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8/14/2019 The Numbers Behind The Stories
1/27
The Numbers
Behind the
Stories
PEPFAR Funding
for Fiscal Years
2004 to 2006
Nandini Oomman
Michael Bernstein
Steven Rosenzweig
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The Numbers
Behind the
Stories
PEPFAR Funding
for Fiscal Years
2004 to 2006
Nandini Oomman
Michael Bernstein
Steven Rosenzweig
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3/27
iii the numbers behind the stories
Contents
Summary 1
PEPFAR and its data 3
Issue 1. How do congressional unding restrictions (earmarks) infuencePEPFAR allocations or prevention, treatment, and care? 6
Issue 2.What is the role o aith-based organizations in PEPFAR? 9
Issue 3. What is the role o host country governments in PEPFAR? 12
Issue 4. Has PEPFAR been building local capacity by unding localrecipients? 14
Final refections 17
Annex A. Data and methods 18
Annex B. Using the data 21
Annex C. Funding data collected by PEPFAR 23
Reerences 24
Copyright 2008 by the Center for Global DevelopmentISBN 1-933286-30-X
Center for Global Development
1776 Massachusetts Avenue, NWWashington, D.C. 20036
el: 202 416 0700Web: www.cgdev.org
Support for this project was generously provided by the Bill & Melinda Gates Foundation.
Te views expressed are those of the authors and should not be attributed to the directors
or funders of the Center for Global Development.
Cover photo by Michelle Bashin/Courtesy of Photoshare.
Tis photograph is used for illustrative purposes only; it does not imply any particular
health status, attitude, behavior, or action on the part of the person appearing in the
photograph.
Editing and typesetting by Communications Development Incorporated, Washington, D.C.
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pepfar funding for f iscal years 2004 to 20 06
Te Presidents Emergency Plan or AIDS Relie (PEPFAR), the largest under o
global HIV/AIDS programs, does not regularly release detailed inormation about
how the money is spent.We recommend that PEPFAR publish ocial data on
obligations to prime recipients and subrecipients to improve transparency and
accountability, permitting program cost-efectiveness analyses and comparisons
o investments with results. In addition, making data available would strengthen
coordination with other stakeholders; help host country governments plan or theuture; and make those in the policy and advocacy communities who are careully
watching PEPFAR less dependent on anecdotes and impressionistic inormation.
s
o demonstrate the value o making PEPFARspending data public, this report presents previ-
ously unreleased data acquired by the Center orPublic Integrity or 2004 to 2006 and shows how
analyzing them can clariy several much-debatedissues pertaining to PEPFARs eectiveness and
sustainability. Based primarily on 2005 data, thereport examines how unds were obligated to
PEPFARs 15 ocus countries. It shows that:Congressionally imposed unding restric-tions (earmarks) inuence how PEPFARunding in each ocus country is divided
among programs or prevention, treatment,and care, with treatment receiving the great-est share. Te authors recommend that Con-
gress make PEPFAR unds more exible byremoving the earmarksmaking alloca-
tions more responsive to circumstances ineach country, more consistent with national
AIDS plans, better oriented to local epide-miological conditions, and better coordi-
nated with other stakeholders activities.Faith-based organizations (FBOs) have re-ceived on average 10% o PEPFAR unds,nearly hal o it or treatment. Although
PEPFAR oen deends its ocus on FBOsas a means o support or local groups with
deep roots in their communities, only a smalshare o PEPFAR unding or FBOs goes to
local groups. Te authors recommend thatPEPFAR reevaluate its policy o targeting
FBOs as a way to reach local groups andinstead seek more eective strategies or
achieving that goalstrategies that shouldreect individual country contexts and the
variety o local actors providing services.Host country governments have received onaverage 13% o PEPFAR unds, more thanhal o it or prevention. While the authors
recognize that PEPFAR need not channea large share o its unds through govern-ments, they recommend that it work closely
with host country governments to ensurthat its programming helps them ull
their role as stewards o the national AIDSresponseenabling governments to help
plan and oversee PEPFAR-unded activitiesproviding them and other key stakeholders
with up-to-date inormation on PEPFAR programs, and, through timely inorma
tion sharing and joint planning, helpinggovernments to coordinate their PEPFAR
programs with the myriad other AIDS activities in their countries.
