PEPFAR Implementation Progress and Promise (2007) / Chapter Skim
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Appendix C Plan for a Short-term Evaluation of PEPFAR Implementation -- Letter Report # 1
Appendix C Plan for a Short-term Evaluation of PEPFAR Implementation -- Letter Report # 1
Pages 301-332
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appendix C Plan for a Short-term Evaluation of PEPFAR Implementation Letter Report # 1 Committee on the President's Emergency Plan for AIDS Relief (PEPFAR) Implementation Evaluation Board on Global Health Board on Children, Youth, and Families 0
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Additional copies of this report are available in limited quantities from the Committee for the Evaluation of PEPFAR Implementation, Board on Global Health, Institute of Medicine, 500 Fifth Street, N.W., Washington, DC 20001. The full text is available online at http://www.nap.edu.
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0 APPENDIX C "Knowing is not enough; we must apply. Willing is not enough; we must do." -- Goethe Advising the Nation.
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0 PLAN FOR A SHORT-TERM EVALUATION OF PEPFAR IMPLEMENTATION 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 Academy has a mandate that requires it to advise the federal government on scientific and technical matters.
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, Professor of Nursing and Associate Dean, International Programs, School of Nursing, University of California, San Francisco STEFANO BERTOZZI, Director of Health Economics, National Institutes of Health, Mexico GEOFF GARNETT, Professor of Microparasite Epidemiology, Faculty of Medicine, Imperial College, London, United Kingdom RUTH MACKLIN, Head, Division of Philosophy and History of Medicine, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York AFFETTE McCAW-BINNS, Professor, Reproductive Health Epidemiology, Section of Community Health, University of the West Indies, Jamaica A DAVID PALTIEL, Associate Professor and Head, Division of Health Policy and Administration, Yale University, New Haven, Connecticut PRISCILLA REDDY, Director, Health Promotion Research and Development, National Health Promotion & Behavioural Intervention Research Unit, Medical Research Council of South Africa DAVID ROSS, Director, Public Health Informatics Institute, Decatur, Georgia HEATHER WEISS, Director, Harvard Family Research Project, Harvard University, Boston, Massachusetts Subcommittee Members, Liaisons, and Study Consultants MAUREEN BLACK, John A
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OLAITAN SOYANNWO, Professor of Anesthesia and Consultant Anesthetist, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria BURTON WILCKE, Jr., Chair and Associate Professor, Department of Biomedical Technologies, University of Vermont, Burlington MICHAEL MERSON, (Board on Global Health Liaison)
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KIMBERLY WEINGARTEN, Senior Program Assistant ELIZABETH SHARP, Science and Technology Policy Fellow (January 2005 through April 2005) SHARLENE BAGGA, Science and Technology Policy Fellow (June 2005 through August 2005)
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Benatar, Professor of Medicine and Director, Bioethics Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa Thomas J Coates, Professor, Department of Medicine, Division of Infectious Diseases, Prevention and Policy Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles Nils Daulaire, President and CEO, Global Health Council, White River Junction, Vermont Anne Mills, Professor of Health Economics and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom Philip Onyebujoh, Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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0 APPENDIX C Mauro Schechter, Professor of Infectious Diseases, and Head, AIDS Research Laboratory, Hospital Universitario Clementino Fraga Filho Universidade, Rio de Janeiro, Brazil Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Neal A
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The IOM's legislative mandate to conduct an evaluation of PEPFAR is a complex challenge, in part because PEPFAR is effectively many programs in one. PEPFAR seeks to prevent seven million HIV infections, provide two million HIV-infected people with antiretroviral therapy, and care for ten million people affected by HIV/AIDS.
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However, it cannot adequately measure what matters most -- the impact on the lives of the people the legislation seeks to serve. In recognition of this, in addition to providing the short-term evaluation that will be responsive to the legislative mandate, the IOM Committee was charged to plan a longterm evaluation to determine whether PEPFAR has ultimately succeeded in improving the lives of the people in the focus countries by preventing infections, treating patients, and caring for people.
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The legislation emphasized the establishment of programs that focus on national HIV/AIDS strategies of recipient countries, women and children, strengthening of health care infrastructure and workforce, and effective monitoring and evaluation to assess programmatic success. This legislation also required the President to establish the Office of the Global AIDS Coordinator (OGAC)
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5-year Global HIV/AIDS Strategy: "The President's Emergency Plan for AIDS Relief", or PEPFAR. In order to measure the progress of the initiative, the PEPFAR strategy establishes three overarching goals: • To encourage bold leadership at every level to fight HIV/AIDS; • To apply best practices within bilateral HIV/AIDS prevention, treatment, and care programs, in concert with the objectives and policies of host governments' national HIV/AIDS strategies; and • To encourage partners, including multilateral organizations and other host governments, to coordinate at all levels to strengthen response efforts, to embrace best practices, to adhere to principles of sound management, and to harmonize monitoring and evaluation efforts to ensure the most effective and efficient use of resources (OGAC, 2004)
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government agencies, are responsible for supporting programs in PEPFAR countries with specific technical and implementation issues. Each of the focus countries has a U.S.
