Summary of the HIV/AIDS Partnership Framework with the Republic of Malawi (May 2009)


The Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act (P.L. 110-293) reauthorized the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The law provides support for the U.S. Government (USG) to enter into Partnership Frameworks (PFs) with host governments as a means of promoting national ownership of sustainable HIV programs. PFs seek to more closely align USG-funded HIV/AIDS efforts with national programs and the efforts of other international partners and civil society at the country level. PFs provide a 5-year joint strategic framework focused on service delivery, HIV/AIDS policy reform, and shared financial and/or in-kind commitments. After a PF is signed, a more detailed 5-year PF Implementation Plan is anticipated, with annual benchmarks for progress against the Framework and a matrix detailing partner inputs to the PF objectives.

On May 18, the United States signed the first Partnership Framework with the Government of the Republic of Malawi (GOM). Through the PF, the USG intends to contribute to, and align efforts with, GOM’s implementation of the goals, objectives, strategies, and action points of GOM’s National Action Framework (NAF) on HIV/AIDS. The Malawi PF focuses on reducing new HIV infections, improving the quality of treatment and care, mitigating the impacts of HIV/AIDS on individuals and households, and supporting systems needed to achieve these goals. Additional details will be provided in the PF Implementation Plan.

Malawi’s Partnership Framework

This PF represents a commitment to enhanced engagement by the GOM, with support from PEPFAR, to fight the HIV/AIDS epidemic in Malawi, and highlights a new model for collaboration and coordination among USG, GOM, and other country stakeholders.

In tandem with the development of the PF, the United States PEPFAR Malawi team, other donors and implementing partners supported the GOM’s effort to revise Malawi’s NAF for the coming years. Through expansive consultation, the GOM updated seven priority areas for the revised NAF. The timing of the two processes resulted in a transparent and collaborative discussion between the USG and the GOM that fostered close alignment of the PF with the NAF. PEPFAR and the GOM mutually identified a subset of the NAF priorities as strategic GOM directions and program areas to be supported by PEPFAR through the PF.

The PF is presented in four sections: country context, five-year strategic overview, partners’ roles and commitments, and joint governance system to oversee implementation. Programmatically, the PF focuses on support for the GOM’s efforts in the following areas: reducing new HIV infections in Malawi; improving the quality of treatment and care for Malawians impacted by HIV/AIDS; mitigating the economic and psychosocial effects of HIV/AIDS and improving the quality of life for people living with HIV/AIDS (PLHIV), orphans and vulnerable children (OVCs), and other affected individuals and households; and supporting these goals in Prevention, Care, and Treatment by providing discrete systems-strengthening support in the key areas of laboratory services, health management information systems, human resources, procurement and supply chain management, and health finance. Under each of the stated goals, PEPFAR and the GOM jointly identified overarching GOM national targets, specific program areas to be addressed by PEPFAR support, key GOM policy reforms needed to support and sustain the stated goal, and 5-year benchmarks by which to measure success. The document also lays out the expected areas of support by PEPFAR, the GOM, and other stakeholders. The PF will be supplemented by a more detailed Implementation Plan with annual benchmarks for progress against the Framework and a matrix detailing partner inputs to the PF objectives.

This PF represents a significant innovation, as this is the first time under PEPFAR a partner government has formally committed to policy reforms related to USG engagement. These GOM commitments, while not legally binding, will create a policy environment that supports and sustains USG investments, as well as the long-term success of Malawi’s efforts to fight HIV/AIDS.

Finally, the PF delineates the roles and responsibilities of each stakeholder and the governance structure by which the GOM and partners are to oversee the implementation of and accountability under the PF. In developing the PF, the PEPFAR Malawi team utilized pre-existing structures (e.g., technical working groups) already in place in Malawi, and it intends to use these structures to ensure the success, oversight, and accountability of the PF. These mechanisms also provide an excellent platform for aligning and harmonizing PEPFAR activities with those of the GOM and other development partners.

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