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2 the numbers behind the stories
On average, 70% o PEPFAR unding hasgone to international organizations, while30% has gone to locally based groups. Al-though PEPFAR already invests signicant
sums in capacity building activities, its cur-rent strategy o promoting capacity building
by engaging local subrecipients is not su-cient, since only a small share o its total
unds is being subgranted to them. Te au-thors recommend that PEPFAR reexamine
its capacity building eorts and seek waysto build the capacity o local organizations
to receive greater shares o its undinga
critical sustainability aim, as important asachieving PEPFARs global targets.Te authors hope that these ndings will in-
orm policy debates, including those that bear onPEPFARs impending reauthorization by the U.S.
Congress. Te report also raises questions or ur-ther study, encouraging other researchers and in-
terested parties to build on the authors ndings.Te dataset accompanying the report can
be downloaded at http://www.cgdev.org/hivmonitor/PEPFARdata.
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pepfar funding for f iscal years 2004 to 20 06
With PEPFAR due to expire in 2008, the U.S.Congress is now debating its reauthorization.President Bush has requested $30 billion over
ve years. Bills passed in the House and underconsideration in the Senate call or $50 billion.
Because the bills enjoy bipartisan support, theprogram will almost certainly be reauthorized
at $50 billion. Less certain, however, is howthe unds will be spent. Many strong and con-
icting views exist about how much PEPFARshould provide to dierent recipients and pro-
gram areas.Despite this vigorous debate, ew systematic
data are available on how PEPFAR unds arenow being divided.1 PEPFAR collects nancial
and related data about its programs, but manyo these data are not public. Even some PEP-
FAR sta do not have access to certain inor-mation, such as expenditure data or undingrecipients.
A call to PEPFAR:
Release more unding data
PEPFAR should release, at least once per year,the detailed unding and programmatic data
1. Several institutions and initiativesthe Institute o Med-
icine, the Center or Global Developments HIV/AIDS Moni-
tor, the Global HIV/AIDS Initiatives Network, and others
have undertaken case studies in recipient countries. But there
has been no systematic analysis o allocations by grant level,
program area, and recipient type at the country level.
that it already collects. Specically, or eachgrant or contract PEPFAR should disclose:
Te annual amount obligated to prime recipients and subrecipients.Te organization type or each prime recipient and subrecipient (or example: nongovernmental organization, host country
government).Te amount o unds or each strategic area(prevention, care, treatment, other).Each program area unded (or example
blood saety, condoms).2
Each activity area unded (or exampletraining, logistics).Te geographic origin o each prime recipienand subrecipient (local or international).Te programs geographic coverage area (regions or provinces reached within the program country).Te programs target populations (or example: pregnant women, orphans).Te programs stated targets (or example: somany people to be tested or HIV, so manyorganizations to be provided with technica
assistance).A comparison o targets with resultachieved (or example: so many people were
2. When PEPFAR discloses data or this and the precedin
item, it should note the amount obligated to each prime recipi
ent and subrecipient or each strategic and program area. Ta
is the ormat used in this reports accompanying dataset.
Te U.S. Presidents Emergency Program or AIDS Relie (PEPFAR) is the largest
under o global HIV/AIDS programs. A ve-year, $15 billion program, PEPFAR
has pursued three broad goals since its creation in 2003: treating 2 million AIDS
patients, preventing 7 million new HIV inections, and providing care to 10 million
people aected by the disease.
pepfar
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4 the numbers behind the stories
tested or HIV, so many organizations were
provided with technical assistance).3
Releasing these data will improve transpar-ency and accountability, permitting program
cost-eectiveness analyses and comparisons oinvestments with results. It will strengthen co-
ordination among all AIDS stakeholders. Andit will help host country governments prepare
annual budgets.
