EVALUATION OF

PEPFAR

Committee on the Outcome and Impact Evaluation of Global HIV/AIDS
Programs Implemented Under the Lantos-Hyde Act of 2008

Board on Global Health
Board on Children, Youth, and Families

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
Committee on the Outcome and Impact Evaluation of Global HIV/AIDS Programs Implemented Under the Lantos-Hyde Act of 2008 Board on Global Health Board on Children, Youth, and Families

OCR for page R1
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract/Grant No. SAQMMA09M0693 between the National Academy of Sciences and the U.S. Department of State. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-26780-9 International Standard Book Number-10: 0-309-26780-3 Library of Congress Control Number: 2013939517 Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent ad- opted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Evaluation of PEPFAR. Washington, DC: The National Academies Press.

OCR for page R1
“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health.

OCR for page R1
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding en- gineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

OCR for page R1
COMMITTEE ON THE OUTCOME AND IMPACT EVALUATION OF GLOBAL HIV/AIDS PROGRAMS IMPLEMENTED UNDER THE LANTOS-HYDE ACT OF 2008 ROBERT E. BLACK (Chair), Johns Hopkins University, Baltimore, MD JUDITH D. AUERBACH, Consultant, San Francisco AIDS Foundation, CA MARY T. BASSETT, Doris Duke Charitable Foundation, New York, NY RONALD BROOKMEYER, University of California, Los Angeles LOLA DARE, Center for Health Sciences Training, Research and Development International, Ibadan, Nigeria ALEX C. EZEH, African Population and Health Research Center, Nairobi, Kenya SOFIA GRUSKIN, University of Southern California, Los Angeles ANGELINA KAKOOZA, Makerere University College of Health Sciences, Kampala, Uganda JENNIFER KATES, Henry J. Kaiser Family Foundation, Washington, DC ANN KURTH, New York University, New York ANNE C. PETERSEN, University of Michigan and Global Philanthropy Alliance, Ann Arbor DOUGLAS D. RICHMAN, VA San Diego Healthcare System and University of California, San Diego JENNIFER PRAH RUGER, Yale University, New Haven, CT DEBORAH L. RUGG, United Nations Inspection and Evaluation Division, New York, NY DAWN K. SMITH, U.S. Centers for Disease Control and Prevention, Atlanta, GA PAPA SALIF SOW, Bill & Melinda Gates Foundation, Seattle, WA SALLY K. STANSFIELD,1 Independent Consultant, Geneva, Switzerland TAHA E. TAHA, Johns Hopkins University, Baltimore, MD KATHRYN WHETTEN, Duke University, Durham, NC CATHERINE M. WILFERT, Retired, Elizabeth Glaser Pediatric AIDS Foundation, Durham, NC Consultants SHARON KNIGHT, East Carolina University, Greenville, NC KATHRYN TUCKER, Statistics Collaborative, Inc., Washington, DC JANET WITTES, Statistics Collaborative, Inc., Washington, DC 1  Committee member through August 2012. v

OCR for page R1
Staff KIMBERLY A. SCOTT, Study Co-Director BRIDGET B. KELLY, Study Co-Director MARGARET HAWTHORNE, Program Officer LIVIA NAVON, Program Officer CARMEN CECILIA MUNDACA, Postdoctoral Fellow IJEOMA EMENANJO, Senior Program Associate (through January 2011) MILA C. GONZÁLEZ DÁVILA, Associate Program Officer (through August 2012) KRISTEN DANFORTH, Research Associate REBECCA MARKSAMER, Research Associate (from August 2012) KATE MECK, Research Associate COLLIN WEINBERGER, Research Associate (April 2011 through June 2012) LEIGH CARROLL, Research Assistant (from October 2011) TESSA BURKE, Senior Program Assistant (through May 2011) ANGELA CHRISTIAN, Program Associate WENDY E. KEENAN, Program Associate JULIE WILTSHIRE, Financial Associate KIMBER BOGARD, Board Director, Board on Children, Youth, and Families (from October 2011) ROSEMARY CHALK, Board Director, Board on Children, Youth, and Families (through July 2011) PATRICK KELLEY, Senior Board Director, Boards on Global Health and African Science Academy Development vi

