Governance is one of the WHO's six building blocks of a well-functioning health system, and is often a focus of larger development efforts. Financing, budgeting, planning, and prioritization are essential skills for governments that are establishing or expanding HIV and other health services. When corruption exists, wasted money limits the impact of investments in health services. Corruption can also constrain donor engagement, and ultimately hurt the individuals who are in need of care.
With its successes in service delivery, PEPFAR's first five years helped to dispel concerns that corruption would limit the effectiveness of USG foreign assistance programs. PEPFAR's new emphasis on building country-level capacity creates additional opportunity to support accountable and competent leadership in low-resource nations. Country ownership cannot be complete without adequate accountability and financial management systems through which governments can track and report on funding. By working to develop technical expertise with civil service employees at partner ministries across sectors, PEPFAR supports a government culture that emphasizes knowledge and technical skills.
PEPFAR's efforts to build management in the health sector will contribute to and reinforce messages that support competent and honest governance. This message must also be put forward by other donors, including the Global Fund and USG programs like the Millennium Challenge Corporation.
In its next phase, PEPFAR is promoting country leadership capacity with the following activities:
Supporting Development of Country Plans
PEPFAR has always supported countries in the development of country-level plans for a national HIV response, an approach enhanced through the Partnership Framework process. To develop these plans, countries must justify distribution of resources based upon epidemiology, as well as meet the standards of multiple donors. Developing and overseeing national plans also provides countries with an opportunity to coordinate among donors to maximize impact. The act of engaging in needs assessment, planning, and coordination is in and of itself an exercise in capable governance.
Promoting Accountability and Transparency
The Partnership Framework process involves working with countries to jointly establish targets for HIV/AIDS programming. As the process of implementation unfolds, country teams work with partner governments to ensure that they are able to meet and report out on these targets. By supporting stronger linkages between civil society and governments, PEPFAR is helping citizens assist and hold governments accountable in meeting the HIV/AIDS and health needs.
Strengthening financial management
Transitioning management of programs to countries requires strong country financial capacity to oversee programs. Through PEPFAR's plans to support managerial capacities within the civil service of partner countries, it will expand the ability of Ministry of Finance employees to manage donor and national funding in a transparent way. It is important to note that civil society plays a strong role in reinforcing government accountability and ensuring that funding is used in an efficient and effective manner.
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