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Effective foreign aid programs, such as PEPFAR, take the essence of partnership and operate with the tenants of accountability, transparency, and impact. Photo by Paul Morse

How to avoid future threats of rescission: follow the principles of PEPFAR

August 28, 2019 3 minute Read by Crystal Cazier
To maintain support and realize the benefits of foreign aid, those who manage federally-funded international programs should follow principles that guarantee the best return on investment for American taxpayer dollars. PEPFAR is one program that embodies these principles.

Over the past month, the global health and wider development community have been following the administration’s threat to rescind a variety of unspent foreign aid funding. Last week, due to pressure from Congress, pushback from the State Department, and strong opposition from advocates and citizens, the administration announced they had abandoned these plans 

At the Bush Institute, we recognize the value of well-planned foreign aid programs that are held to account and have proven results. These programs foster peace and stability, drive economic growth, and improve U.S. relations and reputation abroad. While skepticism of foreign aid seems to increase with growing isolationist and populist sentiments, its encouraging to know that most Americans still feel U.S. engagement around the world is important 

To maintain this support and realize the benefits of foreign aid, those who manage federally-funded international programs should ensure they follow principles that guarantee the best return on investment for American taxpayer dollars. The President’s Emergency Plan for AIDS Relief (PEPFAR) is one program that embodies these principles. By requiring accountability, transparency, and impact, PEPFAR maximizes every dollar it spends. 

  • Accountability: When President Bush authorized the construction of PEPFAR, he shifted the foreign aid model from paternalism to partnership, empowering countries to design and implement their own programs. In return, countries were held accountable for every dollar spent, a principle PEPFAR continues today. Beyond fiduciary accountability, PEPFAR holds countries responsible for the policies and systems that either facilitate or hinder access to healthcare services. PEPFAR also welcomes outside input. For example, civil society organizations are invited to participate as PEPFAR develops annual country operational plans (COP), which outline how PEPFAR allocates its funds.  
  • Transparency: Each country’s COP is available online, not only to keep PEPFAR accountable for its plans, but also to allow an inside look into PEPFAR’s programs. PEPFAR’s data is also available on open-access dashboards. Anyone can see how PEPFAR is performing at a granular level. PEPFAR’s transparency instills confidence that the program allocates funds wisely and achieves its intended impact.  
  • Impact: PEPFAR uses data to drive decision making and hold countries accountable for their results. By taking a critical look at what’s working, whats not, and where the greatest needs are, PEPFAR is able drive impact. PEPFAR prides itself on using data down to the site level to maximize the efficiency of its programs. Thorough monitoring ensures effective, targeted interventions that make the best use of allocated funds. This careful use of data has allowed PEPFAR to achieve tremendous impact, even with a flat budget since 2008.  

These principles have enabled PEPFAR to achieve transformative results. Effective foreign aid doesn’t throw money at a problem, but invests in the value of human life. Yes, we have our own issues at home. But addressing injustice around the world is both the right thing to do and the smart thing to do, and it costs less than 1% of the federal budget. 


Author

Crystal Cazier
Crystal Cazier

Crystal Cazier serves as Program Manager for the Global Health Initiative and for Evaluation and Research at the George W. Bush Institute. In this role, she helps coordinate the Bush Institute’s involvement in The Partnership to End AIDS and Cervical Cancer, a collaboration of the Bush Institute, PEPFAR, and UNAIDS that works with eight countries in sub-Saharan Africa to prioritize HIV-positive women in national cervical cancer prevention and control programs. She also serves on the research and evaluation team which supports programming across the Bush Institute.

Before joining the Bush Institute, Crystal worked as a Clinical Research Associate at Carle Cancer Center in Urbana, Illinois where she managed budgetary and contractual negotiations for both pharmaceutical and government-sponsored clinical trials. 

Crystal received her undergraduate degree from the University of Illinois in Urbana-Champaign and is currently pursuing a Master of Public Health at the University of Texas Health Science Center.

Full Bio

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