OCR for page R1
Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: PIERRE BARKER, Institute for Healthcare Improvement CHRIS BEYRER, Johns Hopkins University ANASTASIA TZAVARAS CATSAMBAS, EnCompass LLC DAVID CELENTANO, Johns Hopkins University PAUL De LAY, Joint United Nations Programme on HIV/AIDS WAFAA M. EL-SADR, Columbia University KURT FIRNHABER, Right to Care MITCHELL H. GAIL, National Institutes of Health ROBERT GROSS, University of Pennsylvania JOHN E. LANGE, Bill & Melinda Gates Foundation CHEWE LUO, United Nations Children’s Fund JONATHON LEE SIMON, Boston University RJ SIMONDS, Elizabeth Glaser Pediatric AIDS Foundation vii

OCR for page R1
viii REVIEWERS SHOSHANNA SOFAER, City University of New York MIRIAM WERE, University of Nairobi Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclu- sions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Kristine M. Gebbie, Flinders University School of Nursing and Midwifery, and Ann M. Arvin, Stanford University. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

OCR for page R1
Acknowledgments The committee, project staff, and consultants are deeply appreciative of the diverse and valuable contributions made by so many who assisted with this study. For information and support provided throughout the project, we thank the staff of the Office of the U.S. Global AIDS Coordinator, with particular gratitude to Paul Bouey and Tiffany Parker, who facilitated our engagement during the study, as well as staff from other President’s Emer- gency Plan for AIDS Relief (PEPFAR) implementing agencies. We are also grateful to the leadership of the U.S. missions and the PEPFAR staff in the countries visited for this evaluation, whose hospitable and gracious assis- tance was essential to the success of our country visits. We also thank the many other individuals in the countries visited who assisted us with logistics and support during our visits. We are grateful to Eran Bendavid from Stanford University for his valu- able consultation during the study. We appreciate the essential technical support provided to the project by Danielle Beaulieu, Jessica Case, Megan Somerday, Jeff Steen, and Neil Wohlford from Statistics Collaborative, Inc. We thank Kathryn Stadeli from University of California, San Diego, School of Medicine for her assistance with research for the study. We also thank Megan Perez and Meredith Cantwell for their excellent work on this study as interns at the Institute of Medicine as well as Wyatt Smith and Peter Dull, who provided temporary assistance during the project. We are grateful to Teresa Bergen and Diane Wellman for their diligent work as transcriptionists. We appreciate the creativity and effort of Jay Christian ix

OCR for page R1
x ACKNOWLEDGMENTS and LeAnn Locher for their design work. In addition, we convey our deep gratitude and appreciation for the hard work of the many staff in various offices of the Institute of Medicine and the National Academies who lent their support to the project. There are a number of other individuals who were crucial for the ad- ministrative and logistical success of this project. For help with scheduling and communication for the committee, we thank Sharon Abbruscato, Lola Adedokun, Philomena Agaloi, Jillian Albertolli, Michele Augustus, Nkiru Azikiwe, Anna Both, Cindy Chu, Kyle Hamilton, Jennifer Heflin, Maria Male, Sheila Mwero, Catherine Nyawire, Audrey Palix, Jessica Raback, Mary Rybczynski, Fortuna Salinas, Abir Shady, Cassie Toner, Rachel Upton, Kevin Vavasseur, Jackylene Wegoki, and Marie Young. We are also immensely grateful to Anthony Mavrogiannis and the staff at Kentlands Travel for their assistance with the complex travel needs of this project. Finally, although we cannot name them here for reasons of confiden- tiality, we offer our most profound thanks to the hundreds of individuals who participated in interviews and site visits as part of the evaluation data collection effort. Their generosity with their time and their willingness to share their insights were fundamental to the evaluation; it was a privilege and an inspiration to hear directly from those whose dedication and tre- mendous effort underlie the successes of the response to HIV globally and in PEPFAR partner countries.

