Conclusions

The AIDS epidemic in sub-Saharan Africa has grown beyond a public health  problem to become a humanitarian and developmental crisis. However,  USAID’s ability to measure the impact of its activities on reducing  transmission of HIV/AIDS is limited by (1) inconsistent use of performance  indicators, (2) sporadic data collection, and (3) lack of routine reporting of  results to headquarters. As part of its approach for allocating the  53-percent increase in funding ($114 million to $174 million) for HIV/AIDS  prevention activities in sub-Saharan Africa for fiscal year 2001, USAID  prepared a plan to expand monitoring and evaluation systems in “rapid  scale-up” and “intensive focus countries”—countries designated as in need  of significant increases in assistance. However, when implemented, the  monitoring and evaluation requirements in the plan will not initially include  all countries where USAID missions and regional offices in sub-Saharan  Africa implement HIV/AIDS programs. Further, the plan does not specify to  whom these data will be reported or how the information will be used. Failure to address these issues not only inhibits USAID’s ability to measure  the performance of its HIV/AIDS activities but also hinders the agency’s  decision-making regarding allocation of resources among missions and  regional offices and limits efforts to identify best practices. Specifically, we (1) identified  the development and impact of the HIV/AIDS epidemic in sub-Saharan  Africa and the challenges to slowing its spread, (2) assessed the extent to  which the U.S. Agency for International Development’s initiatives have  contributed to the fight against AIDS in sub-Saharan Africa, and  (3) identified the approach the agency used to allocate increased funding  and the factors that may affect the agency’s ability to expand its HIV/AIDS  program in sub-Saharan Africa in response to this funding.
What GAO Found

The AIDS epidemic in sub-Saharan Africa has grown beyond a public health problem to become a humanitarian and developmental crisis. The Agency for International Development (AID) has contributed to the fight against human immunodeficiency virus (HIV)/AIDS in sub-Saharan Africa by focusing on interventions proven to slow the spread of the disease. However, AID's ability to measure the impact of its activities on reducing transmission of HIV/AIDS is limited by (1) inconsistent use of performance indicators, (2) sporadic data collection, and (3) lack of routine reporting of results to headquarters. As part of its approach for allocating the 53 percent increase in funding for HIV/AIDS prevention activities in sub-Saharan Africa for fiscal year 2001, AID prepared a plan to expand monitoring and evaluation systems in countries designated as in need of significant increases in assistance. However, when implemented, the monitoring and evaluation requirements in the plan will not initially include all countries where AID missions and regional offices in sub-Saharan Africa implement HIV/AIDS programs. Further, the plan does not specify to whom these data will be reported or how the information will be used. Failure to address these issues not only inhibits AID's ability to measure the performance of its HIV/AIDS activities but also hinders the agency's decision-making regarding allocation of resources among missions and regional offices and limits efforts to identify best practices.