PEPFAR’s updated 5-year strategy, released in  2009 as mandated by the 2008 Leadership Act, highlights alignment with  national strategies as a key component of promoting sustainability of U.S.- supported HIV/AIDS efforts through partner country ownership. The U.S. Our analysis of PEPFAR  documents and national strategies and discussions with PEPFAR country  teams in the four countries we visited showed overall alignment between  PEPFAR activities and the national strategy goals. Conversely, PEPFAR may support activities  not mentioned in the national HIV/AIDS strategy but that are addressed in  relevant sector- or program-specific strategies. PEPFAR country teams  have engaged in various efforts to help ensure that PEPFAR activities  support the achievement of national strategy goals, including assisting in  developing national strategies, participating in formal and informal  communication and coordination meetings, engaging regularly with  partner country governments during the COP development process, and  developing new partnership frameworks. PEPFAR and Country Documents and Statements by PEPFAR and HIV/AIDS Stakeholders Indicate Alignment of Program Activities with National HIV/AIDS Goals

Our analysis shows that PEPFAR activities described in the 2010 COPs for  Cambodia, Malawi, Uganda, and Vietnam directly or partially address most  of the goals and objectives outlined in the countries’ national HIV/AIDS  strategies. PEPFAR officials—including  officials at OGAC, USAID, CDC, and HHS—and other HIV/AIDS  stakeholders and experts operating at a global level, as well as partner  government ministry officials, other donors, civil society representatives,  and PEPFAR officials in four countries told us that PEPFAR activities are  aligned with the goals and objectives outlined in partner countries’  national strategies and support the overall national program. PEPFAR Officials Noted Several Factors Influencing Alignment of PEPFAR Activities with National Strategy Goals

Several factors may influence the degree to which PEPFAR activities align  with national HIV/AIDS strategy goals, according to PEPFAR officials. Size of PEPFAR program. Policy restrictions. Meetings with partner governments and other stakeholders. First,  PEPFAR indicators sometimes differ from indicators used by partner  countries and other international donors. Second, gaps may exist in the  sharing of PEPFAR information with partner country governments and  other donors. Third, lack of country leadership and capacity to develop  strategies and manage programs affects PEPFAR country teams’ ability to  ensure that PEPFAR activities align with national strategy goals. Guidance for Measuring Progress of Partnership Frameworks Does Not Include Metrics of Country Ownership

PEPFAR guidance on developing partnership frameworks and  implementation plans includes detailed instructions for developing  baseline assessments of partner countries’ HIV/AIDS epidemics and of  efforts to respond to the epidemics. Recommendation for Executive Action

To enhance PEPFAR country teams’ ability to achieve the goal of  promoting partner country ownership of U.S.-supported HIV/AIDS  activities, we recommend that the Secretary of State direct OGAC to  develop and disseminate a methodology for establishing indicators needed  for baseline measurements of country ownership prior to implementation  of partnership frameworks. Appendix I: Scope and Methodology

In response to a directive in the 2008 Leadership Act, this report (1)  examines alignment of the President’s Emergency Plan for AIDS Relief  (PEPFAR) programs with partner countries’ HIV/AIDS strategies and (2)  describes several challenges related to alignment of PEPFAR programs  with the national strategies or promotion of partner country ownership.
Why GAO Did This Study

The President's Emergency Plan for AIDS Relief (PEPFAR), reauthorized at $48 billion for fiscal years 2009 through 2013, supports HIV/AIDS prevention, treatment, and care services overseas. The reauthorizing legislation, as well as other key documents and PEPFAR guidance, endorses the alignment of PEPFAR activities with partner country HIV/AIDS strategies and the promotion of partner country ownership of U.S.-supported HIV/AIDS programs. This report, responding to a legislative directive, (1) examines alignment of PEPFAR programs with partner countries' HIV/AIDS strategies and (2) describes several challenges related to alignment or promotion of country ownership. GAO analyzed PEPFAR planning documents and national strategies for four countries--Cambodia, Malawi, Uganda, and Vietnam--selected to represent factors such as diversity of funding levels and geographic location. GAO also reviewed documents and reports by the U.S. government, research institutions, and international organizations and interviewed PEPFAR officials and other stakeholders in headquarters and the four countries.

What GAO Found

PEPFAR activities are generally aligned with partner countries' national HIV/AIDS strategies. GAO's analysis of PEPFAR planning documents and national HIV/AIDS strategies, as well as discussions with PEPFAR officials in the four countries GAO visited, showed overall alignment between PEPFAR activities and the national strategy goals. In addition, statements by global and country-level PEPFAR stakeholders indicate that PEPFAR activities support the achievement of partner countries' national strategy goals. PEPFAR officials noted that a number of factors may influence the degree to which PEPFAR activities align with national strategy goals, including the activities of other donors, the size of the PEPFAR program, and policy restrictions. PEPFAR may also support activities not mentioned in the national HIV/AIDS strategies but that are addressed in relevant sector- or program-specific strategies. PEPFAR officials reported various efforts to help ensure that PEPFAR activities support the achievement of national strategy goals, including assisting in developing national strategies, participating in formal and informal communication and coordination meetings, engaging regularly with partner country governments during the annual planning process, and developing a new HIV/AIDS agreement, known as a partnership framework, between PEPFAR and partner country governments. PEPFAR stakeholders highlighted several challenges related to aligning PEPFAR programs with national HIV/AIDS strategies or promoting country ownership of U.S.-supported HIV/AIDS programs. First, PEPFAR indicators, including indicator definitions and timeframes, sometimes differ from those used by partner countries and other international donors. Second, gaps may exist in the sharing of PEPFAR information with partner country governments and other donors. Third, limitations in country leadership and capacity, such as lack of technical expertise to develop strategies and manage programs, affect country teams' ability to ensure that PEPFAR activities support achievement of national strategy goals. Fourth, Office of the U.S. Global AIDS Coordinator (OGAC) guidance to country teams regarding development of partnership frameworks does not include indicators for establishing baseline measures of country ownership prior to implementation of partnership frameworks. Without baseline measures, country teams may have limited ability to measure the frameworks' impact and make needed adjustments.

What GAO Recommends

GAO recommends that the Secretary of State direct OGAC to develop and disseminate a methodology for establishing baseline measures of country ownership prior to implementing partnership frameworks. OGAC concurred with this recommendation.