For the past decade, global AIDS donors have responded to HIV/AIDS in sub-Saharan Africa as an emergency and have mobilized health workers from weak and understaffed workforces. They must begin to address the long-term problems underlying the shortages and the effects of their efforts on the health workforce more broadly.
This report focuses on the workforce strengthening strategies of three of the major HIV/AIDS donors—the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), and the World Bank’s Africa Multi-country HIV/AIDS Program (the MAP)—and identifies six tasks for donors, national governments, and country stakeholders to undertake to reverse the severe shortage of skilled, motivated, and productive health workers.
Billions of dollars have been allocated to fight HIV/AIDS in poor countries over the past decade, yet less than half of those requiring treatment receive it, and for every two people put on treatment, five more become infected. Donors have to do more with available funds. Now is the time to link funding decisions to performance.
This report examines the use of performance-based funding (PBF) among the big three funders of HIV/AIDS programs in developing countries: the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS Tuberculosis and Malaria, and the World Bank’s Multi-Country HIV/AIDS Program for Africa (the MAP).
Few people doubt that gender inequality influences the spread of HIV/AIDS, yet public health efforts tend to focus on changing individual behavior rather than addressing structural factors—social, economic, physical and political—that influence the spread and effects of HIV and AIDS. This brief shows how three of the biggest donors to global HIV/AIDS programs can go beyond their stated commitments to address gender inequality and more effectively combat HIV and AIDS.
Gender inequality drives the HIV epidemic, increasing the burden on women and girls and undermining the global response to the disease. A new HIV/AIDS Monitor report finds that despite well-meaning language and admirable broad goals, three of the biggest HIV/AIDS funders have yet to translate their concern for women and girls into systematic, effective programming. The report shows how to make that happen.
CGD senior fellow Mead Over and Owen McCarthy offer a users' manual and Stata software to help students and instructors of public health, development economics, or health economics to project the future budgetary cost of AIDS treatment in poor countries and to explore the many factors affecting the calculation.
This dataset compiles selected global variables on AIDS and its treatment and prevention. The data are in the format developed by the Stata statistical software corporation and are intended for use with Over and McCarthy's AIDSCost package for the purpose of projecting the future budgetary cost of scaling up AIDS treatment.
This report by the UNAIDS Leadership Transition Working Group argues that the new executive director of the Joint United Nations Programme on HIV/AIDS should focus on a few essential tasks: promoting evidence-based prevention and treatment strategies, ensuring that UN agencies adequately support countries severely affected by HIV, and pressing rich-country governments to live up to their pledges to help poor countries respond to the epidemic.
AIDS Treatment in South Asia: Equity and Efficiency Arguments for Shouldering the Fiscal Burden When Prevalence Rates Are Low - Working Paper 161
Senior fellow Mead Over estimates the effect of AIDS on poverty in South Asia and analyzes public policy options to help the region’s predominantly private health care systems meet the challenge of treating AIDS. He finds that South Asian governments should play a larger role in AIDS treatment than in other aspects of health care, in the interest of both efficiency and equity.
Nandini Oomman, director of CGD's HIV/AIDS Monitor, calls on President-elect Obama to push PEPFAR (the President's Emergency Plan for AIDS Relief)to release official data on obligations to prime partners, subpartners, and program areas to improve transparency and accountability.
Donors spend billions of dollars to fight HIV/AIDS in developing countries, but poor integration between donors and host country health systems risks undermining international efforts to prevent and treat AIDS. In this analysis, CGD’s HIV/AIDS Monitor argues that donors need to pay more attention to their overall effect on health systems, finding that the big international donors often create duplicate AIDS-specific systems that competitively draw on the health resources of developing countries. The report recommends taking specific steps to more broadly improve health information systems, improve supply chain systems, and strengthen the health workforce.