Analyzing the newly
available unding data
Tis report analyzes previously unavailable
PEPFAR unding data or scal 2004 to 2006(October 1 scal year).4 By clariying our
much-debated issues pertaining to PEPFARs
eectiveness and sustainability, the analysisshows how regularly releasing such data couldimprove PEPFAR programming through evi-
dence-based research and recommendations.Te reports recommendations, based on
its ndings, can and should be used to improveuture PEPFAR programs. In addition, the au-
thors encourage other researchers to build on thendings with their own analyses o the newly
published data. (Te dataset accompanying the
3. In addition to these data, the HIV/AIDS Monitorbelieves that PEPFAR should release data on outlays to prime
recipients and on prime recipients expenditures (or details
see Bernstein and Hise 2007).
4. Te dataset accompanying this report includes details
about the rst, second, third, ourth, and sixth items on
the preceding bullet list. Note that the Center or Global
Developmentnot PEPFARcollected the data or the
sixth item (geographic origin).
report can be downloaded at http://www.cgdev.
org/hivmonitor/PEPFARdata.)Te report addresses our issues:
How do congressional unding restric-1.
tions (earmarks) infuence PEPFAR
allocations or preention, treatment,
and care?o investigate the exibil-ity o PEPFAR unding, the report
looks at the variation across countriesin the amount o money obligated to
each strategic area (prevention, care,treatment, or other programs) and
to each programmatic subarea (orexample: abstinence and be aithul,
blood saety).What is the role o aith-based organi-2.
zations (FBOs) in PEPFAR?o in-
vestigate their role in PEPFAR, thereport examines the amount obligatedto FBOs as a share o total PEPFAR
unds in each country. It looks at the program areas that FBOs are being
unded to address. Finally, it makesobservations about some o the largest
FBO recipients.What is the role o host country gov-3.ernments in PEPFAR?o investigatetheir role in PEPFAR, the report con-
siders the proportion o total PEPFARunds obligated to host country gov-
ernments, as opposed to nongovern-mental recipients, and analyzes the
breakdown o those unds by programarea.
Has PEPFAR been building local ca-4. pacity by unding local recipients?oinvestigate PEPFARs support or lo-
cally based organizations, the reportestimates the amounts obligated to
local groups, the proportion o moneysubgranted to subrecipients, and the
share o subgranted unds going tolocal groups.
Except in its investigation o unding ex-ibility across strategic areas, this reports analy-
sis is based on unds appropriated by the U.S.Congress in 2005 (2005 unds; box 1), or
which the most complete picture o total obli-gations was available. Some PEPFAR recipients
A PEPFAR obligation is a legal commitment to pay a prime recipient, either now or
in the future. For this reason obligations are technically considered commitments.But because the funds are made available for use by prime recipients as soon as
they are needed, PEPFAR obligations are in practice less like commitments than like
disbursements from other funding agencies.
A PEPFAR prime recipient receives funds through a direct transfer from the U.S.
Government. Prime recipients often transfer funds to other organizations through
subgranting. Organizations receiving such subgrants are called subrecipients. This
report refers to prime recipients and subrecipients collectively as recipients.
An appropriation is money that the U.S. Congress legally authorizes to be
transferred from the U.S. Treasury to an executive branch agency.
Box 1 Key terms
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pepfar funding for f iscal years 2004 to 20 06
may not receive obligations o unds appropri-
ated in 2006 until 2007 or later. Tereore, anyanalysis o the unding breakdown to individualrecipients would be limited i based on data or
2006 unds.
The data in this report
Because PEPFAR operates through dierentU.S. government agencies and departments,
there are several ways to capture data on pro-gram unding. Tis reports analysis uses previ-
ously unavailable unding data rom PEPFARsmain data-capture mechanism, the Coun-
try Operational Plan and Reporting System(COPRS). Te COPRS provides a wide range o
inormation about each PEPFAR grant, includ-
ing the recipient o unds, the amount obligated,
the program areas unded, any amounts passed
on to subrecipients, and the geographic areasserved.
