resources, yet the NGOs felt that they were providing invaluable services to people affected by HIV/AIDS and that their communities looked to them for services that were not accessible or available elsewhere (587-21-PCNGO; 166-14-PCNGO). In many cases, the NGOs were long-standing agencies in the country, and once respected for their efforts and activities, were sought after by the country government for active partnerships in HIV/AIDS planning and implementation. Their involvement with the government ranged from developing training materials and curricula for use in government facilities to serving on national-level technical working groups that also made recommendations for policy making related to HIV/AIDS (240-ES; 542-ES; 166-ES; 116-ES). OGAC financially incentivized broader efforts for local capacity building for NGOs by awarding points that would result in increased funding for prime partners that used umbrella grant mechanisms for capacity building (NCV-16-USG). Civil society was described as having a “watchdog role” for governmental accountability for service provision and efforts for supply to keep pace with demand for quality services (542-5-USPS). In almost every partner country visited, there was a description of individual and institutional local capacity building efforts for the maintenance and sustainability of the HIV/AIDS response in nearly every area (monitoring and evaluation and research are further discussed in Chapter 11 on knowledge management). PEPFAR annual reports, from the very beginning, have also reported that “the investment in capacity building through bilateral programs reflects the United States’ commitment to helping nations increase their ability to respond to both current and future HIV/AIDS challenges and establish programs that are sustainable in the long term” (OGAC, 2005, p.75).

Track 1.0 partners deserve credit and acknowledgment for much of the capacity building for the provision of prevention, care, and treatment services for adults and children, including training of health personnel, as well as for rapid scale-up in the early days of PEPFAR and continuing through the transition of their programs to local entities within the countries they have worked (OGAC, 2005). The USG has consistently emphasized scaling up of services using core competencies of USG agencies (and their partners) across sectors (Goosby et al., 2012a). While workforce capacity building efforts are largely described in the chapter on health systems strengthening (Chapter 9), it should be noted that the reauthorization legislation highlighted the need for local capacity—“foreign service nationals provide critically important services in the design and implementation of United States country-level HIV/AIDS programs and their skills and experience as public health professionals should be recognized within hiring and compensation practices.”25

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25Supra, note 4 at img103, 22 U.S.C. 7612(d)(2).



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