Therefore, the aim of this evaluation approach was not to determine the direct attribution of PEPFAR funds to effects on health outcomes. Rather, the aim was to reasonably assess the contribution of PEPFAR to changes in health outcomes and health impact within the landscape of other funding sources, other HIV programs, and other factors that affect health. This contribution analysis is accepted as an appropriate standard for large-scale development assistance programs (Leeuw and Vaessen, 2009) and is consistent with the guidance about expectations for the evaluation provided by congressional staff during the planning phase for this evaluation (Bressler, 2009; Marsh, 2009).

EVALUATION METHODS

This section provides a brief overview of the methodological approach for the evaluation; more detailed descriptions of the methods can be found in Appendix C. The evaluation utilized a mix of methods and data sources, including the mapping of investment using financial data, assessing trends over time using program monitoring indicators and clinical data, benchmarking of progress against stated programmatic targets and goals, document reviewing, and analyzing of primary data collected through site visits and semi-structured interviews.

Interview Data

As the largest component of the data-gathering effort for the evaluation, committee members, IOM staff, and consultants conducted primary data collection through semi-structured interviews. The scope of these interviews is summarized in brief here; the design and methods for data collection and data analysis are described in full detail in Appendix C.

Country Visit Interview Data

From November 2010 to February 2012 the evaluation committee, IOM staff, and consultants conducted 13 country visits. These countries were selected by the evaluation committee through purposeful sampling based on a review of background data for each of the 31 PEPFAR countries covered by the evaluation. Background data covered a range of variables, including country income level, geographic location, HIV epidemic type, HIV prevalence, status as a focus country, population size, PEPFAR funding per capita and per person living with HIV, and relative contribution of PEPFAR to the national response compared with the Global Fund. Committee members iteratively grouped countries by different variables and



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