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PEPFAR’s Smart Investments to Save More Lives: Efficiencies, Innovation and Impact

Ashton Wingate — February 17, 2011 – 12:22 pm

The President’s Emergency Plan For AIDS Relief (PEPFAR) hosted a full-day discussion on Thursday, February 10th,  to highlight the program’s successes in the shadow of looming budget cuts. Hosted at the World Bank, implementers, advocates, and PEPFAR country staff filled the auditorium for the discussion that focused on partnership frameworks, the use of economic modeling, program integration, and the role of external partners and new technologies in the fight against HIV/AIDS and TB.

The session overwhelmingly focused on the buzz word “efficiency” by discussing how the program is shifting to a country-ownership model,  emphasizing the importance of the partnership framework as a significant milestone to program sustainability. More than one joke was made on how the program ought to drop the “E” for “emergency” and substitute “efficient” instead. Ambassador Goosby emphasized the need to educate new Members of Congress on the efficiencies and impact of PEPFAR programs. PEPFAR hosted a Congressional breakfast on Friday the 11th to jumpstart this effort.

TB-HIV was highlighted several times throughout the session.  Representatives from the Ministries of Health of both Botswana and South Africa highlighted the prioritization of TB-HIV in their program management, including the rollout of the new TB diagnostic, Xpert MTB/RIF. A PEPFAR implementer from ICAP in Rwanda discussed the enormous successes afforded by integrating TB with HIV/AIDS services, from building lab capacity, to promoting screening and testing in both HIV and TB settings. Successes touted from this program seemed to stem largely from strong leadership from the government of Rwanda working in collaboration with PEPFAR implementers and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The day ended with an interesting session titled “Programmatic innovations to drive impact and efficiency”, which hosted speakers from the private sector. The discussions ranged anywhere from Becton Dickenson’s support of expanding lab capacity to Right to Care’s use of new medical software to improve standards of care and treatment. Often as advocates it’s hard to remain connected to the real life issues on the ground, but listening to implementers discuss daily challenges and innovative solutions reaffirms the need to support this creative thinking with adequate funding.

Despite the evidence, anecdotes, and worthwhile discussion demonstrating the enormous impact that PEPFAR has in its seven years of life, the session had a tone that was somewhat accepting of an unfriendly budgetary environment. PEPFAR staff emphasized how they will make every dollar stretch farther, whether by improving country ownership, purchasing generic ARVs, or continuing cost-effectiveness modeling to ensure that as much as possible is squeezed from its funding. Nonetheless, a colleague at the PEPFAR budgeting office left the session early to begin calculating scenarios such as the number of children that could die with cuts in PEPFAR funding. Despite its efficiencies, PEPFAR will have a significant challenge to cope with its budgetary flat lining. This reaffirms the need for advocates to promote this messaging and educate Members of Congress on the importance of supporting our HIV/AIDS and TB programs.