PEPFAR 3.0: The Easiest Decision for Congress This Week

Policy makers on Capitol Hill have some pressing policy issues to tackle in the coming weeks (like reaching an agreement to fund the government and raising the debt ceiling).  Fortunately, one bill that landed on their desk last week shouldn’t require much debate:  The PEPFAR Stewardship and Oversight Act of 2013 (S.1545/ H.R. 3177) which aims to extend and modernize the landmark US global AIDS program for another five years.  The bill is short (18 pages!), has bipartisan support, and doesn’t contain any major overhauls to the (very good) existing policy. 

While nothing is easy in Congress these days, this is about as straight forward as it gets.  And congressional action matters. 

The President’s Emergency Plan for AIDS Relief (or PEPFAR) has been a game changer in the world’s fight against AIDS for the past decade.  The program is credited with saving hundreds of millions of lives around the world and Congress has played an important role in this success from the beginning. The program was authorized by Congress in 2003 and reauthorized in 2008 with bipartisan support, something no other existing development program can claim.  The PEPFAR Stewardship and Oversight Act – introduced by Senators Robert Menendez (D-NJ) and Bob Corker (R-TN) in the Senate and Reps. Ed Royce (R-CA) and Eliot Engel (D-NY) in the House – would codify that support for another five years. 

The bill isn’t a full reauthorization like in years past; it simply extends provisions in the current law that would otherwise expire on September 30 and updates PEPFAR’s annual reporting requirements to strengthen congressional oversight of the program.  Here’s what the bill will (and will not) do: 

Extend a number of key authorities through 2018, including:

• The funding requirements for treatment (at least 50 percent) and orphans and vulnerable children (10 percent).
• The requirement for Inspectors Generals from State, USAID, and HHS to develop annual, joint oversight plans.
• The requirement to conduct cost studies that capture per-patient costs for PEPFAR-supported treatment and care (which has likely been useful at driving down costs).
• The 33 percent cap on US contributions to the Global Fund, which has proven a useful tool to leverage funding from other donors.

Introduce new requirements for reporting (which, with hope, will lead to more informative annual reports from PEPFAR), including:

• Annual targets for prevention, treatment, and care efforts that include how the target will lead to reductions in the numbers of new HIV infections below the numbers of deaths among people living with HIV;
• HIV treatment coverage rates by country;
• Retention rates in antiretroviral treatment programs;
• A strategy for appropriately timed transitions to country ownership with an explanation of metrics used to determine the pace of transitions.

Doesn’t include a price tag.  Unlike the 2008 PEPFAR authorization, the bill doesn’t authorize a specific dollar amount for funding.  But with hope, PEPFAR will continue to enjoy strong funding regardless.  Current indications of are strong -- In the FY14 budget requests, the Administration, House and Senate all requested $6 billion for global HIV/AIDS assistance, including $4 billion for PEPFAR.  

There are things in this bill that I love,  like how it pushes the Global Fund to report better data on performance and the disbursement of its funds (for both principle and sub-recipients) – something we call for in our recent report,  More Health for the Money.  And of course, there are things that will benefit from further clarification and close observation as it progresses.  For instance, the new reporting requirements for PEPFAR focus on measures of effectiveness and outcomes (hooray!) but in practice they should replace – not add to – existing indicators to avoid making the reporting process even more cumbersome.   

No doubt, PEPFAR – like all development programs – has room for improvement over the next five years (like we’ve noted here).  But overall, this streamlined piece of legislation will give the program room to improve with the critical oversight and support from Congress that has served it well for the past decade.  Sounds decidedly easier than the rest of this week’s (month's?) legislative agenda, right?