• The U.S. Government (USG) is the largest donor to the global HIV epidemic, and PEPFAR’s investment represents an historic contribution in countries with few resources and a great need for support in their response to HIV.
• The greater part of PEPFAR’s funding has always gone to support programs and activities implemented in partner countries. Consistent with one aspect of PEPFAR’s articulated strategy to move toward sustainability, more PEPFAR funding over time has been directed to local prime partners. Based on an analysis of a subset of data and countries, the increase in local prime partner funding has been driven primarily by increased funding to nongovernmental entities based in partner countries; the proportion of funding to partner country governments as prime partners has remained relatively stable over time.
• PEPFAR is increasingly emphasizing a range of efforts to more strategically and efficiently use its resources through the generation and use of economic and financial data; the allocation of resources based on anticipated impact; improved collaboration with partner country governments, other donors, and the Global Fund to align priorities and programs; and streamlining of business processes. PEPFAR has started to see some gains from these efforts. Continuing to identify and implement opportunities for more strategic and efficient use of resources will be critical for making progress toward optimal return on investment in the response to HIV in partner countries.
• Because of limitations in the available financial data, it was difficult to fully assess the amount and distribution by program area and partner type of the annual direct investment of PEPFAR in partner countries. PEPFAR would benefit from the collection and reporting of financial data that not only serves for accounting purposes, but also are more closely aligned with programmatic data and program implementation. These data are critical for PEPFAR and external stakeholders to more