President's Emergency Plan for AIDS Relief: Efforts to Align Programs with Partner Countries' HIV/AIDS Strategies and Promote Partner Country Ownership

GAO-10-836 Published: Sep 20, 2010. Publicly Released: Sep 20, 2010.
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The President's Emergency Plan for AIDS Relief (PEPFAR), reauthorized at $48 billion for fiscal years 2009 through 2013, supports HIV/AIDS prevention, treatment, and care services overseas. The reauthorizing legislation, as well as other key documents and PEPFAR guidance, endorses the alignment of PEPFAR activities with partner country HIV/AIDS strategies and the promotion of partner country ownership of U.S.-supported HIV/AIDS programs. This report, responding to a legislative directive, (1) examines alignment of PEPFAR programs with partner countries' HIV/AIDS strategies and (2) describes several challenges related to alignment or promotion of country ownership. GAO analyzed PEPFAR planning documents and national strategies for four countries--Cambodia, Malawi, Uganda, and Vietnam--selected to represent factors such as diversity of funding levels and geographic location. GAO also reviewed documents and reports by the U.S. government, research institutions, and international organizations and interviewed PEPFAR officials and other stakeholders in headquarters and the four countries.

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Recommendations for Executive Action

Agency Affected Recommendation Status
Department of State To enhance PEPFAR country teams' ability to achieve the goal of promoting partner country ownership of U.S.-supported HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) activities, the Secretary of State should direct the Office of the U.S. Global AIDS Coordinator (OGAC) to develop and disseminate a methodology for establishing indicators needed for baseline measurements of country ownership prior to implementation of partnership frameworks.
Closed – Implemented
While commenting on the report, State concurred with GAO's recommendation. State subsequently indicated in its 60 day response letter that PEPFAR was responding to GAO's recommendation by working with McKinsey & Company to develop a framework that would permit measurement of country ownership. Briefing slides developed by PEPFAR and by McKinsey & Company in 2011, and PEPFAR FY 2012 Country Operational Plan (COP) guidance identified criteria, grouped as four "dimensions," to assess partner country ownership of PEPFAR programs. During a May 2012 meeting, an official from OGAC confirmed that OGAC had developed the four dimensions to assess country ownership, conducted pilots using the dimensions in two PEPFAR countries (South Africa and Botswana), and rolled out the assessment initiative to all PEPFAR country teams in PEPFAR FY 2012 COP Guidance issued by OGAC. The official also stated that GAO's report "absolutely" and "without a doubt" influenced the internal dialogue at OGAC about country ownership, and the decision to bring in McKinsey & Company to assist in developing the four dimensions. As such, we consider OGAC's actions to be responsive to our report.

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