On World AIDS Day, December 1, we honor the advocates that transformed HIV/AIDS from a death sentence to a chronic disease. These activists bequeathed a golden age of global health—a boom in money and programs that is sustained today, evidenced by the recent reauthorization of PEPFAR. But as UNAIDS recognized last year, we still have miles to go despite this extraordinary mobilization. Even today, 40 percent of people in need still lack lifesaving antiretroviral treatment.
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In July, United States Global AIDS Coordinator Deborah Birx made a striking commitment: under her leadership, the President’s Emergency Plan for AIDS Relief (PEPFAR) would direct at least 40 percent of its funding to host country governments or organizations by the end of 2019—rising to 70 percent by the end of 2020. The bottom line: PEPFAR’s local targets are commendable in theory, but we suspect their application in practice will prove complicated. Below is our take on the related issues—and some recommendations for PEPFAR to forge the most effective path forward.
We finally have some clarity on PEPFAR’s new “acceleration” strategy toward epidemic control: a lot more allocated to a few countries, and a lot less for others.
In its opening days, the Women Deliver conference in Copenhagen has bestowed praise and congratulations on the women’s rights advocacy community writ large—and appropriately so. Some of the panelists have risked their lives and livelihoods to create a better world for women and girls; recognition of their accomplishments is truly the least we can do. Many others have dedicated their distinguished careers to this cause, trailblazing the path for later generations. But there’s a lot we still have to accomplish.
This week, the Global Fund partnership will meet in Tokyo to plan for its fifth voluntary replenishment, covering the period 2017-2019. The stakes are high: in an austere budget climate, the Global Fund’s ability to raise the needed resources—and then to spend them effectively over the subsequent three years—will have outsize importance in determining the trajectory of the historic fight against AIDS, tuberculosis, and malaria.
While the numbers coming out of side events at Addis were hardly worth the single shake of a string-free pom-pom, and the launch of a Global Partnership for Sustainable Development Data raised a lot of questions, there were some bright spots in the US commitments to that partnership.
Last September, we released a report on how the Global Fund could get more health for its money. In it, we offered concrete suggestions for improvements in several different value-for-money domains, all with an eye toward maximizing the health impact of every dollar spent.
As the largest bilateral donor in global health, the President’s Emergency Plan for AIDS Relief (PEPFAR) is unequaled in its reach and impact. Yet despite its larger-than-life profile, we’ve found that the details of its implementation arrangements and decision-making often remains obscure to the longstanding chagrin of global health observers. Among the common questions: Where does scarce PEPFAR funding go? Which countries and implementers receive the bulk of PEPFAR funds? And what factors influence PEPFAR’s allocation of resources across recipient countries?
This is a joint post with Rachel Silverman.
Through our Value for Money working group, we’ve spent much of the past year immersed in the world of global health funding agencies. With so many new agencies, particularly in the last quarter century (Figure 1), understanding the intricacies of the global health family can be daunting, even for the most devoted observers.
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.