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US Development Policy

CGD experts track US development policy and offer ideas and analysis to improve its impact on developing countries. Also check out our Views from the Center blog and Global Health Policy blog.

 

Ambassador Deborah Birx speaking at CGD. Photo by Kaveh Sardari

PEPFAR’s New Targets for Local Implementation: Commendable in Theory, Complicated in Practice

In July, United States Global AIDS Coordinator Deborah Birx made a striking commitment: under her leadership, the President’s Emergency Plan for AIDS Relief (PEPFAR) would direct at least 40 percent of its funding to host country governments or organizations by the end of 2019—rising to 70 percent by the end of 2020. The bottom line: PEPFAR’s local targets are commendable in theory, but we suspect their application in practice will prove complicated. Below is our take on the related issues—and some recommendations for PEPFAR to forge the most effective path forward.

PEPFAR at 10

This is a joint post with Jenny Ottenhoff.

Ten years ago – on May 27, 2003 – the President’s Emergency Plan for AIDS Relief was born with the stroke of a pen by President George W. Bush.  Over the last decade, the program has experienced tremendous growth and made inroads against HIV/AIDS, TB and malaria in some of the world’s hardest hit areas.  And through it all, PEPFAR managed to maintain bi-partisan support that bridged two US Administrations, six US congressional sessions, and one global economic crisis.

Is USAID Being Set Up to Fail on the GHI?

Since the launch of the Obama administration’s $63 billion Global Health Initiative (GHI) in May 2009, we have followed its ups and downs with great enthusiasm (see for example: here, here, here and here), trying to better understand its structure and role within the U.S. government’s complicated global health architecture. One recurring question we have continually raised has focused on leadership: who, exactly, was to be in charge of this massive undertaking? Who would be accountable for meeting the initiative’s eight high-level targets and adhering to its seven guiding principles?

Last December, the State Department’s Quadrennial Diplomacy and Development Review (QDDR) appeared to put those questions to rest. According to the 200+ page document, USAID would assume leadership of the GHI by September 2012, contingent upon fulfilling a set of 10 benchmarks to demonstrate its capacity. But upon closer inspection of the GHI over the last year, the QDDR provision only seems to have generated a new set of questions that are more difficult to resolve. While there are no easy answers, the administration should consider these issues as it thinks through the tough decision of pulling the GHI together under one leader and demonstrating success by meeting its targets:

A Slouching Report on the Millennium Challenge Account

Usually a big fan of the succint and balanced reporting of Congressional Quarterly, last weeks article by Tom Starks entitled "A Slouching Millennium Challenge." was a let down. A lost opportunity to provide a balanced view to some of the stale assertions. Readers know that because I care about the success of the MCA as a new foreign aid program for a new era, I am often a constructive critic But this article screams for more food for thought:
Says Starks: