PEPFAR’s broad guidelines for spending $1.5 billion backlog

The following document was released to GlobalPost on April 17. Read correspondent John Donnelly's reporting on PEPFAR's $1.46 billion in unused funds here.

Over the past year, PEPFAR has been conducting detailed assessments of country and central budgets as the program moves from an emergency to a sustainable response. Our goal was to identify what unexpended resources the program has that could be used to save more lives and, ultimately, achieve the goal of creating an AIDS-free Generation.

As part of this process, we have strengthened our management practices to provide further assurance that country programs are fully accountable for using the money they receive.

Coupled with these management practices, PEPFAR will consult with key stakeholders to refocus country teams’ investments of the $1.46 billion toward three major areas in which PEPFAR already has large investments and a track record of success:

Investing in Commodities – From internal analysis, it is clear that condoms and HIV rapid test kits are frequently in short supply and rationed. Additionally, provision of additional voluntary medical male circumcision kits, including new devices when approved, can accelerate scale-up in Southern Africa. PEPFAR will invest in the immediate procurement of essential commodities to be used over the course of the next two years.

Investing in Systems and Institutions – There are three essential systems that have a disproportionate effect on how successful we are in delivering care, prevention and treatment services – human resources in health; supply chains; and the management and use of program, epidemiological and financial data. PEPFAR will strengthen country efforts in these areas over a period of two to three years.

Investing in Program Strengthening for Greater Impact 

• Expanding existing programs – PEPFAR has made major investments in certain countries that still demonstrate a significant unmet need in areas such as treatment, VMMC, prevention of mother-to-child transmission (PMTCT), counseling and testing, condoms, and HIV testing. PEPFAR will invest in selected countries to expand these programs over a period of two years, in concert with investments by host governments and the Global Fund.
• Supporting key populations – PEPFAR will provide funds for targeted direct service delivery and technical assistance in countries with key populations at high risk over the next two years.
• Identification of new investment countries — PEPFAR will identify potential countries for expanded program scale-up that have substantial unmet need, but have received lower levels of PEPFAR investment. Programs will be established with a clear commitment from the outset to strengthen and support country ownership, in concert with investments by host governments and the Global Fund, in order to ensure program sustainability. Subject to Congressional approval, this effort will take three to four years to implement