Washington, D.C. — In advance of World AIDS Day, the Center for American Progress today released “The Turning Point in Spending for Combating HIV/AIDS,” which highlights CAP’s recommendations for the flagship international anti-HIV/AIDS effort of the United States—the President’s Emergency Plan for AIDS Relief, or PEPFAR—to encourage greater burden-sharing with upper-middle-income countries and regions where Washington has established “Partnership Frameworks.” This would help these countries and regions become more self-sufficient in managing their health challenges, including the challenge of HIV/AIDS.
In the larger CAP report “Engagement Amid Austerity,” we argued that these more well-off developing countries should be able to take over 60 percent to 80 percent of the programs and activities currently funded by the President’s Emergency Plan for AIDS Relief within five years. While some thought this recommendation controversial at the time, the new “World AIDS Day Report” issued by the United Nations suggests that, if anything, we aimed too low. According to this report, domestic spending in developing countries on HIV/AIDS outpaced international investments in 2011.
While the cost-sharing component in the U.S. government’s Partnership Frameworks is good for the U.S. international affairs budget, the lasting benefit may well come from their ability to provide a model for how to foster country ownership and transfer financial responsibility to recipient countries. The President’s Emergency Plan for AIDS Relief has become more effective as it has transitioned from acting like an emergency humanitarian assistance program to instead focusing on shaping a long-term, sustainable, and integrated approach to health and development. Unfortunately, only about one-third of countries receiving funding from the plan (22 of 59 countries) currently have a Partnership Framework in place. But when operational, these frameworks have enjoyed a relative degree of success.
This opportunity for greater country ownership shouldn’t be confined to the more affluent developing countries. Yes, upper-middle-income standouts like South Africa and Botswana have dramatically increased domestic HIV spending, quintupling and doubling it, respectively, from 2006 to 2011. But the picture for many low-income developing countries is just as heartening. Kenya doubled its domestic HIV spending from 2008 to 2010, Togo doubled its domestic spending from 2007 to 2010, and Rwanda doubled its domestic spending from 2006 to 2009.
As low-income countries marshal increased resources for HIV/AIDS, funding and allocation decisions should also equitably increase. Every country that receives funds from the President’s Emergency Plan for AIDS Relief should be operating under a Partnership Framework that enumerates this devolution of decision-making duties and provides a clear guide for appropriate burden sharing.
If a country like Togo is willing to double its HIV/AIDS investment, the United States should be there, ready to assist its partner country build up and manage its national health system through a sustainable approach to health that fits within a broader development model. This approach isn’t about the United States slashing foreign aid programs—it’s about using every dollar wisely to secure enduring change.
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