Prevention Failure: The Ballooning Entitlement Burden of U.S. Global AIDS Treatment Spending and What to Do About It - Working Paper 144
U.S. global AIDS spending is helping to prolong the lives of more than a million people, yet this success contains the seeds of a future crisis. Escalating treatment costs coupled with neglected prevention measures mean that AIDS spending is growing so rapidly that it threatens to squeeze out U.S. spending on other global health needs, even to the point of consuming half of the entire U.S. foreign assistance budget by 2016. Mead Over argues that AIDS treatment spending could quickly become a global entitlement since withdrawing funding for life-saving drugs would mean death for the beneficiaries. He offers suggestions for avoiding a ballooning AIDS treatment entitlement, including greatly stepped-up prevention efforts.
The President's Emergency Plan for AIDS Relief (PEPFAR) is the single largest funder of global AIDS relief programs, but it does not regularly release data on how its money is spent. In this report, CGD's HIV/AIDS Monitor Team analyzes a newly available dataset of PEPFAR funding. They find, among other things, that only 30% of funds in 15 focus countries have gone to local organizations. They urge PEPFAR to regularly publish such funding data to improve transparency and strengthen coordination with host country governments and other stakeholders, and they suggest actions PEPFAR should take to improve the effectiveness and sustainability of its programs.
The President's Emergency Plan for AIDS Relief (PEPFAR) provides more than $5 billion per year to prevent and treat HIV/AIDS. Exactly how is that money spent? Donors, recipients, and even PEPFAR staff are often left guessing, because much of the extensive data the U.S. government collects on the program isn't released. In this new CGD note, Michael Bernstein and Sarah Jane Staats (Hise) urge the U.S. Congress to require that PEPFAR regularly release this data. They argue that this would improve coordination between PEPFAR and other donors, help PEPFAR staff assess progress and hold recipients accountable, and increase cost-effectiveness. Some of the data will soon be available anyway: CGD's HIV/AIDS Monitor is preparing to release PEPFAR funding data for Fiscal Years 2004-2006 obtained by a partner organization through a Freedom of Information Act request.
Following the Funding for HIV/AIDS: A Comparative Analysis of the Funding Practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia
Donor funding for HIV/AIDS has skyrocketed in the last decade: from US$ 300 million in 1996 to US$ 8.9 billion in 2006. Yet, surprisingly little is known about how this money is spent. Following the Funding for HIV/AIDS, by CGD's HIV/AIDS Monitor team, analyzes the policies and practices of the world's largest AIDS donors—the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Multi-Country HIV/AIDS Program for Africa (MAP)—as they are applied in three case study countries: Mozambique, Uganda and Zambia. The report urges all three funders to improve country-level coordination, tracking of funds, and the collection and disclosure of data. It also identifies the strengths and shortcomings of each of the funders and offers suggestions for improvement.
A Trickle or a Flood: Commitments and Disbursement for HIV/AIDS from the Global Fund, PEPFAR, and the World Bank's Multi-Country AIDS Program (MAP)
In response to both public health imperative and unprecedented political pressure, aid to fight HIV/AIDS has increased massively in recent years: global funding to combat the disease in low- and middle-income countries has more than tripled since 2001, from $2.1 billion to an estimated $8.9 billion in 2006. This paper, by Michael Bernstein and Myra Sessions, discusses the increase in aid commitments by the three main financing agencies--the President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank's Multi-Country HIV/AIDS Program (MAP)--and the receiving countries' ability, or lack thereof, to absorb the aid. It is one in a series of analyses of the sources of funding for HIV/AIDS programs in developing countries conducted under the Center for Global Development’s HIV/AIDS Monitor.
Challenges and Opportunities for the New Executive Director of the Global Fund: Seven Essential Tasks
In its first four years, the Global Fund to Fight AIDS, Tuberculosis and Malaria has become one of the most important aid agencies in the world. As the Global Fund undergoes its first leadership transition, this CGD Working Group Report identifies seven tasks for the new Executive Director, starting from country operations, where ultimate results are achieved; through supporting arrangements (such as technical assistance, performance-based funding, procurement and supply chain strategies, and secretariat operations) and ending with the overarching issues of financing and Board relationships. The report offers specific recommendations for the new Executive Director and for the Board.