New Year's Resolutions from PEPFAR, The Global Fund and the World Bank: For 2008, we will...

*This is a joint post with Michael Bernstein and Steve Rosenzweig New Year's Resolutions are typically announced by the people who are going to fulfill them, but we know just how busy the three major global HIV/AIDS donors are to be able to do this! So, we decided to highlight significant changes announced by PEPFAR, The Global Fund and the World Bank MAP for Africa in 2007 (that will improve their performance and increase the impact and effectiveness of their programs) to convert them into some "evidence-based" New Year Resolutions. We would like to look back at the end of 2008 to say that each donor is putting its money where its mouth is. This isn't a wish list at all (that would be much longer!), but rather one that paraphrases recent policy decisions of each donor that are practical and very doable in 2008.PEPFAR: We will play better with othersThe Global Fund: We will stay true to ourselvesThe World Bank: We will make the global HIV/AIDS response stronger and more effective by creating and sharing knowledge Read on for more about the facts behind these resolutions.PEPFARHighlights from the Past YearWith PEPFAR now in its fifth and final year of its first phase (the program was initially authorized for fiscal years 2003 - 2008) debates about how to structure the next phase of the program are well underway. In May of 2007, President Bush announced his intent to ask Congress for $30 billion for the next phase of PEPFAR (although many advocates and Congressional leaders are calling for a figure of $50 billion). He also proposed new targets to be achieved during PEPFAR II. These targets seem to indicate a shift in PEPFAR's emphasis from treatment towards prevention, since the most ambitious new target will be to prevent 5 million new infections. As part of PEPFAR II, administration officials have announced that they intend to institute a new "Partnership Compact" model. Currently, there are few details about how this compact will work - including whether it will differ from MCC compacts - but the intent of relying on partnership compacts seems to be: 1) To ensure that governments are investing their own resources in AIDS programs; 2) To formalize the relationships between PEPFAR and other stakeholders such as the government, other donors, civil society and the private sector; and 3) To implement AIDS programs in a way that supports broader development objectives, including gender equality and economic growth.New Year's Resolution: We will play better with othersPEPFAR has achieved many impressive results in its first phase, but one area that could be further improved is the way it works with other AIDS stakeholders. For example, PEPFAR does not adequately involve host country governments in planning and oversight of its programs. It also does not systematically share much information about its grants. This makes it difficult for governments to ensure that PEPFAR programs are well-coordinated with those of other actors.The new partnership compacts are an opportunity for PEPFAR to improve systematic coordination with other stakeholders, especially the government. Compacts could include specific plans between PEPFAR and the government for joint planning and oversight. They could also include commitments by PEPFAR to routinely share information, and, where appropriate, to begin channeling a portion of funding through SWAps and common funding pools. Global FundHighlights from the Past YearThe Global Fund has made several important policy decisions over the last year but two of the most important changes to Global Fund policy have been the adoption of "dual-track" financing and the decision to accept National-Strategy Applications for funding. Both policies were adopted at the 15th Board Meeting in April.Dual-track financing would have countries routinely include both government and non-government Principal Recipients (PRs) in their proposals for funding. The new policy is meant to ensure greater civil society participation in the planning and implementation of Global Fund programs. This would seem to be a positive development - HIV/AIDS Monitor research has shown that public sector PRs of Global Fund monies have faced major difficulties in disbursing funds due to poor absorptive capacity, and in Zambia, where the Global Fund disburses to two public sector and two civil society PRs, civil society PRs have demonstrated somewhat better disbursement rates. This suggests that the new dual-track financing mechanism could improve the performance of Global Fund grants in the future.The Global Fund's decision to adopt National-Strategy Applications means that countries will soon be able to apply for funding using their pre-existing National Plans (as long as they are deemed acceptable by an independent review mechanism). This is welcome news because it will make it easier to apply for funding and also incentivize countries to develop effective national plans. New Year’s Resolution: We will stay true to ourselvesThe Global Fund is different from traditional donors. Its role as a financing mechanism rather than an implementing agency and its country-led, performance-based funding model makes it unique in the world of global health and development. While the lack of an on-the-ground presence and hands-off approach create certain challenges, these principles are part of what makes the Global Fund's approach an important experiment on how to make aid more effective. For this reason, the Global Fund should continue to pursue policies - such as the National-Strategy Application and Rolling Continuation Channel (see Board Decisions 6-8 from the 16th Board Meeting) that promote country ownership and harmonization with host country systems. At the same time, new policies to improve Global Fund operations such as a forthcoming comprehensive gender policy can present challenges the key principle of country ownership. There are many good reasons to adopt a gender policy but it should be designed to encourage countries to address gender issues in a way that is consistent with national strategic plans. The World Bank MAP for Africa Highlights from the Past YearThe World Bank MAP had a busy year. In July 2007 it released its first comprehensive review of the Multi-Country HIV/AIDS Program (MAP) for Africa, one of the first major donor initiatives to tackle HIV/AIDS on the continent. As Steve Rosenzweig noted in an earlier blog the report was not able to tie MAP activities to outcomes (more knowledge about preventing HIV) or impact (lower prevalence) but, recognizing this limitation, the report's authors called for better measurement and evaluation in the future. This recommendation was further developed in An Agenda for Action 2007-2011, launched in November 2007. At the time of release of this agenda, Nandini Oomman summarized the 4 key pillars of the new Agenda for Action: 1) Focus efforts on evidence-based strategies appropriate to the country context, 2) Fund a comprehensive approach that includes activities like increasing awareness and promoting gender equality, 3) Improve Monitoring and Evaluation in order to improve results; and 4) Help all donors work better together.New Year's Resolution: We will make the global HIV/AIDS response stronger and more effective by creating and sharing knowledge The decision to increase knowledge creation and sharing - including through better Monitoring and Evaluation - provides the Bank with great potential to leverage its shrinking AIDS dollars, relative to other financiers. The World Bank should use its unique position - it works across regions, with many different stakeholders, and has strong experience in research - to study specific questions that will help make all AIDS programs more effective, and then actively share lessons learned. Some of the key questions to be addressed include: Which prevention programs work best where? How can AIDS funding also strengthen health systems? How can HIV/AIDS programs be integrated better with other development programs? Closing comment: Of course, New Year's resolutions come and go, often even before February, but count on us to help the donors and others keep track of progress over the course of the coming year.