PEPFAR at 10

This is a joint post with Jenny Ottenhoff.

Ten years ago – on May 27, 2003 – the President’s Emergency Plan for AIDS Relief was born with the stroke of a pen by President George W. Bush.  Over the last decade, the program has experienced tremendous growth and made inroads against HIV/AIDS, TB and malaria in some of the world’s hardest hit areas.  And through it all, PEPFAR managed to maintain bi-partisan support that bridged two US Administrations, six US congressional sessions, and one global economic crisis. 

So we ask: how should we celebrate the world’s largest bilateral health initiative’s birthday?   

Indeed, PEPFAR has already received plenty of gifts this year.  The Institute of Medicine (IOM) released its congressionally mandated evaluation of the program in March.  The Government Accountability Office (GAO) recently released two reports on PEPFAR – one on treatment costing and one on treatment program quality (a third on supply chains will be released later this month).  And PEPFAR’s own Scientific Advisory Board’s Data Working Group (DWG) is set to “gift” their recommendations to PEPFAR early this summer (my colleague Mead Over gave a preview of these recommendations last year).  

So instead of piling on and giving PEPFAR our customary gift – unsolicited advice – we thought we’d amplify some major areas of consensus from these three institutions that we think are reflective of PEPARs past and future.

First, the IOM, GAO and DWG (and we!) agree PEPFAR has helped changed the equation on what was once – not too long ago – seen as an insurmountable plague. This is evident from looking at the change in treatment coverage over the last decade alone.  In 2012, an estimated 8 million people were receiving treatment in low- and middle-income countries – of which PEPFAR directly supported 5.1 million.  This represents a 20-fold increase in treatment coverage since PEPFAR was created in 2003. 

Of course PEPFAR will need to make some major reforms as it matures from an emergency program to a sustainable, long-term response. And there is widespread agreement around one area in particular that should be at the top of PEPFAR’s agenda: data management and disclosure.

While the scopes of their recommendations differ, the IOM, GAO and DWG all suggest that PEPFAR’s indicators and measurement need to be strengthened (e.g. to better capture the retention as well as the enrollment of AIDS patients,) and also streamlined (to minimize the collection and reporting of unusable or unused indicators).  They also propose that efforts around PEPFARs Expenditure Analysis Initiative should also be expanded to capture spending among different donors, so that these data are “harmonized,” or at least consistent and comparable.  And finally, PEPFAR must share its program data – principally its financial data – with countries and multilateral partners for the transition to a sustainable and shared response to take place.    

So while we mark PEPFAR’s 10^th birthday and applaud the program’s success, we’re pleased that PEPFAR has also received 800+ pages of recommendations for the future.  After all, this milestone should be less about celebration, and more about reforms that will usher PEPFAR through another decade of progress marked by sustainable partnerships with countries. 

And don’t worry – we plan to give PEPFAR “one to grow on” later this summer when we release our Value for Money working group report with recommendations on how global health donors can get more health for the money they invest. 

Amanda Glassman (@glassmanamanda) is the director of global health policy and senior fellow, and Jenny Ottenhoff (@ottenvos) is a policy outreach associate for global health at the Center for Global Development.