The adaptation of PEPFAR to the aid effectiveness challenge
On January 14, GMF hosted Ambassador Mark Dybul, the U.S. global AIDS coordinator of the President's Emergency Plan for AIDS Relief (PEPFAR) in Washington, DC, for a discussion on the adaptation of PEPFAR to the aid effectiveness challenge. PEPFAR is a $15 billion, five-year international health initiative dedicated to HIV/AIDS prevention, treatment, and care, representing the single largest commitment of its kind toward one disease. The U.S. global AIDS coordinator, reporting to the U.S. Secretary of State, leads PEPFAR implementation, and coordinates the overall U.S. government emergency response to the global AIDS epidemic. PEPFAR supports international and host country partners at the local and national level to deliver targeted assistance across multiple sectors. The event was moderated by GMF senior transatlantic fellow Jim Kolbe. For a podcast recording of the discussion, click here.
Despite massive increases in funding for HIV/AIDS, it requires more effective aid, including greater coordination, coherence, and alignment with local country priorities. Referring to a recent article published in the New York Times, "In Global Battle on AIDS, Bush creates Legacy," Amb. Dybul outlined the "philosophical revolution" underlying PEPFAR, which explains the two main guiding principles of this philosophy: the appreciation of all human life and mutual respect. These, along with international agreements, are the key overarching principles incorporated into PEPFAR's work on-the-ground. Consistent with the principles of the Monterrey Consensus and the Paris Declaration, PEPFAR works toward building partnerships. In its truest sense, a partnership implies mutual respect of partners and values resulting in conditionality on both ends, based on the aforementioned principles. Amb. Dybul fervently argued that the premise of the discussion on vertical funds was not accurate. There are no "vertical" or "horizontal" funds as such. The way we perceive international aid in capitals runs counter to the reality on-the-ground. This is not helpful.
PEPFAR is an intermediary step to achieve the Paris Declaration. While the public sector dictates policy, there are multiple implementers and potential supporters such as the private sector and faith-based organizations. The private sector, for example, is ideally situated to help address absorption issues faced by PEPFAR and other donor partners. Prevention is critical and requires working outside the health sector and involves the wider community (this means local partnerships and ownership). Some argue that we need first to build the local health system or wait until we create horizontal/multilateral approaches. But waiting here means lives lost. That does not mean PEPFAR does not support local capacity building — it certainly does through training and community treatment and care programs. Chronic disease means working across all sectors (water, sanitation, education, warehousing, supply chains, etc) and PEPFAR aims to move toward creating "partnership compacts" similar to what the Millennium Challenge Corporation (MCC) does. PEPFAR is an intermediary step as it moves from bi-lateral to toward a multilateral model.
Ultimately, the best coordinated efforts within the aid infrastructure are in HIV/AIDS, which is far ahead of other sectors. Given the drastic shift in funding to PEPFAR in the recent past and near future, there is legitimate concern of shifting priorities. Especially in the area of economic development, we must ensure a balance between working toward AIDS prevention alongside other priorities such as economic growth.