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.
CGD Policy Blogs
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.
There is a growing paradox on the US aid transparency front. The US government is simultaneously home to the world’s most open and most opaque development agencies. And the chasm between them has grown wider over the last year. That’s our main takeaway from Publish What You Fund’s (PWYF) latest Aid Transparency Index rankings of 67 major donor organizations.
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.
PEPFAR deserves to be commended for its efforts to define key measurable outcomes for its orphans and vulnerable children (OVC) portfolio. Approximately 17 million children worldwide have lost one or both parents due to HIV/AIDS. In response, PEPFAR has earmarked 10% of its annual program funds to help mitigate the psychological and developmental effects this loss can have on children.
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.
This is a joint post with Yuna Sakuma.
The majority of the world’s sick live in middle-income countries (MIC) – mainly Pakistan, India, Nigeria, China and Indonesia (or PINCI), according to new data from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Sound familiar? Andy Sumner, Denizhan Duran, and I came to the same conclusion in a 2011 paper, but we used 2004 disease burden data, which didn’t provide an up-to-date view of reality. So I was pleased to see that our findings still hold based on IHME’s 2010 Global Burden of Disease (GBD) estimates.