CGD Policy Blogs
Value for money was at the top of our agenda this year, so I was pleased to see the topic also top the list of CGD’s most popular Global Health Policy blogs in 2013. The rest of this year’s list is a mixed bag, reflecting a number of debates that will likely stick around in 2014 (data for development, universal health coverage, and the state of global health financing, to name a few).
Over the last few months, we have been busy tracking and analyzing a number of notable developments in the global AIDS space. So in commemoration of World AIDS Day, marked annually on December 1st, here is a roundup of what we’ve been talking about, complete with links to our most recent work.
The Global Fund to Fight AIDS, TB and Malaria will host its fourth replenishment meeting this week in Washington, DC where it’s hoping to raise $15 billion to support its work for the next three years. On the eve of the replenishment, the BBC will air a 30-minute segment on its show Panorama titled “Where’s Our Aid Money Gone” that – judging by the synopsis – will likely take a more critical view of the Global Fund than much of its recent press (see here, here, and here).
Last year, PEPFAR submitted guidelines which encouraged country staff to submit a proposal to conduct an “impact evaluation” (IE) as part of their annual Country Operation Plan (COP). Subsequently, they received four submissions, of which three were funded. But they also learned that many PEPFAR staff – who are mostly program implementers, or the managers of program implementers – didn’t fully understand what they were being asked to do; what does PEPFAR mean by “impact evaluations”?
Earlier this month, Ambassador Goosby officially announced that he was stepping down from his role as Global AIDS Coordinator where he led the President’s Emergency Plan for AIDS Relief for the past four years. As my colleague Amanda blogged in anticipation of Dr. Goosby’s departure, his service will be remembered for strengthening the evidence base behind PEPFAR’s work.
It’s one thing to measure the quality of AIDS care; it’s another to understand how to improve it. Our last blog showed how the metaphor of the “treatment cascade” can be a useful way to conceptualize and measure the quality of AIDS care and that PEPFAR supported care has room for improvement on this measure (see more on the treatment cascade here). In order to achieve the health benefits that would result from reducing patient attrition over the course of the treatment cascade, PEPFAR and its partners need to learn why some facilities do better than others and what factors contributors to treatment success.
Counting the number of patients on treatment is no longer enough. For years even the friendliest critics of the global struggle against AIDS have pointed out that this metric unfairly neglects the people who are not put on treatment and then die, largely because their deaths are uncounted except in so far as they increase the treatment “coverage rate.” This diverts attention from the challenge of assuring that patients are retained on treatment and remain alive and healthy, rather than failing treatment and dying, sometimes after only a few months.
It appears that the worst kept secret in Washington is out: Ambassador Goosby is expected to step down as Global AIDS Coordinator later this year. As CGD has done for similar leadership transitions, we are working on a report to examine the future direction of PEPFAR and consider which tasks PEPFAR’s next leader should put near the top of the program’s list of priorities. One preliminary conclusion: Goosby’s successor will certainly face programmatic challenges, but the political ones may prove to be more difficult.