OCR for page R1
Contents PREFACE xxv ACRONYMS AND ABBREVIATIONS xxix SUMMARY 1 Evaluation Approach, 2 Evaluation Conclusions and Recommendations, 3 Conclusion, 14 PART I: INTRODUCTION 1 BACKGROUND 19 Global Burden of HIV, 20 History of U.S. Investment to Respond to Global HIV/AIDS, 21 References, 36 2 EVALUATION SCOPE AND APPROACH 39 Congressional Charge, 39 Planning Phase for the Evaluation, 40 Interpretation of the Charge, 42 Operational Planning Phase, 45 Conceptual Framework for the Evaluation, 45 Evaluation Methods, 50 Overarching Evaluation Challenges and Limitations, 55 xi

OCR for page R1
xxiv TABLES, FIGURES, AND BOXES 9-1 PEPFAR Budget Code Definitions for HSS, 442 9-2 OGAC Definitions of Technical Assistance (TA) Related to Leadership and Governance, 452 9-3 Select Innovative Financing Mechanisms from Committee- Collected Interview Data, 467 9-4 Select Examples of PEPFAR-Supported Information Systems, 477 9-5 SCMS Member Organizations, 485 9-6 PEPFAR’S Laboratory Systems Strengthening Initiatives Over Time, 491 9-7 MEPI, 500 9-8 NEPI, 501 9-9 Select Examples of PEPFAR-Supported Models and Approaches to Service Integration, 518 10-1 Select Global Accords That Influence Sustainability of HIV/AIDS Responses, 550 10-2 Measures of Progress and Achievements in the Paris Declaration, 552 10-3 Elements of Country Ownership from Interview Data, 561 10-4 IOM Committee-Recognized Impediments to Country Ownership from Interview Data Analysis, 564 10-5 OGAC’s 14 Initiatives to Address Priority Themes to Accelerate Country Ownership, 565 10-6 USG-identified Potential Measures of Success for Country Ownership, 572 11-1 Select PEPFAR Efforts to Align with Partner Country M&E Systems, 627 11-2 Institutional Affiliations of Scientific Advisory Board Members, October 2012, 659 11-3 Pathways of Knowledge Transfer in PEPFAR, Beyond Routine Reporting, 668 11-4 “Organization X” Innovative Knowledge Transfer, 683 11-5 PEPFAR-Supported Websites, 692 C-1 Interview Citation Key, 788

OCR for page R1
Preface The HIV/AIDS pandemic has beleaguered the world for more than three decades. The countries most affected continue to be in sub-Saharan Africa, home to an estimated two-thirds of people living with HIV. There have been major increases in international aid assistance as well as in na- tional commitments to and investments in HIV prevention, treatment, care, and capacity building activities, yet funding remains insufficient to meet the estimated immediate and projected needs. In 2003, in response to the devastating consequences of the HIV pan- demic, the U.S. Congress funded a major new U.S. global health initiative, which became known as the President’s Emergency Plan for AIDS Relief, or PEPFAR.1 PEPFAR remains the largest bilateral initiative aimed at address- ing HIV/AIDS. At the time of its initial authorization, PEPFAR was seen as a bold initiative, testing, among other strategies, whether treatment could be successfully and intensively scaled up in low-resource settings. The initial authorizing language mandated that the Institute of Medicine (IOM) assess the progress of PEPFAR implementation to help guide the future directions of this innovative program. The findings and recommendations of that IOM study, published in 2007, informed PEPFAR processes, policies, and activi- 1  UnitedStates Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, P.L. 108-25, 108th Cong., 1st sess. (May 27, 2003). xxv

