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PEPFAR: Measurement as a Management Tool

A core value from the beginning

Report by Deborah L. Birx, M.D. and Bill Steiger September 15, 2022

Introduction

When President George W. Bush announced the President’s Emergency Plan for AIDS Relief (PEPFAR) in his State of the Union address in January 2003, he was harnessing the generosity of the American people to confront a crisis that was devastating many resource-limited countries. The president committed the U.S. government to step up and challenged the rest of the world to do the same. His vision for PEPFAR was a comprehensive response that would combat HIV and AIDS by combining prevention, treatment, and care for the first time. He outlined an innovative approach to managing foreign assistance that became equally important as well as integral to PEPFAR and its later success: a new, whole-of-government structure and required, quantifiable results linked to the investment (initially $15 billion over five years).

Clear Goals and Expected Results

When Congress authorized PEPFAR in May 2003, it also did something new: It formalized the link between PEPFAR’s funding and results. The law codified the president’s goals of reaching 2 million people with lifesaving treatment for AIDS; preventing 7 million new infections; and caring for 10 million children and adults either living with or affected by HIV, including orphans and vulnerable children who had already lost parents to the disease. Progress was to be measured every six months. Linking dollars to specific results enabled a swift humanitarian response to the devastation of AIDS around the globe.

These clear goals drove and sustained the program’s achievements and incentivized building accountable partnerships that fit the specific requirements of each country. PEPFAR hasn’t been just about saving lives, but doing so in the most-effective, highest-quality manner with the greatest impact. This is only possible through the constant collection and use of data.

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