and contribute to other health needs, PEPFAR should continue to implement and leverage efforts that have had positive effects within partner country health systems. PEPFAR should maintain efforts in all six building blocks but have a concerted focus on areas that will be most critical for sustaining the HIV response, especially workforce, supply chain, and financing.

Further considerations for implementation of this recommendation:

•    An important focus for PEPFAR’s future activities and policies should be support for partner country capacity to locally produce and retain clinical, nonclinical, and management professionals whose training and scope of practice are appropriate and optimized for the tasks needed. The Medical Education and Nursing/Midwifery Education Partnership Initiatives have provided a starting point for the training of physicians and nurses; however, the training of associate clinician providers and other cadres will also be critical to the sustainable management of the response. In addition, PEPFAR needs to augment its efforts to build partner country capacity to track the placement of trained workers, to promote retention, and to develop long-term human resources plans. (See also the discussion and recommendation for capacity building in Chapter 10 on progress toward a sustainable response.)

•    Building on the progress made through the public–private partnership with the Supply Chain Management System, PEPFAR should enhance and expand efforts with a greater focus on capacity building for accountable supply chain management in partner countries. The aim of this improved capacity should be to gradually shift to local or regional leadership, coordination, and management to ensure a reliable supply chain for essential medicines and commodities.

•    Financing and leadership and governance are particularly critical for the sustainable management of the HIV response; this area is addressed in Recommendation 10-1 (see Chapter 10).

•    To contribute to the knowledge base for health systems strengthening, PEPFAR should include this area in its research and evaluation agenda and its knowledge dissemination efforts. (See also recommendations for PEPFAR’s knowledge management in Chapter 11.)



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