OCR for page R1
xxvi PREFACE ties as well as the legislation that reauthorized the initiative, known as the Lantos-Hyde Act of 2008.2 The reauthorization legislation mandated that the IOM assess the per- formance of U.S.-assisted global HIV/AIDS programs and evaluate the im- pact on health of prevention, treatment, and care efforts supported by U.S. funding (see Appendix A for the statement of task). This report is intended to provide a rigorous, evidence-based, multidisciplinary, and independent evaluation of PEPFAR to Congress and the Department of State as well as to the scientific community, program implementers, policy makers, civil society, people living with and affected by HIV/AIDS, and international stakeholders in global public health. In response to its mandate, IOM first convened a planning committee to develop a strategic approach for conducting the evaluation. This approach, published in a 2010 report, addressed the complexities of evaluating an initiative with the scale and diversity of programs that PEPFAR supports and with the range of countries in which it operates. The dynamism of an initiative that was operating and evolving over the course of the evaluation presented additional complexity. To carry out the evaluation, the IOM convened a diverse expert com- mittee that included considerable overlap with the members of the planning committee. Guided by the strategic approach, the committee, IOM staff, and consultants carried out a mixed-methods approach. The qualitative data that were collected included extensive document review and more than 400 semi-structured interviews conducted from 2010 to 2012. Each member of the committee visited at least one PEPFAR partner country, and in total the evaluation team conducted 13 data collection visits to partner countries, hearing the perspectives of a wide range of stakehold- ers. PEPFAR headquarters and mission staff, partner country stakeholders, and global partners all generously contributed their time and experience to the committee. Quantitative data included financial data, program and clinical monitoring data, and epidemiological information. The committee struggled to find quantitative data to address some of the elements of the statement of task. Beyond the specific issues of available data to address the legislated task, however, there is also the critical imperative that PEPFAR be able to determine the key questions to ask in order to assess its own performance and effectiveness and to plan in advance for the collection of meaningful data to answer those questions and guide the ongoing evolution of PEPFAR. 2  Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tu- berculosis, and Malaria Reauthorization Act of 2008, P.L. 110-293, 110th Cong., 2nd sess. (July 30, 2008).

OCR for page R1
PREFACE xxvii The 2008 reauthorization of PEPFAR emphasized that the program must transition from its initial goal of providing an emergency response to longer-term goals of enhancing sustainability, promoting country own- ership, and strengthening health systems. One of the clear findings that emerged from this evaluation is that as PEPFAR evolves in this way, major dilemmas are emerging that create tensions for decision making related to a country’s HIV response; these dilemmas will require attention as the program moves forward. As the HIV response becomes more country- driven, PEPFAR—and any other external donor effort—will need to focus its contributions on national efforts rather than on the direct provision of services and attribution of results. This will have consequences for program planning, implementation, and evaluation. Furthermore, focusing on coun- try ownership will require relinquishing some control over the response, which in turn will have unknown consequences for quality and access to services; PEPFAR and its partner countries will have to grapple with these issues together. PEPFAR has been globally transformative—changing in many ways the paradigm of global health and what can be accomplished with ambitious goals, ample funding, and humanitarian commitment to a public health crisis. As it moves forward, PEPFAR must continue to be bold in its vi- sion, implementation, and global leadership, but now toward its aims of continuing to strengthen the capacity of partner countries to respond to the pandemic. The committee hopes that this evaluation will serve as a tool to achieve these aims. The committee extends its gratitude to all those who provided informa- tion to assist in the evaluation. The committee has continuing deep admira- tion for those carrying out the difficult work of responding to the pandemic. I was privileged to serve as the chair for both the planning committee and the evaluation committee. I would like to express my appreciation to the members of both committees for the expertise and perspective they contrib- uted, for their robust participation in discourse and deliberation, and for the immeasurable time and energy they volunteered. The IOM committee staff, very ably led by study co-directors Bridget Kelly and Kimberly Scott, have been highly professional, thoughtful, and committed to ensuring the most responsive and rigorous evaluation possible. I thank the entire staff and the committee consultants for their tireless efforts in support of the committee. Robert E. Black, Chair Committee on the Outcome and Impact Evaluation of Global HIV/AIDS Programs Implemented Under the Lantos-Hyde Act of 2008

OCR for page R1

OCR for page R1
Acronyms and Abbreviations AIDS acquired immune deficiency syndrome ANC antenatal care APR annual program results ART antiretroviral therapy ARV antiretroviral AZT zidovudine BCC behavior change communication BPE basic program evaluation CBO community-based organization CCM country coordinating mechanism CD4 cluster of differentiation 4 CDC U.S. Centers for Disease Control and Prevention CGD Center for Global Development CHERG Child Health Epidemiology Reference Group CHSW community health or para-social worker COP country operational plan COPRS Country Operational Plan Reporting System CPT cotrimoxazole preventive therapy CRC Committee on the Rights of the Child CSO civil society organization CTX cotrimoxazole xxix

