BOCYF Theme: International

Strategic Approach to the Evaluation of Programs Implemented Under the Tom Lantos and Henry J. Hyde U.S. Global Leadership Against HIVAIDS, Tuberculosis, and Malaria Reauthorization Act of 2008
2010
(collaborative project with the Board on Global Health)

The world has grappled with the HIV/AIDS pandemic for three decades. International aid organizations and national governments are investing more money than ever to mount a response, especially in developing countries. The U.S. is one of the largest supporters of the global response to HIV/AIDS. The Lantos-Hyde Act of 2008 reauthorized U.S. global HIV/AIDS programs and mandated that the IOM assess the progress of these programs and evaluate their impact on health. This report outlines the IOM’s strategic approach for this evaluation. The IOM will conduct the evaluation starting in 2010 and issue a report with findings and recommendations in 2012.

PEPFAR Implementation: Progress and Promise
2007
(collaborative project with the Board on Global Health)

In 2003 Congress passed the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, which established a five-year, $15 billion initiative to help countries around the world respond to their AIDS epidemics. The initiative is generally referred to by the title of the five-year strategy required by the act—PEPFAR, or the President’s Emergency Plan for AIDS Relief.

A requirement of the act which established PEPFAR was that the Institute of Medicine (IOM) provide Congress with an evaluation of the initiative’s progress three years after the passage of the Leadership Act. In response, the IOM Committee for the Evaluation of PEPFAR Implementation examined the initiative, including visits to most of the fifteen PEPFAR focus countries.

Overall, the Committee concludes that PEPFAR has made a promising start, but it warns that there is an enduring need for U.S. leadership in the effort to respond to the HIV/AIDS pandemic. To that end, the Committee has made a number of recommendations, including the following:

• A transition from its focus on emergency relief to an emphasis on long-term strategic planning and capacity building for a sustainable response.

• Addressing the long term factors that underlie the epidemics in each country including:

• Emphasizing and enhancing prevention with accumulation of better data to determine the most appropriate interventions needed in the countries.

• Empowering women and girls by increasing focus on the factors that put them at greater risk of HIV/AIDS, and to support improvements in their legal, economic, educational, and social status.

• Building workforce capacity by increasing its support and including the education of new health care workers in addition to AIDS-related training for existing health care workers.

• Expanding the knowledge base by emphasizing evidence-based approaches, learning from experience, and adaptation to new developments; as well as conducting operations research and robust program monitoring and evaluation.

• Improving Harmonization by improving coordination with partner governments and other donors and supporting the WHO Prequalification Process for medications obtained through PEPFAR. In addition, the Committee recommends that Congress remove the budgetary allocations but replace them with alternative mechanisms for accountability to ensure results and to permit Country Teams the maximum flexibility to achieve the 5-year performance targets for supporting prevention of 7 million infection, providing antiretroviral therapy to 2 million people, and care for 10 million people affected by HIV/AIDS including orphans and vulnerable children.

• Expanding, improving, and integrating prevention, treatment, care, and orphan and vulnerable children services; and increasing attention to marginalized populations including commercial sex workers, people who use injecting drugs, prisoner, and men who have sex with men.