cases surpassed—its initial ambitious aims. These efforts have saved and improved the lives of millions of people around the world. That success has in effect “reset” the baseline and shifted global expectations for what can be achieved in partner countries. The reauthorization of PEPFAR not only set new aims to continue to scale up services, but also heightened the emphasis on health systems strengthening and sustainability, a shift in focus that has been increasingly reflected in the initiative’s policies, activities, and dialogue with stakeholders.
The statement of task for this evaluation was derived from the legislation that reauthorized PEPFAR, which mandated that the Institute of Medicine (IOM) assess PEPFAR’s performance and its effects on health.2 Specifically, the task was to evaluate progress in meeting prevention, care, and treatment targets; the impact of PEPFAR-supported HIV prevention, treatment, and care programs; the effects of PEPFAR on health systems; PEPFAR’s efforts to address gender-specific aspects of HIV/AIDS; and the impact of PEPFAR on child health and welfare.
To conduct a rigorous assessment that took into account PEPFAR’s complexity and varied contexts, the IOM committee employed a mix of methods using financial data, program monitoring indicators and clinical data, extensive document review, and primary data collection carried out through more than 400 semi-structured interviews and site visits. A range of stakeholders were interviewed in 13 PEPFAR partner countries, at the U.S. headquarters of PEPFAR, and at other institutions and multilateral agencies.
The availability of the data needed to address all the health outcomes and impacts in the mandate was limited, and few data sources exist that are comparable and comprehensive across all PEPFAR partner countries. Therefore, the evaluation relied on sources from which robust information could be gathered on subsets of countries and select components within programmatic areas. Then, by assessing convergence and consistency among findings from different yet complementary data sources and methods, the committee analyzed and interpreted the available data to develop reasonable conclusions and recommendations about performance, impact, and progress across the whole of PEPFAR.