Evaluation of PEPFAR (2013) / Chapter Skim
Currently Skimming:
3 PEPFAR Organization and Implementation
3 PEPFAR Organization and Implementation
Pages 65-90
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 65... ...
As described in Chapter 1, PEPFAR focuses primarily on activities that facilitate the delivery of HIV prevention, care, and treatment services to beneficiaries in partner countries. These activities include directly supporting service provision as well as supporting activities that promote or facilitate the delivery of services, such as strengthening health care and other systems, building capacity, providing technical assistance, and engaging with governments and other stakeholders to encourage a policy environment that supports an effective response to HIV (OGAC, 2004, 2009b)
|
From page 66... ...
OGAC staff members, including detailees from other USG agencies, coordinate administrative, financial, and programmatic implementation, oversight, and guidance. OGAC also has country support team leaders who serve as the principal point of contact and liaison to in-country PEPFAR mission teams (IOM, 2007; PEPFAR, 2013a)
|
From page 67... ...
Peace DOD DOL Corps USG agency headquarters and PEPFAR interagency mission teams oversee USG Agency HQ/PEPFAR Mission Team implementation of PEPFAR-supported activities. Some activities are implemented by mission team staff.
|
From page 68... ...
68 Principal U.S. U S Global AIDS Deputy Coordinator Coordinator Director of Special Special Inter Assistant Assistant departmental Coordination Special Advisor for Global Legal Advisor Senior Advisor Health Partnerships Deputy Deputy Deputy Chief Senior Advisor Coordinator for Coordinator for Coordinator for p Operations for Policy Polic Strategic Private Pri ate Sector External E ternal Officer Information Engagement Relations Chief Director of Medical Director of Director of Director of Directory of Director of Sustainability Executive Officer and Congres- Director of Multilateral Management Country Technical and Director Director of sional Public Affairs Diplomacy and Budget Support Leadership Integration Research Relations and Science FIGURE 3-2 Organizational structure of OGAC (last updated November 14, 2011)
|
From page 69... ...
The various agencies and departments involved in the USG response to the global HIV/AIDS include the following: • The Department of State houses OGAC and provides its infra structure, including information technology, human resources, and accounting. In partner countries, Department of State chiefs of mission provide overall leadership for interagency HIV/AIDS teams and engage in discussions of policy with partner country leaders.
|
From page 70... ...
These staff members provide technical assistance and direct support to strengthen and build sustainable laboratory, epidemiology, sur veillance, and health information systems; expand high-quality HIV service delivery and transition these services to local own ership; implement evidence-based HIV prevention programs; and conduct research on program impact and cost-effectiveness. DGHA is also able to coordinate with other HHS global health programs, such as global disease detection, public health train ing, and prevention and control of other infectious diseases, as well as with domestic HIV/AIDS prevention programs in the United States (PEPFAR, 2012)
|
From page 71... ...
supports HIV/AIDS prevention, treatment, and care; strategic information; infrastructure develop ment and support; human capacity development; and program and policy development in host militaries and civilian communities of 73 countries around the world. These activities are implemented through direct military-to-military assistance, support to nongov ernmental organizations and universities, and collaboration with other USG agencies.
|
From page 72... ...
For example, USG agency program directors make up the group of deputy principals who give policy and programmatic guidance to political appointees in the agency principals groups as well as to the AIDS Coordinator. Input also comes from the country support teams that liaison with and share information from the country and region implementing teams.
|
From page 73... ...
Private Sector; USACA = U.S. Academia; Partner Country: PCGOV = Partner Country Government; PCNGO = Partner Country NGO; PCPS = Partner Country Private Sector; PCACA = Partner Country Academia; Other: CCM = Country Coordinating Mechanism; ML = Multilateral Organization; OBL = Other (non-U.S.
|
From page 74... ...
Mission teams coordinate all of the program activities in the country and are almost all anchored by a country coordinator. The members of the mission teams work with implementing partners, other international organizations and donors, and partner country governments and nongovernmental entities to implement programs and services, develop partnerships, participate in coordination and planning processes, and support policies that contribute to an effective response to HIV and ensure that more attention and resources are put toward HIV/AIDS.
|
From page 75... ...
Most of the activities that PEPFAR supports and implements in partner countries are determined by and contracted through the in-country mission teams, although some programs and initiatives are funded and managed at the central, headquarters level. Chapter 4 describes in more detail the different ways in which programs are funded and implemented.
|
From page 76... ...
PERSPECTIVES ON INTERAGENCY IMPLEMENTATION PEPFAR is the largest bilateral global health program in history, and in order to implement such large amounts of foreign assistance for such a range of activities in such a short time, the operational structure of PEPFAR was strategically designed to use a number of existing USG agencies in a whole-of-government approach (Simonds, 2012)
|
From page 77... ...
PEPFAR mission teams described their efforts to identify the comparative advantages of each USG agency and to assign responsibility for projects accordingly. This process was a considerable challenge in some countries where mission teams have struggled to reduce duplication and overlap of activities by USG agencies, and some interviewees described a lack of clarity or agreement among the agencies, either in the country or from headquarters, on which agencies were better at which types of activities or working with which types of partners (272-ES; 331-2-USG; 587-2-USG; 240-3-USG; 240-8-USG; 240-ES; 2721-USG; 272-33-USG)
|
From page 78... ...
