A leading global AIDS program lacks a clear long-term strategy to help countries build the capacity to tackle the epidemic themselves, an independent report prepared for U.S. Congress suggests.
The report by the National Academy of Sciences’ Institute of Medicine enumerates a number of factors that have hampered the progress of programs supported by the U.S. President’s Emergency Plan for AIDS Relief, which has been widely praised for helping transform AIDS from a death sentence to a manageable chronic disease for millions.
This year, PEPFAR celebrates its 10th anniversary. And throughout the years, it has poured in billions of dollars into AIDS prevention, treatment and care programs.
“The over-reliance on external donor funding in partner countries creates funding fragility and the possibility that the HIV response would be critically disrupted if funding were to be discontinued or severely reduced,” the report says.
There were instances, according to the report, when multiple partners were doing the same service — antiretroviral treatment and capacity building — because they were funded to do so. In some partner countries, for instance, there are more than 100 prime partners and at least the same number of subpartners.
Projects take a long while to finish, according to the report, and between 2004 and 2011, at least $1.46 billion was unspent. Releasing money in steady and timely manner was also found to be difficult at times, leading to gaps between partner contracts in countries.
Differing priorities between partner country governments and PEPFAR were also noted in the report.
“PEPFAR mission teams described struggling to collaborate with partner country governments with competing priorities or those that did not view the HIV and AIDS response as a priority,” the report notes.
Sometimes, PEPFAR has also funded relatively richer countries with fairly low rates of HIV prevalence. For instance, the Dominican Republic, a lower-middle-income country with low HIV prevalence, received $173 million, according to the report.
Another stumbling block is poor data recording.
“The lack of accessible data on actual annual expenditures, regardless of the year in which the money was appropriated or obligated, represents a significant data gap for PEPFAR,” the report note.
The report discloses that Office of the U.S. Global AIDS Coordinator has been unable to track and assess how funds have moved from Congress to OGAC to implementing agencies to prime partners to subcontractors, “since implementing agencies were not required to report on expenditures at all levels of the program.”
Responding to the report’s findings, Ambassador Eric Goosby has attributed the problems to inefficient bureaucracies, delays due to extended negotiations on realigning programs with recipient country priorities, and a slowdown in few countries because the AIDS problem was much smaller than originally estimated.
To better support partner countries, PEPFAR — which in late 2012 released its blueprint for an AIDS-free generation — needs to invest in strengthening academic institutions, degree programs and training courses. This is one way to improve local capacity, which is key to retaining clinical, nonclinical and management professionals, the report argues.
Apart from improved data reporting to document progress and effectiveness, PEPFAR should create a knowledge management framework that would assess PEPFAR’s models of implementation and contribution to sustainable management of the HIV response in partner countries.
“PEPFAR would benefit from the collection and reporting of financial data that serve not just an accounting purpose but are also more closely aligned with programmatic data and program implementation,” the report says.
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