•    PEPFAR has supported training for management and leadership to build capacity for improved functioning of health systems with a variety of activities, including curriculum development, mentorship, and shorter-term trainings and workshops. However, the focus and outputs of these training efforts are varied, and it was difficult for the committee to determine the impact of these efforts from the data currently available.

•    PEPFAR’s capacity building approach has been holistic and includes developing human resources; strengthening financial management; and building organizational capacity at national, provincial, and district levels and across government, private, and civil society sectors. Despite these efforts, leadership and financial management capacity were frequently mentioned as challenges to effective HIV/AIDS responses.

Financing

•    Data on partner country government expenditures for HIV/AIDS responses from National Health Accounts and National AIDS Spending Assessments for the 31 countries that are the focus of this evaluation were unavailable for many countries and years, making it difficult to examine trends in HIV/AIDS funding.

•    Although there are nascent efforts in PEPFAR for the costing of services and the projecting of needs to help countries develop a costed HIV/AIDS response, PEPFAR has not yet systematically implemented assistance for partner countries to develop resource mobilization plans, conduct costing activities and resource projections, or identify funding needs.

Information Systems

•    Despite initial PEPFAR-specific systems for program monitoring data, PEPFAR has worked with partner country governments to integrate and strengthen health information systems, including work that has strengthened partner country Laboratory Information Management Systems. However, ongoing support to strengthen partner country health information systems—and better alignment and integration with those systems—is needed to enhance timely data availability and quality for use in strategic program planning, resource allocation, and commodities procurement.

Medical Products and Technologies

•    PEPFAR has improved the capacity of partner country governments to quantify, forecast, procure, store and warehouse, distribute, and track commodities, but challenges to assuring consistent and reliable



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