PEPFAR IMPLEMENTATION IN THE CONTEXT OF THE HIV EPIDEMIC IN PARTNER COUNTRIES The diverse nature of the HIV epidemic in the various partner countries where PEPFAR supports programs brings with it key contextual aspects that are not specific to PEPFAR but that affect its implementation; among the most influential of these are factors that relate to risk and vulnerability -- the risk of HIV infection and transmission and vulnerability to poor health and other adverse outcomes. Understanding the many complex factors that contribute to risk and vulnerability is critical to understanding the nature of the epidemic and to the planning and implementing of an effective response to HIV; this principle is often articulated as "Know your epidemic, know your response" (UNAIDS, 2007)
|
From page 79... ...
Although not a comprehensive listing, the wide range of populations identified as "vulnerable" or "most in need" by interviewees in PEPFAR partner countries is illustrated in Box 3-1. The populations identified as key populations at elevated risk in HIV programming were consistently among those identified as vulnerable, including people who inject drugs, men who have sex with men, and people
|
From page 80... ...
Women and children as well as serodiscordant couples and people with multiple concurrent sexual partners were also commonly identified as vulnerable. Many interviewees also characterized populations as vulnerable because of such factors as life-stage, geographical region, socioeconomic status, occupation, and ability to access services.
|
From page 81... ...
mission team members, civil society groups, and stakeholders within partner country governments that achieving a shift in priorities can require a great deal of evidence and effort, especially if there are social, political, policy, or cultural barriers to implementing certain intervention approaches or focusing on certain marginalized populations. Examples of such barriers perceived by interviewees included a lack of government commitment to specific populations or programs, restrictive or punitive national policies, governmental resistance to acknowledging some populations at elevated risk as part of their epidemic, and the criminalization of some behaviors or practices associated with these populations (240-ES; 396-ES; 461-ES; 166-ES; 270-ES; 240-ES; 542-ES; 331-ES; 935-ES)
|
From page 82... ...
For example, even where epidemiological data exist or had been produced through PEPFAR support, PEPFAR and partner countries sometimes experienced conflict about the translation of epidemiological data and other information about the response into aligned program priorities. In undertaking targeted prevention efforts, PEPFAR and partner country stakeholders, particularly partner country governments, disagreed in some cases about the populations to be targeted.
|
From page 83... ...
PEPFAR Implementation and the Policy Environment in Partner Countries In the partner countries where PEPFAR is implemented, the countries' policies affect every aspect of program implementation, from how prevention, treatment, and care services can be provided to the infrastructure and functioning of health and other systems that contribute to the HIV response as well as the broader policy and legal environment. As such, partner country policies are inextricably linked with PEPFAR's efforts to address the HIV epidemic and with the program implementation decisions that PEPFAR makes in different contexts.
|
From page 84... ...
PEPFAR Implementation and the Global Policy Environment Although the committee was not mandated to examine the role of PEPFAR in global HIV policy and this study was not designed to carry out a comprehensive assessment in this area, this topic emerged from the planning and data collection during the evaluation as an important aspect of PEPFAR operations and implementation that intersects with the effects of PEPFAR's programmatic contribution to the HIV response. Therefore, a broad synthesis of perspectives on PEPFAR's influence in the arena of global HIV is presented here, drawn from interviews conducted with individuals across a diverse range of stakeholders in the global HIV response, including advocates, representatives of bilateral and multilateral organizations involved in the AIDS response, and PEPFAR staff.
|
From page 85... ...
PEPFAR was identified by interviewees as a central force in the global HIV/AIDS response and some interviewees acknowledged that there was the potential for PEPFAR to be a dominating force. However, they noted that this had generally not happened in their engagement and interactions with PEPFAR leadership and staff and also recognized the challenges in policy engagement faced by those responsible for implementing PEPFAR at all levels, given the complex political and policy environment and range of influences under which PEPFAR operates (NCV-16-USG; NCV-27-ML; NCV-32-OBL)
|
From page 86... ...
Although PEPFAR's engagement in the global policy arena was overall seen as positive, interviewees identified specific PEPFAR policies and funding limitations as challenges in achieving a coordinated and well-aligned global response to HIV. These included some challenges that were noted as having improved over time, including, for example, working toward improved harmonization of indicators and shifting to a less restrictive resource allocation for prevention to allow country programs to match evidence-based programming to the epidemic more appropriately (NCV-11-USG; NCV-3-USG; NCV-7-USG; NCV-21-ML; NCV-10-USG; NCV-17-USG)
|
From page 87... ...
As PEPFAR increasingly emphasizes country ownership and alignment with national plans, the extent to which the USG directly influences all levels of priority setting, decision making, and implementation can be quite limited. As discussed in depth in the description of the evaluation approach in Chapter 2, the committee endeavored to conduct a rigorous evaluation of PEPFAR that took into account the complexities of implementation in order to develop a credible assessment of the contribution of PEPFAR to changes in health outcomes and health impact within the landscape of other funding sources, other HIV programs, and other factors that affect health.
|
From page 88... ...
2011. The President's Emergency Plan for AIDS Relief: FY2012 country operational plan guidance technical considerations.
|
From page 89... ...
U.S. Government-funded technical support to recipients of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.