the Office of the U.S. Global AIDS Coordinator (OGAC), while in partner countries PEPFAR is housed in U.S. diplomatic missions under the oversight of the U.S. ambassador to the country. From this home base in the Department of State, the implementation of PEPFAR involves multiple USG agencies that oversee and manage PEPFAR-supported programs at both headquarters level and in partner countries (IOM, 2007; PEPFAR, 2012). PEPFAR also engages implementing partners, which may be based in the United States, in partner countries, or in other countries (IOM, 2007). Figure 3-1 shows a schematic overview of how PEPFAR is implemented, from congressional appropriations through service delivery to beneficiaries. The sections that follow describe the core components and levels of PEPFAR’s organization and implementation. This chapter is complemented by a more detailed discussion in Chapter 4 of the flow of PEPFAR funding through the levels described in Figure 3-1. This chapter focuses on organization and implementation within and among the levels of PEPFAR. Chapter 11 provides an in-depth discussion of PEPFAR’s knowledge management, including systems for monitoring, evaluation, research, and information transfer.


Office of the U.S. Global AIDS Coordinator

The formal organizational unit for PEPFAR is OGAC at the Department of State. OGAC is overseen by the Coordinator, an appointed position at the level of ambassador who reports directly to the U.S. Secretary of State. OGAC serves as the administrative office for PEPFAR and directs and coordinates activities at both the headquarters level in Washington, DC, and at the country level, where PEPFAR operates under the additional oversight of the U.S. ambassador of the country. OGAC staff members, including detailees from other USG agencies, coordinate administrative, financial, and programmatic implementation, oversight, and guidance. OGAC also has country support team leaders who serve as the principal point of contact and liaison to in-country PEPFAR mission teams (IOM, 2007; PEPFAR, 2013a). The organizational structure of OGAC has changed over time; the current structure at the time of this evaluation is shown in Figure 3-2.

In addition, the Coordinator and other OGAC staff represent the United States on global bodies responding to the HIV/AIDS pandemic and participate with multinational organizations, including the Joint United Nations Programme on HIV and AIDS (UNAIDS), the Global Fund, the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF), on a range of aspects of the global HIV response, such as

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