Questions for Dr. Goosby: How Can You Make PEPFAR Even Better?

The Senate Foreign Relations Committee will hold a confirmation hearingon June 9th on the nomination of Eric P. Goosby to become ambassador at large and coordinator of U.S. government activities to combat HIV/AIDS globally. When President Obama announced Eric Goosby as his nominee for this position, I posted a blogthat outlined five key issues for the new Global AIDS Coordinator to address as soon as he assumes office. I raise those issues again (from the HIV/AIDS Monitor’s research) with the hope that members of Congress will ask Dr. Goosby some of the following questions and that we might hear some of the responses that follow too:

1. How do you plan to make PEPFAR results more country specific in addition to achieving its global 3-12-12 targets for prevention, treatment and care?

   PEPFAR must demonstrate commitment to country specific responses, and continue to make programs more responsive to country needs and build country ownership. Prevention, treatment and care programs must be designed and executed to implement a country specific response rather than in response to globally set objectives and targets. (see Following the Funding for HIV/AIDS). PEPFAR must deliver measurable results by country: those that also add up to real changes in the fight against HIV at the end of 5 years. i.e. that new infections decrease over time and that fewer people die from AIDS. (See The Numbers Behind the Stories: PEPFAR Funding for Fiscal Years 2004 to 2006).

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2. PEPFAR is shifting from an emergency response to a sustainable response. What are three key issues that will need to be addressed to achieve this transition?

   PEPFAR will have to manage the transition from an emergency to a sustainable response that involves the transfer of skills, expertise, technological know-how (see Following the Funding and The Numbers Behind the Stories: PEPFAR Funding for Fiscal Years 2004 to 2006) and financial sustainability (see Prevention Failure: The Ballooning Entitlement Burden of U.S. Global AIDS Treatment Spending and What to Do About It by my colleague Mead Over). In this financial downturn, budgets are getting tighter and tighter, as more and more global health priorities are considered every day. Dire warnings about ARV treatment interruption are circulating at the global and country levels.

3. It is clear that health systems of many AIDS affected countries are weak and unable to cope with a range of health problems, let alone AIDS. In your view, how will funding from PEPFAR programs strengthen health systems or at least do no harm to them?

   PEPFAR can develop strategies to ensure that health systems (including health information systems, supply chains for ARVs and essential drugs, and the health work force) benefit from PEPFAR support for the national AIDS response. These include developing systems that will jointly distribute ARVs and essential medicines and be managed using the same logistics management information systems, building on the efficiency of ARV supply chains; providing more support to train new health workers (pre-service training) in addition to on the job short-term training and hiring these workers in to the work force and at the same time working with ministries to improve public-sector human resource policies and planning; and coordinating government and donor health information needs through one system to minimize duplicative and burdensome reporting and to improve data quality (See Seizing the Opportunity on AIDS and Health Systems)

4. PEPFAR has established a sophisticated data reporting system and database for its own use of funding and program data, but this database is not publicly accessible in any form for others to conduct useful analyses on program outcomes and impact. What are three steps you will take to make these data available for public analysis?

   See our Memo to President Obama that recommends that the administration publish existing PEPFAR official data on obligations to prime partners, sub-partners, and program areas to improve transparency and accountability.

5. How will PEPFAR address factors that make women and girls vulnerable to HIV infection?

   PEPFAR must ensure that gender-based vulnerabilities and gender differences that drive infections and impede access to services are addressed and that measures to demonstrate gender-related outcomes are reported for prevention, treatment and care. (Forthcoming analysis from CGD’s HIV/AIDS Monitor and ICRW.)

Those are my top five questions for Dr. Goosby. What else would do you think the members of Congress should ask Dr. Goosby, to decide whether he is the right man for one of the most difficult jobs in the world?