Building Local Capacity to Manage AIDS Programs: Does PEPFAR have a plan?

David Brown of the Washington Post reported today on the Second Annual Progress Report (PDF) on the President’s Emergency Plan for AIDS Relief (PEPFAR):

In its first two years, the Bush administration's global AIDS plan has spent $5.2 billion to help prevent 47,100 infections in infants, bring drug therapy to 471,000 ill people and care for more than 1.2 million children orphaned by the disease…The program's approach "is to empower every nation to take ownership of its own fight against HIV/AIDS," Secretary of State Condoleezza Rice told reporters at a news briefing.

Many PEPFAR countries face serious capacity constraints in running their own prevention and treatment programs. These constraints include poor leadership, weak infrastructure, and a lack of trained doctors and nurses.PEPFAR programs aren’t doing enough to build local capacity. Most PEPFAR funds go first to American NGOs, who in turn may sub-grant to a local organization. The American NGOs hire away the best doctors and health workers for their programs, while doing too little to replace the professionals they are taking out of the local health system.In one 4 month period in Rwanda, I watched American NGOs hire 30 Rwandan doctors away from a public health system that had only 220 practicing doctors – while putting no money into the local medical university that supplies new doctors. These doctors were hired for non-clinical management jobs, and were taken out of hospitals desperately short of physicians. PEPFAR could improve this problem by funding medical training, developing health system managers, and building local NGO capacity.A new PEPFAR initiative is aimed at increasing the number of Faith- and Community-Based partners. Let’s hope PEPFAR builds local capacity rather than just funding more American Faith-Based Organizations. Countries will be empowered to fight AIDS when PEPFAR and other global AIDS programs direct resources into countries in ways that build up – and don’t fracture – local efforts.