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CGD Policy Blogs

 

Leveraging Nobel Prize Economics for Improved Global Fund Grant Performance

Those who follow CGD will be familiar with our branded meme: “Cash on Delivery” aid, or COD. Many are enthusiastic about COD’s potential to revolutionize aid effectiveness. Yet within some global development organizations, leadership and staff alike express common concerns: is COD practical in the real world? Have you thought about this problem, or that constraint? How would this work in the context of our organization? And if we decided to move forward, how would we design a COD grant?

PEPFAR Teams Are Designing Impact Evaluations: Retrospective, Prospective, and Randomized

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”?

Sneak Preview: CDC’s Effort to Measure the Determinants of AIDS Treatment Quality

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. 

A Question of Quality: Why Retention Matters for AIDS Treatment

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.  

Institute of Medicine Pushes PEPFAR on Data Collection, Disclosure

The Institute of Medicine, the prestigious health arm of the National Academy of Sciences, has weighed in with a massive report on the President’s Emergency Plan for AIDS Relief (PEPFAR), the multibillion dollar US effort to confront the epidemic in the developing world. The evaluation validates PEPFAR’s enormous reach during its first 10 years and identifies concrete actions that Congress and PEPFAR should take for the program to become more sustainable moving forward.

World AIDS Day 2012: Getting to the Beginning of the End

Around this time last year, world leaders called for “the beginning of the end of AIDS” and an “AIDS-free generation”, and committed to reaching the ambitious disease-specific targets for HIV/AIDS: the virtual elimination of mother-to-child transmission; 15 million people on treatment and a reduction in new adult and adolescent HIV infections — all by a rapidly approaching 2015. And this year, US Secretary of State Hillary Clinton recommitted to these ambitious goals in the release of the PEPFAR Blueprint, saying “An AIDS-free generation is not just a rallying cry — it is a goal that is within our reach”. While the overarching World AIDS Day message remains clear – we have made tremendous progress thus far, and there is still a long way to go in the fight against AIDS – one question remains: is this really the beginning of the end of AIDS?

Improving PEPFAR’s Data Management and Disclosure

The US government spends about $6.4 billion a year on preventing and treating HIV/AIDS in the developing world, and 4.5 million AIDS patients depend mostly on US generosity each day for the AIDS medicines that keep them alive.

A Global Health Mystery: What’s Behind the US Government Position on AMFm?

As the Global Fund’s November board meeting approaches – where the future of the Affordable Medicines Facility for Malaria (AMFm) hangs in the balance – there is much anxiety that AMFm will be terminated in 2013. The reason for such anxiety is clear: no donors have pledged funding commitments for after December 2012. But there’s another elephant in the room: the US government’s apparent lack of support, particularly its legislated “opt-in” stance on AMFm: “the Global Fund should not support activities involving the ‘Affordable Medicines Facility-malaria’ or similar entities pending compelling evidence of success from pilot programs as evaluated by the Coordinator of United States Government Activities to Combat Malaria Globally.” (Conversely, an opt-out stance would be to support AMFm unless no compelling evidence is presented.) This very specific and strict provision makes the AMFm’s continued survival all but impossible without an explicit endorsement by US Global Malaria Coordinator (currently Rear Admiral Tim Ziemer) who leads the US President’s Malaria Initiative (PMI) housed in the US Agency for International Development (USAID).

“A Chronicle of Hope and Promise”: Observations from Recent Journal Issues on PEPFAR

This month, both Health Affairs and the Journal of Acquired Immune Deficiency Syndrome (JAIDS) released special thematic issues on the US President’s Emergency Plan for AIDS Relief (PEPFAR) in which the articles – mainly commentaries but some analyses – provide an exceptionally positive readout on PEPFAR’s past performance and future direction. In principle, this is great – any insights into PEPFAR are always welcome, and it’s clearly valuable to discuss and disseminate lessons learned from the program. If these articles were posted on the PEPFAR website, or released as official PEPFAR reports, we wouldn’t bat an eye. But within scientific, peer-reviewed journals, the articles read more like PEPFAR PR rather than commentary and analysis from independent, third-party observers and stakeholders. A quick skim of the titles in the table of contents illustrates this point (see word cloud of selected title excerpts), and a closer look at the contributors sheds some light on why this may be the case: most authors of the articles are somehow affiliated with PEPFAR or with organizations that have received money from the program.

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