efforts and guide future activities is not sufficient or is not available in a manner that facilitates use.

PEPFAR’s indicators, like many program monitoring systems, are focused primarily on outputs, such as the number of individuals provided with a service. These serve an important function to monitor implementation of activities but do not reflect quality, efficiency, or effectiveness. Measuring program progress and effectiveness is not always best achieved through program monitoring systems. Therefore, strategic and coordinated evaluation and research are also critical activities that complement program monitoring indicators in order to assess meaningful outcomes and to continually improve the effectiveness and impact of PEPFAR investments. In addition, support for epidemiological data collection through surveillance and special studies in partner countries, which has been a cornerstone of PEPFAR’s contribution, continues to be fundamental to supporting joint planning with partner countries.

PEPFAR would benefit from a more purposeful and strategic determination of which internal and external stakeholders need to know what information, at what level of the PEPFAR operational infrastructure, covering what scope of PEPFAR’s efforts, and with what frequency. The limited personnel, time, and financial resources for knowledge management could then be allocated to monitoring, evaluation, research, and dissemination activities that meet these needs, while reducing the burden of collecting and reporting data and other information that is not useful.

PEPFAR will need to transform its approach to knowledge management in order to adapt to a transition from direct support for delivery of services and programs to increased support and technical assistance for systems strengthening, capacity building, and sustainable management of the response by partner country stakeholders. An investment now to develop reliable, credible approaches to assess the effectiveness of these efforts will be needed to document future progress and to continually improve future efforts. The ability to attribute results by counting services provided or beneficiaries reached will become less relevant; in fact, direct attribution will no longer be an appropriate expectation for accountability. PEPFAR could seize this opportunity to work with others in the global health and development assistance communities to develop appropriate ways to assess contributions to the improved performance and effectiveness of national efforts.

The Office of the U.S. Global AIDS Coordinator (OGAC) should develop a comprehensive knowledge management framework, including a program monitoring and evaluation strategy, a prioritized and targeted research portfolio, and systems for knowledge dissemination. This framework should adapt to emerging needs to

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