OCR for page R1
xxx ACRONYMS AND ABBREVIATIONS DAH development assistance for health DHAP Division of HIV/AIDS Prevention (at CDC) DHS Demographic and Health Surveys DoD U.S. Department of Defense DoL U.S. Department of Labor DoS U.S. Department of State EA expenditure analysis EID early infant diagnosis of HIV FBO faith-based organization FELTP Field Epidemiology and Laboratory Training Program FETP Field Epidemiology Training Program FY fiscal year GAO U.S. Government Accountability Office GBV gender-based violence GHI U.S. Global Health Initiative Global Fund Global Fund to Fight AIDS, Tuberculosis, and Malaria GMS Grants Management Solutions GNI gross national income HAPSAT HIV/AIDS Program Sustainability Analysis Tool HHS U.S. Department of Health and Human Services HIPC heavily indebted poor country HIS health information system HIV human immunodeficiency virus HMIS health management information system HQ headquarters HRH human resources for health HRSA Health Resources and Services Administration HSS health systems strengthening IeDEA International Epidemiological Database to Evaluate AIDS IGA income-generating activity IOM Institute of Medicine IPT isoniazid preventive therapy IPTp intermittent preventive treatment of malaria for pregnant women ITN insecticide-treated net LIMS laboratory information management system LTFu loss to follow-up

OCR for page R1
ACRONYMS AND ABBREVIATIONS xxxi M&E monitoring and evaluation MAT medication-assisted treatment MCC Millennium Challenge Corporation MCH maternal and child health MDG Millennium Development Goal MEPI Medical Education Partnership Initiative MERG Monitoring and Evaluation Reference Group MICS Multiple Indicator Cluster Survey MOH ministry of health MSM men who have sex with men MTCT mother-to-child transmission NAC National AIDS Commission/Committee/Council/Control Agency NAS National Academies of Science NASA national AIDS spending assessment NDOH National Department of Health (South Africa) NEPI Nursing/Midwifery Education Partnership Initiative NGI next generation indicator NGO nongovernmental organization NHA national health account NIH U.S. National Institutes of Health NRC National Research Council NSF National Science Foundation OECD Organisation for Economic Co-operation and Development OGAC Office of the U.S. Global AIDS Coordinator OI opportunistic infection OMB Office of Management and Budget OVC orphans and vulnerable children PCR polymerase chain reaction PEP post-exposure prophylaxis PEPFAR The President’s Emergency Plan for AIDS Relief PEPFAR I The President’s Emergency Plan for AIDS Relief (2004–2008) PEPFAR II The President’s Emergency Plan for AIDS Relief (2009–2013) PEQ priority evaluation question PF Partnership Framework PFIP Partnership Framework implementation plan PHE public health evaluation

OCR for page R1
xxxii ACRONYMS AND ABBREVIATIONS PI principal investigator PICT provider-initiated counseling and testing PIP Program Impact Pathway PLHIV people living with HIV/AIDS PMI President’s Malaria Initiative PMTCT prevention of mother-to-child transmission PPP public–private partnership PrEP pre-exposure prophylaxis QA quality assurance QI quality improvement RFA request for application SAB Scientific Advisory Board (of PEPFAR) SAMHSA Substance Abuse and Mental Health Services Administration SANAC South African National AIDS Council SAPR semi-annual program results SCMS Supply Chain Management System SGBV sexual and gender-based violence SI strategic information SOPA State of the Program Area STD sexually transmitted disease STI sexually transmitted infection TA technical assistance TAB technical advisory board TB tuberculosis TDR transmitted drug resistance TE targeted evaluation TWG technical working group UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s Fund UNODC United Nations Office on Drugs and Crime USAID United States Agency for International Development USG U.S. government VMMC voluntary medical male circumcision WHO World Health Organization

OCR for page R1
ACRONYMS AND ABBREVIATIONS xxxiii INTERVIEW CITATION ABBREVIATIONS Country Visit Exit Synthesis: Country # + ES Country Visit Interview: Country # + Interview # + Organization Type Non-Country Visit Interview: “NCV” + Interview # + Organization Type Organization Types USG U.S. government USNGO U.S. nongovernmental organization USPS U.S. private sector USACA U.S. academia PCGOV partner country government PCNGO partner country nongovernmental organization PCPS partner country private sector PCACA partner country academia CCM country coordinating mechanism ML multilateral organization OBL other (non-U.S. and non-partner country) bilateral OGOV other government ONGO other (non-U.S. and non-partner country) nongovernmental organization

OCR for page R1