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Perspectives on PEPFAR from Lusaka: Balancing Successes with Challenges

* This post is co-authored by Caesar Cheelo, Lecturer in the Economics Department at the University of Zambia and Principal Investigator for the HIV/AIDS Monitor Project.

Last week Laura Bush and daughter Jenna Bush stopped in Lusaka as part of their whirlwind four nation tour through Africa to highlight PEPFAR's programs and its achievements in Senegal, Mozambique, Zambia and Mali. The visit of a First Lady of the US to a country in the developing world, cleverly coined as FLOTUS in a related SAIS blog, does two things: 1) it throws the country in to a frantic and often wasteful scramble - whitewashing walls, scrubbing floors and children, rehearsing shows and painting banners - to present the shiniest version of a program on the day of the visit; and 2) it allows the US to loudly herald its success and it should, especially when you consider what its HIV/AIDS program has done in Zambia, a country heavily ravaged by the HIV/AIDS epidemic:About 16 percent of adults are HIV-positive in Zambia, a politically stable, copper-rich but largely impoverished southern African country of 11.5 million. Zambia has been a major recipient of American HIV/AIDS funding. The country received US$149 million (€109 million) in funding through the U.S. President's Emergency Fund for AIDS Relief (PEPFAR) in fiscal 2006 and will receive almost US$200 million (€149 million) in fiscal 2007. Funding is expected to rise in 2008. While it has struggled to reduce new HIV infections, Zambia's government has put more than 90,000 people on anti-retroviral drugs over the last few years with help from the United States and other partners. The government officially made anti-retroviral drugs free in 2005, though many rural Zambians still find it hard to get care.
PEPFAR and other donors are pouring resources in to Zambia with the clear purpose of supporting the national fight against HIV and this is undoubtedly a good thing. But if those dollars have to keep flowing we need to show what is and what is not being achieved with the money, how and why. CGD's HIV/AIDS Monitor is working with research partners in Africa to examine issues that are central to the global aid effectiveness agenda and some themes that are more specific to HIV/AIDS responses supported by donors and their programs in Africa. Given that data collection for Theme 1 on "Tracking the Funding" is near completion, we invited our country-based research partners to informally share what they have been learning about PEPFAR funding and programs in Zambia in the last 6 months. Their observations point to the success (summarized below) that PEPFAR has had in mobilizing external and domestic resources for HIV/AIDS, in rapidly scaling up treatment and in catalyzing the government to improve public health systems in particular. Early findings about the many challenges (and possible solutions) presented by PEPFAR funds in Zambia are also summarized below.