implementation. Weekly email “Notes to the Field” disseminate the most recent news and guidance from OGAC headquarters and address issues raised in the field.

Institutionalizing the Learning Organization Concept

PEPFAR would benefit from developing a detailed, overall strategy for institutionalizing the concept of being a learning organization, including how it is going to track and report on its progress in this regard. Such a strategy would include the following:

  • Articulation of the learning agenda of PEPFAR programs, including a strategy for the conduct and use of results of operations, behavioral, and epidemiological research and implementation studies.

  • Continued support for targeted evaluation efforts.

  • Specification of how PEPFAR structures and processes will be modified to ensure ongoing communication and access to information and lessons learned at the country and cross-country levels and among others in the global HIV/AIDS community.

  • Definition of the indicators by which PEPFAR will track its progress toward becoming a learning organization and how those indicators will be measured.

An annual report, or a specific section in the overall program’s annual report, on these issues would highlight the importance of this area and enhance its visibility.

BUDGET ALLOCATIONS

PEPFAR is accountable to Congress for implementing a relatively large set of specific budget allocations (see Chapter 2). These allocations derived from Congress’ desire to articulate and enforce certain priorities, in particular to ensure that the scale-up of ART would be the centerpiece of the program. At the time the legislation was passed, the international community, including CDC and USAID, was still debating whether treatment on this scale could be achieved. Relatively little information existed with which to determine precisely how resources should be allocated to achieve the performance targets in the focus countries; thus the budget allocations could not be fully evidence-based. Even in instances where the available information allowed reasonable estimates, the situation has since changed so rapidly that those estimates are no longer accurate. For example, when the Leadership Act was drafted, Congress estimated that antiretroviral medications (ARVs) would account for 75 percent of the cost of providing



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