversees the President’s Emergency Plan for AIDS Relief (PEPFAR), and former Ambassador Leslie Rowe will be in charge of the office’s daily operations. But while the long-awaited announcement said the new office will provide “diplomatic support in implementing the Global Health Initiative’s principles and goals,” it stirred many of the same questions and concerns that arose from the GHI death notice and left me wondering: is this news a Christmas miracle or a lump of coal for US global health programs?
Around this time last year, world leaders called for “the beginning of the end of AIDS” and an “AIDS-free generation”, and committed to reaching the ambitious disease-specific targets for HIV/AIDS: the virtual elimination of mother-to-child transmission; 15 million people on treatment and a reduction in new adult and adolescent HIV infections — all by a rapidly approaching 2015. And this year, US Secretary of State Hillary Clinton recommitted to these ambitious goals in the release of the PEPFAR Blueprint, saying “An AIDS-free generation is not just a rallying cry — it is a goal that is within our reach”. While the overarching World AIDS Day message remains clear – we have made tremendous progress thus far, and there is still a long way to go in the fight against AIDS – one question remains: is this really the beginning of the end of AIDS?
The US government spends about $6.4 billion a year on preventing and treating HIV/AIDS in the developing world, and 4.5 million AIDS patients depend mostly on US generosity each day for the AIDS medicines that keep them alive.
Happy November 7! The election is over and…things pretty much look the same way they did before. While I don’t expect the political gridlock in Washington to abate much over the next years, global health fortunately remains one of the few areas of bipartisan consensus in US policy. When dollar values are taken out of the equation, most policy makers can agree that saving lives of mothers, children and families from preventable, treatable diseases reflects American values and contributes to a safer, healthier world. Here are five things that should be at the top of the President’s global health agenda for the next four years.
There’s an AIDS spending cliff in Ethiopia and the government is already in free fall. Next year, Ethiopia will experience a 79% reduction in US HIV financing from PEPFAR. The announcement of these cuts came with an explanation that PEPFAR was “free(ing) up resources by reducing programs in lower HIV prevalence countries” (see blog). Further, Global Fund monies have gone almost completely undisbursed in 2012. These cuts in spending might be warranted due to epidemiological trends and improved efficiency, or might cripple progress as health programs dependent on external donors are cut back. The truth is, with the current poor status of basic information on beneficiaries and costs, it’s difficult to judge whether these cuts are good or bad.
Christmas came early this year for the wonkiest of PEPFAR-watchers. Our gift: the preliminary report on the pilot of PEPFAR’s Expenditure Analysis Initiative, an important and exciting move by PEPFAR towards evidence-based decision making and greater transparency.