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Evaluation of PEPFAR (2013) / Chapter Skim
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Appendix B: Recommendations
Pages 723-740

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From page 723...
... Further considerations for implementation of this recommendation:  EPFAR has made a commitment to overarching goals for prevention P and for achieving an AIDS-free generation, but this does not constitute a long-term prevention strategy that clearly states prevention objectives and the pathways to achieving them. The following elements will be 1  The recommendation numbers represent the chapters in which the recommendations appear and their order within each chapter.
From page 724...
... PEPFAR-supported research and evaluation activities should employ appropriate meth odologies and study designs, without unduly emphasizing random assignment designs. PEPFAR should support innovations in preven 2  It is the committee's intent that actions recommended to be taken by OGAC should be carried out through PEPFAR's interagency coordination mechanism, which involves not only the OGAC staff but also the leadership and technical staff of the U.S.
From page 725...
... • OGAC should provide general guidance for country programs on continuous program evaluation and quality improvement to help them measure and monitor achievement of the key outcomes. This guidance may include, for example, template evaluation plans and methodological guidance.
From page 726...
... Recommendation 6-3: To assess PEPFAR-supported HIV care and treatment programs and to evaluate new service delivery models, the Office of the U.S. Global AIDS Coordinator should support an en hanced, nested program monitoring effort in which additional longi tudinal data on core outcomes for HIV-positive adults and children enrolled in care and treatment are collected and centrally reported from a coordinated representative sample across multiple countries and implementing partners.
From page 727...
... • This data collection effort should be designed by first identifying and prioritizing the key questions that require longitudinal data and then focusing on relevant key outcomes with measures that are standardized across the sample. Priorities should include core out comes related to clinical care and treatment, including adherence and retention; outcomes related to the reduction of HIV transmis sion through biomedical and behavioral prevention interventions for people living with HIV; quality measures; and program mea sures, such as the costs of services, that can help inform strategies for efficiencies, sustainable management, and resource planning for the trajectory of need.
From page 728...
... With a con tinued focus on supporting developmentally informed programs, consideration should be given to identifying appropriate core out comes for different age groups and for achieving developmental milestones. The program evaluation indicators currently being de veloped already offer a reasonable opportunity to link measures to core target outcomes for OVC programs.
From page 729...
... • To improve the targeted coverage and sustainability for chil dren and adolescents, PEPFAR and its implementing partners should continue to enhance services through existing systems and infrastructure and to support national governments in ex panding social support services and the workforce to meet the health, education, and psychosocial needs of affected children and adolescents. • OGAC should provide general guidance for country programs on continuous program evaluation and quality improvement in order to measure and monitor the achievement of key outcomes.
From page 730...
... If gender efforts are to be appropriately integrated into all the aspects of service delivery and effectively implemented, then this capacity cannot be limited to gender-specific experts but should also be incorporated as part of the core competencies of mission team staff across PEPFAR's programmatic areas. • As an engaged participant with other global and partner country stakeholders, through its implementation PEPFAR should contrib ute to generating evidence to inform gender-focused efforts through
From page 731...
... STRENGTHENING HEALTH SYSTEMS Recommendation 9-1: To support the delivery of HIV-related services, make progress toward sustainable management of the HIV response, and contribute to other health needs, PEPFAR should continue to implement and leverage efforts that have had positive effects within partner country health systems. PEPFAR should maintain efforts in all six building blocks but have a concerted focus on areas that will be most critical for sustaining the HIV response, especially workforce, supply chain, and financing.
From page 732...
... Special pe riodic multi-country studies could be used to evaluate the outcome and impact of the PEPFAR capacity-building initiative. To achieve this, OGAC should, using input from country programs, identify milestones toward achieving specified goals, define core metrics to assess capacity-building efforts, encourage innovative approaches through pilot initiatives and develop tools to help country pro grams monitor and evaluate these efforts: Recommendation 10-2: Building on the Partnership Framework imple mentation process, PEPFAR should continue to work with partner country governments and other stakeholders to plan for sustainable management of the response to HIV.
From page 733...
... PEPFAR'S KNOWLEDGE MANAGEMENT Recommendation 11-1: The Office of the U.S. Global AIDS Coor dinator should develop a comprehensive knowledge management framework, including a program monitoring and evaluation strategy, a prioritized and targeted research portfolio, and systems for knowledge dissemination.
From page 734...
... B.  contribute to filling critical knowledge gaps that impede ef To fective and sustainable HIV programs, OGAC should continue to redefine permitted research within PEPFAR by developing a prioritized portfolio with articulated activities and methods. The planning and implementation process at the country and program level should inform and be informed by the research portfolio, which should focus on research that will improve the effectiveness, quality, and efficiency of PEPFAR-supported activities and will also contribute to the global knowledge base on implementation of HIV/AIDS programs.
From page 735...
... Whenever possible and appropriate, these indicators should be harmonized with exist ing global indicators and national indicators; therefore, some centrally reported indicators will reflect PEPFAR's contribution rather than aiming to measure direct attribution. o 2: A larger menu of indicators defined in OGAC guidance, T  ier from which a subset are selected for their applicability to coun try programs to be reported by implementing partners to the U.S.
From page 736...
... n  ithin W PEPFAR-supported evaluation activities there should be an emphasis on the use of in-country local expertise to enhance capacity building for program evaluation and con tribute to country ownership. • For both program monitoring and evaluation OGAC should continue its work on defining and developing measures to assess progress in the currently under-measured areas of country owner ship, sustainability, gender, policy, capacity building and technical assistance.
From page 737...
... • Given PEPFAR's legislative and programmatic objectives to sup port research that assesses program quality, effectiveness, and population-based impact; optimizes service delivery; and contrib utes to the global evidence base on HIV/AIDS interventions and program implementation, at the time of this evaluation the com mittee identified the following gaps in PEPFAR's research activities: B ehavioral and structural interventions, especially in areas such o as prevention, gender, nonclinical and OVC care and support, and treatment retention and adherence. These research activities should employ appropriate methodologies and study designs, without being unduly limited to random assignment designs.
From page 738...
... The purpose of this policy would be to ensure that, within a purposefully and reasonably defined scope, specified program monitoring data and financial data, evaluation outcomes, and research data and results generated with PEPFAR support by contractors, grantees, mission teams, and USG agencies be made available to the public, research community, and other external stakeholders. OGAC and the PEPFAR implementing agen cies should consult with both internal and external parties that would be affected by this policy to help identify the data that are most critical for external access and that can be reasonably subject to data-sharing requirements, as well as to help develop feasible mechanisms to implement a data-sharing policy.
From page 739...
... o developing the policy and specifying the scope of data to In  be included, several key factors and potential constraints that can affect the implementation of the policy will need to be ad dressed. These include patient and client information confiden tiality; the financial resources, personnel, and time needed to make data available; and issues of data ownership, especially in the context of increasing responsibility in partner countries and the provision of PEPFAR support through country systems or through activities and programs supported by multiple funding streams.


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