Assessing The President's Emergency Plan For AIDS Relief: Past Achievements And Future Prospects For PEPFAR

July 11, 2012

Ambassador Eric Goosby, U.S. Global AIDS Coordinator

*** Remarks as Prepared ***

Thank you Susan. I appreciate the kind introduction and want to take a moment to thank your team at Health Affairs for the hard work all of you have put in to make this a successful issue.

I also want to recognize the issue advisor, Jaime Sepulveda, for guiding the development of the issue. Having served as the chair of the first Institute of Medicine evaluation of PEPFAR, he was a perfect choice.

Special thanks also go out to our Congressional colleagues. Congress is represented here today by Jim McDermott, who has been a leader for such a long time, and now serves as co-chair of the HIV/AIDS Caucus. I also want to recognize the Hill staff who are here or watching the webcast. Without the support of Congress, we would not be able to do the work that we do, and we are grateful.

I appreciate the participation of our business leaders, Jeffrey May and Renuka Gadd from Merck and BD. Thanks also to our partners from PEPFAR’s implementing agencies, including Nils Daulaire from HHS.

I’d also like to thank the authors of the manuscripts for your thoughtful contributions to PEPFAR’s development. Thank you for approaching this effort in a spirit of helping us to do our work better and save more lives.

Most of all, I’d like to salute the contribution of the people who make this work happen in the field. For all of us who work here at home, whether in the government, the private sector, or NGOs, our role is to support our partner countries in saving lives. So what we are really doing today is telling their story.

The health care providers, faith-based organizations and community groups, the businesses, the people living with HIV – they are the hands and feet who have led this transformation over the past decade. It’s thanks to them that the PEPFAR program, and incredible progress in creating hope, has happened.

You’ll be hearing from many people today, so I’ll keep my comments brief.

I’d like to start by highlighting a unique opportunity that PEPFAR has provided us, which this special issue captures in a direct way.

In simple terms, PEPFAR has given us a chance to take new science, put it to work in the field rapidly and at large scale, quickly move to assess its impact, and then to adjust programs accordingly.

All of this has taken place within an incredibly accelerated timeframe. I’m not aware of anything else in the global health space that has been able to ‘telescope’ these different elements with this combination of speed and scale. It’s as close to a real-time feedback loop as we’ve had. The manuscripts you’ll be discussing today are part of this healthy process, and as a learning organization, we are grateful for them.

The world is learning so much from this experience. That wouldn’t happen without this country’s investment and commitment to do the work on a large scale. Without that, we’d still be stuck doing small-scale pilot projects, and still asking ourselves whether it’s really possible to change the dynamic of AIDS.

But that question has been asked and answered. As we continue to expand our impact on AIDS, we face a related need -- to make the best use of the PEPFAR platforms we’ve established to address the range of global health challenges.

We can’t lose sight of the big picture of PEPFAR. Many in this room remember just how desperate the situation was a decade ago in Africa. The hopelessness was overwhelming. But despite the complexities of AIDS, the United States took it on with a targeted approach, on a large scale, and with accountability for results.

This group knows the impact it’s had – though I would note that many others still don’t, so it’s important to get the word out. Yet what even many experts don’t appreciate is the broader, transformational impact of this work on the health sector. The hospitals and clinics, the health workers, the labs, the supply chains – all of these focused investments have strengthened national systems to meet the whole range of health needs.

And that helps us understand the improvements we’ve seen in non-HIV indicators such as maternal, child and TB-related mortality, use of antenatal care, and safe blood supply. I believe we’ve really just scratched the surface of what can be achieved on these platforms we’ve built.

And I note, we’ve done this without compromising our impact on HIV – in fact, we’ve done it even as we’ve steadily increased our HIV results. It’s not either/or – they go hand in hand.

The papers you’ll hear about today that tell this story challenge us to ask, how do we build on this to benefit health at large? I believe PEPFAR has raised the bar for us all.

Of course, we’re not doing any of this alone – nor should we. In PEPFAR’s second phase, we’re prioritized support for country ownership. As Secretary Clinton described eloquently in her Oslo speech last month, that’s what it will take to make this effort a sustainable fixture of the landscape in each country, as it needs to be.

Congress gave us Partnership Frameworks as a tool to advance country ownership, joint roadmaps on AIDS that we enter into with partner governments. These have made it possible for us to plan collaboratively with them on how to build their capacity. They’ve built trust as we’ve had to reveal vulnerabilities and ‘get real.’

These Frameworks have also given us a forum in which to highlight policy or other issues that may be holding countries back, whether it’s failure to focus on key populations at high risk, lack of inclusion of women, or not collaborating with the faith sector that does so much of the work.

And of course, another recurring barrier is inadequate investment in health from national budgets. We have elevated the diplomatic dialogue to put that issue front and center.

Of course, if we look only at our efforts and those of countries, we overlook the essential role of the multilateral sector – the third leg of the stool, you might say. I think by the end of AIDS 2012, the world may be a bit tired of hearing us use the phrase ‘shared responsibility’ – but that’s OK, we’ll keep saying it because that’s exactly what it is!

We continue to see the Global Fund as a good investment for the U.S. Each dollar we invest leverages funds from other donors that do not, and never will, have big bilateral programs like PEPFAR. When it works right, the Fund brings those resources from many directions to bear on unmet needs identified by countries, and it achieves major health impact.

Our confidence that the Global Fund will work right, and that its resources will be used effectively and efficiently, is growing each day, as it implements its reform agenda and comes to see itself as an active investor. The U.S. has been supporting this evolution at every step. I am deeply encouraged to see these changes take root in a deep way. The success of the two programs is inextricably linked.

PEPFAR and the Global Fund are expanding our joint planning at the country level – but more importantly, we are doing it under the oversight of the country. Supporting country ownership means helping them develop their capacity to lead and direct external partners -- including us.

Let me wrap up. These next few weeks as we move into AIDS 2012 are important ones for the future, not only of PEPFAR, but of the global AIDS effort. At a time when money remains tight and will be for the foreseeable future, people want to know if we if we can actually have an AIDS-free generation.

You play a critical role in assuring them that we can. Even with constrained resources for a number of years now, we have continued to increase our results – which is the true test of success.

The papers of in this issue of Health Affairs help make that case. The more people see this information, I believe, the more convinced they’ll be that an AIDS-free generation is something we can achieve – and that this is no time to stop.

Thank you very much.

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