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The Committee is prepared to find considerable changes in PEPFAR throughout its evaluation, and has developed an approach to the evaluation that will allow it to adapt not only to changes in PEPFAR implementation, but also to what the Committee learns as the evaluation proceeds. The Committee's evaluation plan should be viewed as a work-inprogress that will be modified to reflect both the dynamic nature of PEPFAR and what the Committee learns -- particularly as it visits the PEPFAR focus countries to directly observe implementation activities.
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However, it cannot adequately measure what matters most -- the impact on the lives of the people the legislation seeks to serve. In recognition of this, in addition to providing the short-term evaluation that will be responsive to the legislative mandate, the IOM Committee is planning a long-term evaluation to determine whether PEPFAR has ultimately succeeded in improving the lives of the people in the focus countries by preventing infections, treating patients, and caring for people.
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Focus Countries Harmonization To what degree is PEPFAR harmonized with the national plan, national coordinating entity, and national monitoring Strategy Science and evaluation framework? Are programs Are programs and activities and activities Prevention, Treatment, Care aligned with evidence the strategy?
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The global HIV/AIDS community, led by organizations such as those of UNAIDS, has published guidelines outlining international consensus strategies for the development and implementation of prevention, treatment, and care programs. • Does the PEPFAR strategy address the major elements of the Act such as: -- Developing specific objectives, approaches and strategies for activities related to HIV/AIDS prevention, treatment and care?
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. The PEPFAR strategy outlines allocation mechanisms including country allocations based on each country's five-year strategic plan and performance assessments related to reaching annual prevention, treatment, and care targets, as well as a central funding mechanism for regional activities.
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With some unavoidable overlap, questions related to PEPFAR's support of the focus countries' monitoring and evaluation frameworks and capacity are emphasized in the harmonization and capacity building sections respectively. The questions emphasized in this section pertain primarily to PEPFAR's efforts to monitor and evaluate itself and demonstrate that it has achieved its goals.
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• How does PEPFAR assure the quality of programs and services? • What steps is PEPFAR taking to ensure that the necessary epidemiologic data and other information are available from the focus countries to assess the initiative's short-, as well as long-term impact?
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All of the PEPFAR focus countries have national AIDS authorities, and thus with this commitment, "Harmonization" with the Three Ones of each focus country became the centerpiece of the structure of PEPFAR. As such, it is central to the structure of the IOM evaluation.
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. The targets for PEPFAR-funded prevention, treatment and care programs -- to support prevention of 7 million new HIV infections, treatment of 2 million HIV-infected people with ART, and care of 10 million people infected and affected by HIV/AIDS -- were introduced in the State of the Union address given by President Bush in 2003, referenced in the Act, and later included in the PEPFAR strategy (OGAC, 2004)
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. • How is PEPFAR enhancing the capacity necessary for the focus countries to have sustainable HIV/AIDS prevention, treatment, and care programs?
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To answer questions related to PEPFAR resource allocation, the committee will review and analyze budgetary and programmatic data provided by OGAC, PEPFAR Missions, and others. The Committee will examine the major aspects of program implementation including PEPFAR management; harmonization; prevention, treatment, and care programs and activities; capacity building; and integration through a wide variety of approaches including review of the scientific literature; analysis of PEPFAR guidance and other documents, national plans, and focus country reports; analysis of data from PEPFAR and other programs and donors; and discussions with OGAC staff, Mission staff, focus country officials, partners, program officials, community groups, and officials from other donor organizations.
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Thus, visits to the focus countries to directly observe implementation activities are a critical part of the Committee's evaluation plan. The Committee anticipates that these country visits will provide insight into the programmatic successes and challenges through concrete examples and first-hand accounts of how PEPFAR is working on the ground.
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2005c. The President's Emergency Plan for AIDS Relief: Indicators, Reporting Re quirements, and Guidelines for Focus Countries (Revised for FY2006 Reporting)
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APPENDIX 2 PEPFAR Chronology May 2003 PEPFAR authorizing legislation passed: "United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003" October 2003 Ambassador Tobias sworn in as first U.S. Global AIDS Coordinator January 2004 First appropriation under the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003
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August 2005 Basic Requirements Under the President's Emergency Plan for AIDS Relief for all Bilateral Programs published May 2008 United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 expires 2008 Goal of 2 million People with HIV/AIDS on Antiretroviral Therapy 2008 Goal of 10 million People Affected by HIV/AIDS Receiving Care 2010 Goal of Preventing 7 million HIV Infections APPENDIX 3 Abbreviations AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy ARV Antiretroviral Drug CDC Centers for Disease Control and Prevention COP Country Operational Plan DoD Department of Defense DoL Department of Labor
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Treatment Subcommittee Chair -- Charles Carpenter, M.D. Hoosen Cooadia, M.B.B.S., M.D Henry Fomundam Pharm.D.
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Care Subcommittee Chair -- William Holzemer, R.N., Ph.D., FAAN Maureen Black, Ph.D. Affette McCaw-Binns, Ph.D.
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