documented in more detail throughout this report. Therefore, the following is not a comprehensive list but rather examples drawn from those chapters of the types of activities that are supported and implemented through PEPFAR. In supporting the scale-up of HIV-related services, PEPFAR has supported the direct provision of services. This has included clinical, nonclinical, and laboratory services in public (government) and non–public health facilities as well as in community facilities and home-based services. In addition to supporting providers and providing commodities required to deliver these services, PEPFAR has supported the strengthening of infrastructure, such as equipment and facilities. Beyond supporting the direct provision of services, PEPFAR has supported partners in the provision of training, mentoring, technical assistance, and other capacity building for not only service delivery but also program management, leadership, and governance. PEPFAR has also supported policy development at the level of national and sub-national management of the HIV response. In addition, PEPFAR also has supported routine data collection, surveillance, special studies, and evaluation and research activities.
Although the general structure is similar across countries, the model of implementation and types of activities vary, ranging from direct support for service delivery to primary technical assistance. The balance and combination among the different activities and approaches to implementation vary according to the country’s needs, resources, capacity, and infrastructure (USG, 2012). The implementation of these different models is discussed further in Chapter 4 and Chapter 10.
PEPFAR is the largest bilateral global health program in history, and in order to implement such large amounts of foreign assistance for such a range of activities in such a short time, the operational structure of PEPFAR was strategically designed to use a number of existing USG agencies in a whole-of-government approach (Simonds, 2012). In the course of collecting data about the implementation and effects of PEPFAR-supported programs in partner countries, the committee learned about some of the advantages and challenges of the interagency implementation approach. These perspectives are reflected in a brief summary here; this is not a comprehensive assessment of this topic because the committee was not charged nor was this study designed to carry out an assessment of the organizational infrastructure and operational management of PEPFAR, areas which fall under the scope and mandate of other organizations external to PEPFAR that have issued reports of their assessments, such as the Government Accountability Office and the Office of Inspector General (GAO, 2009; OIG, 2008, 2009, 2010).