quire that partner countries receive support to define their prioritized outcomes and their target population and then to conduct baseline assessments so that progress toward outcomes can be measured.

•    PEPFAR U.S. mission teams should work with partner country stakeholders and implementers to assess country-specific needs and to select a subset of the core key outcomes to focus on when planning, selecting, and developing evidence-informed activities and programs for implementation.

•    Prioritization is critical in the presence of great need and finite resources. When planning with partner countries, PEPFAR should improve targeted coverage and the quality of supported services for affected children and adolescents not only by prioritizing outcomes and activities but also by more explicitly, clearly, and narrowly defining the eligibility for PEPFAR-supported services. This prioritization should be based on an assessment of country-specific needs with a process that consistently applies considerations and criteria across countries and programs. This prioritization should be done in coordination across program areas that address the needs and vulnerabilities of children and adolescents. These areas, which may target and serve a broader eligible population of children and adolescents than is determined for specific OVC programs, include care and treatment, PMTCT, other prevention services, and gender programs.

•    To improve the targeted coverage and sustainability for children and adolescents, PEPFAR and its implementing partners should continue to enhance services through existing systems and infrastructure and to support national governments in expanding social support services and the workforce to meet the health, education, and psychosocial needs of affected children and adolescents.

•    The Office of the U.S. Global AIDS Coordinator (OGAC) should provide general guidance for country programs on continuous program evaluation and quality improvement in order to measure and monitor the achievement of key outcomes. This may include, for example, template evaluation plans and methodological guidance. To allow for comparability across countries and programs, evaluation plans should include (but not be limited to) the defined indicators or other measures of the core key outcomes. Evaluations should emphasize the use of in-country local expertise (e.g., local implementing partners and subpartners as well as local academic institutions) to enhance capacity building and contribute to country ownership. (See also recommendations for PEPFAR’s knowledge management in Chapter 11.)

•    PEPFAR should develop a system for the active dissemination and sharing of evaluation outcomes and best practices both within and across countries that is driven as much by country-identified needs for information as by opportunities for exchange of information identified by headquarters-level leadership and technical working groups. (See also recommendations for PEPFAR’s knowledge management in Chapter 11.)



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