PEPFAR Updates

The following sections provide brief descriptions of important updates to PEPFAR programs and policies.

Five-Year Strategy

In December 2009, PEPFAR released its Five-Year Strategy, which outlines the high-level direction of the program for its next phase. This strategy reflects lessons learned in the first five years of the program, expands existing commitments around service delivery, and places a heightened emphasis on sustainability.

PEPFAR will aim to build programs that are country-owned and country-driven, address HIV/AIDS within a broader health and development context, and build upon strengths and efficiencies identified in the first phase of PEPFAR.

The full text of the Five-Year Strategy is available online at:

Global Health Initiative

The U.S. Government continues to lay the groundwork for efforts under the U.S. Global Health Initiative (GHI). This initiative is designed to help partner countries improve measurable health outcomes by strengthening health systems and building upon proven results. It places a particular focus on improving the health of women, newborns and children. Pursuing a comprehensive approach, GHI includes programs addressing HIV/AIDS, malaria, tuberculosis, maternal and child health, nutrition, family planning and reproductive health, and neglected tropical diseases. These U.S. global health investments are an important component of our national security "smart power" strategy, critical to national security as well as our common security.

GHI activities are being implemented in the more than 80 countries where U.S. Government global health dollars are already at work. Under GHI, the U.S. Government will coordinate with partner country governments to ensure that investments align with national priorities and build capacity. As of August 2010, eight countries have been selected as the first set of “GHI Plus” countries: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda. These countries will receive additional technical and management support to quickly implement GHI’s approach, including integrated programs and investments across the spectrum of infectious diseases, maternal and child health, family planning, and health systems activities. GHI Plus countries will provide enhanced opportunities to build upon existing public health programs; improve program performance; and work in close collaboration with partner governments, across U.S. Government agencies, and with global partners.

Through GHI, the U.S. Government is pursuing a comprehensive “whole-of-government” approach to global health and health assistance, including representatives from various offices at the Department of State, the U.S. Agency for International Development, the Department of Health and Human Services, the Department of Defense, the Department of Treasury, the Millennium Challenge Corporation, and Peace Corps.

Additional information about GHI, including the March 2011 “United States Government Global Health Initiative Strategy,” is available at

Partnership Frameworks

The development of Partnership Frameworks began in FY 2008 (Frameworks were called Compacts during early concept development). The goal of a Partnership Framework is to advance the progress and leadership of partner countries in the fight against HIV/AIDS. Partnership Frameworks will help create the policy and financial commitment platform necessary to successfully invest funding and achieve the five-year goals for prevention, care and treatment. This is to be accomplished through long-term, consultative frameworks, which outline mutual, non-binding, political commitments and responsibilities for the USG and partner country governments, and set forth a progression over time of U.S. support and partner country investment and policy change. While this is the overarching goal, negotiations at the country level will define each Partnership Framework and will reflect each country’s unique situation, capabilities and priorities. Partnership Frameworks should be fully in line with the national HIV/AIDS plan of the partner country, and should continue to emphasize sustainable programs with increased country ownership (including decision-making authority and leadership).

Twenty-one countries – Angola, Botswana, Caribbean Regional, Central America Regional, the Democratic Republic of Congo, Dominican Republic, Ethiopia, Ghana, Kenya, Lesotho, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Swaziland, Tanzania, Ukraine, Vietnam, and Zambia – already have signed Partnership Frameworks, posted online at

In some countries, additional funding for country programs will be made available after the Partnership Framework has been established.

Updated Partnership Framework Guidance (Version 2.0) can be found on at

Management and Operations

In the FY 2010 PEPFAR Operational Plans, the “USG Management and Operations” (M&O) section captures information about the USG PEPFAR footprint in country in a central, consolidated section – how the team is organized; each agency’s roles and responsibilities on the interagency team; staffing requests and vacancies; and the costs of doing business in country, by agency, for PEPFAR. This reflects an effort to centrally organize these costs in one location and allow easier itemization of individual costs; reduce the burden for country teams by centralizing data entry; and provide more transparency to Congress, OMB, and other stakeholders on the costs for each USG agency of managing and implementing the PEPFAR program. The revised methodology captured funding for continuing costs that had previously been captured in prevention, care and treatment budget codes. These funds support the costs of key personnel (including locally-employed staff) to provide oversight, technical assistance, management, and leadership of the PEPFAR programs in country.

Country teams continue to be encouraged to evaluate the appropriate alignment of M&O costs, interagency organization and structure, and staffing data to the program. Metrics are based on PEPFAR rightsizing principles, unique country/regional contexts, and field planning processes. They emphasize field teams’ careful consideration of the appropriate mix of technical, professional and administrative staff; ratio of locally employed staff to USG direct hires; growth in costs annually and over time; and increases in staff in relation to financial growth of the overall program portfolio.

The management and operations of the USG in each country, with a strong emphasis on interagency coordination, continue to be important priorities for PEPFAR. While planning for the FY 2010 Operational Plans, PEPFAR country teams were encouraged to re-evaluate their USG staffing footprint and organizational structure to ensure the maximization interagency planning, implementation, and evaluation. These staffing reviews embody the interagency structure and culture needed to integrate the “one USG team” fully, and institutionalizes management, operations, and staffing decisions based on meeting the overall PEPFAR prevention, care, and treatment goals in the most efficient and effective way possible.

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