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PEPFAR Implementation: Progress and Promise
THE PEPFAR FOCUS COUNTRIES
Funds from PEPFAR support HIV/AIDS relief in more than 120 countries, but two-thirds of the funds—$10 billion out of $15 billion over 5 years—is to be spent on the development of comprehensive and integrated prevention, treatment, and care programs in the 15 focus countries (OGAC, 2004, 2005b). PEPFAR has established 5-year targets for its prevention, treatment, and care programs in these countries to support prevention of 7 million new HIV infections; treatment of 2 million HIV-infected people with antiretroviral therapy; and care for 10 million people infected and affected by HIV/AIDS, including orphans and other vulnerable children.3
Among the 12 PEPFAR focus countries in sub-Saharan Africa, the adequacy of the health workforce varies considerably. For example, the average doctor-to-population ratio is 22 per 100,000 among the focus countries. Only South Africa and Vietnam report more than 50 doctors per 100,000; Ethiopia, Mozambique, Rwanda, Tanzania, and Uganda report 5 or fewer. (By comparison, the United States has 256 physicians per 100,000 population.) Similar disparities exist for other types of health care workers (see Table 2-3).
The focus countries are among those nations with the lowest per capita incomes in the world, but important variations exist in their gross domestic product and unemployment rates (see Table 2-4). The average gross domestic product per capita for the 15 focus countries at the end of 2005 was approximately US$3,003 (UNAIDS, 2006). Among the focus countries, Botswana, Namibia, and South Africa have gross domestic products per capita greater than US$5,000. At US$10,960, South Africa has the highest per capita gross domestic product (CIA, 2006) At the other end of the spectrum, Ethiopia, Nigeria, Tanzania, and Zambia have gross domestic products per capita of less than US$1,000. Tanzania has the lowest of all, at US$660 (UNAIDS, 2006). The World Bank has classified 9 of the focus countries—Ethiopia, Guyana, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Côte d’Ivoire, and Haiti—as “heavily indebted poor countries.” In 3 focus countries, half of the population lives on less than US$1 per day; in Nigeria, the proportion is 70 percent (UNDP, 2005). Unemployment rates in the focus countries are highly variable. Five have unemployment rates below 10 percent, with Nigeria having the lowest at 3 percent (World Bank, 2006). In contrast, Kenya, Namibia, South Africa, and Zambia all report unemployment rates higher than 25 percent. Zambia’s is highest, at 50 percent (World Bank, 2006).
The focus countries all are generally experiencing devastating HIV/
For purposes of this goal, PEPFAR defines “treatment” narrowly as antiretroviral therapy (ART) and categorizes other types of treatment—such as therapy for opportunistic infections or for pain management—under “care.”