around research restrictions. In the words of the interviewee ‘In the first phase of PEPFAR, OGAC could not use the word research, so people referred [to research activities] as evaluation’ (NCV-7-USG).
Over time, leadership recognized that although PEPFAR was not intended to be a research organization, research was important to optimizing programs and maximizing the impact of knowledge and experiences created through PEPFAR (IOM and NRC, 2010). Recognizing this, the PEPFAR II reauthorization legislation and the second Five-Year Strategy helped clarify the research and evaluation policy to encourage these activities within PEPFAR (OGAC, 2009f). The reauthorization legislation and the second Five-Year Strategy called for the integration and expansion of research (e.g., biomedical research, health services research, impact evaluation research, and operations research) within PEPFAR in order to assess program quality, effectiveness, and population-based impact; to optimize service delivery; and to contribute to the global evidence base on HIV/AIDS interventions and program implementation (OGAC, 2009f).6
Evolution of PEPFAR-Supported Evaluation and Research Activities in PEPFAR I and II
As PEPFAR priorities and programming progressed, the frame within which PEPFAR conceptualized evaluation and research activities expanded from the initial Targeted Evaluations (TEs) to Public Health Evaluations (PHEs) Phases I and II to the current Implementation Science (IS) and Impact Evaluations. As the frame has evolved, the scope, allowable methods, funding mechanisms, oversight entities, and priorities of these research and evaluation activities have changed; this evolution is summaried in Table 11-5. Throughout this evolution, research and evaluation remained comingled in the operational structures of TEs and PHEs, with no clear articulation of the distinctions between PEPFAR’s research activities and aims and evaluation activities and aims, which is discussed below. The following sections focus on activities that have been implemented during PEPFAR I and into PEPFAR II, while a subsequent section will discuss in more detail the new research and evaluations activities being implemented under the IS umbrella, which were only just beginning as this evaluation was under way.
Targeted evaluations Targeted evaluations began in 2005 to provide an evidence base, beyond routine program monitoring and evaluation or surveillance, to inform program planning and implementation (OGAC, 2005b, 2006b). The goals of targeted evaluations were to assess program outcomes, indicate whether programs achieved their goals, and identify
6Supra, note 5.