Te COPRS data used here constitute part
o the COPRS data or scal 2004 through2006, but not all. Tey ocus on unding obli-
gations, a term specic to the U.S. government(see box 1). Te Center or Public Integrity ac-
quired these data through legal action againstthe U.S. State Department (see annex A).5 It
then shared the data with the Center or GlobalDevelopmenta generous act or which the au-
thors o this report are grateul. (On the dataelds used in the dataset, see annex B. For in-
ormation about all data collected by PEPFARand where to nd it, see annex C.)
5. See also Bengts son and Morera (2006).
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6 the numbers behind the stories
ISSUE1
An early evaluation o PEPFAR by the Insti-tute o Medicine in 2007 ound that the ear-marks were unnecessarily constraining the ex-
ibility o unds at the country level, and calledor removing them when PEPFAR is reautho-
rized in 2008.7 In contrast, PEPFAR ofcialshave argued that the earmarks direct spend-
ing towards important program areas, such asorphans and vulnerable children, that other-
wise would receive too little attention.8
Country-level allocationsto PEPFAR program areas
have generally ollowed the
earmarkswith some deviations
Te data reveal a similar pattern o PEPFAR
allocations across countries.9 hat pattern
6. Te earmarks or prevention and care are so earmarks,
meaning they are suggested. Te earmarks or treatment and
orphans and vulnerable children became mandatory in s-
cal 2006. For details on the unding earmarks see Oomman,
Bernstein and Rosenzweig (2007).
7. Institute o Medicine (2007).
8. Personal communication with PEPFAR ofcial, Febru-
ary 11, 2008.
9. Because PEPFAR determines whether earmarks are being
met by examining planned unding levels, obligations data
cannot determine conormity with congressional directives.
Instead, the important task undertaken here is to examine
how the earmarks aect obligationsthe money actually
made available to countries in a given year.
suggests that earmarks are inuencing allocations, despite variations in disease epidemiologyand other important contextual actors.
Figure 1 shows that each ocus countrygenerally appears to be ollowing the allocation
patterns set out in the congressional global earmarks or PEPFAR program areas.10
reatment programs have received the great-est share o unds in all ocus countries, many o
which approach or exceed 55% in their allocations to treatment. Similarly, prevention und-
ing has hovered around the 20% earmark, witha ew countries allocating less but most slightly
more.O the three program areas, it is treatment
whose PEPFAR allocations have been arthest rom the congressional earmark o 55%
Te average share o 2006 unds obligated ortreatment was 44% (gure 2). A likely reasontreatment programs take a long time to set up
especially in countries with inadequate inrastructure or other capacity decits. raining
providers, building health acilities, and procur-ing large drug shipments can take time and delay
putting treatment programs into practice.As these initial investments are made, how
ever, and as treatment programs are scaled up
10. Te Ofce o the U.S. Global AIDS Coordinator report
to Congress on the programmatic breakdown o unding
or its ocus countries only, not or all PEPFAR unding
combined.
Te exibility o PEPFAR unding is much debated, with particular attention to
how congressionally mandated restrictions inuence PEPFAR allocations to dier-
ent program areas. Such legislative restrictions, or earmarks, now direct PEPFAR
to spend 55% o its global unding on treatment, 20% on prevention, 15% on care
and 10% or orphans and vulnerable children.6
hw (k) pepfar v, , ?
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pepfar funding for f iscal years 2004 to 20 06
treatment is likely to receive a greater share o
PEPFAR unds. Indeed, the average share ounds obligated to prime recipients or treat-ment grew signicantly rom 2005 to 2006,
rising rom 37.5% to 44% across the 15 ocuscountries, while the average share o obligations
or prevention ell modestly (by 3%).Although the overall unding patterns in
each country appear to be inuenced by thecongressional global earmarks, some PEPFAR
ocus countries have deviated rom the ear-marks. Four countries Cte dIvoire, Guyana,
Mozambique, and anzaniaallocated around30% o their 2006 unds or prevention. And
most countries have been obligating more than15% toward care.
Few countries have met theabstinence and be aithul
earmarkbut allocations to
such activities increased
rom 2005 to 2006
Several earmarks within program areas appear
to inuence how unds are obligated. One, re-quently debated, is the requirement that two-
thirds o all money or preventing sexual trans-mission o HIV must be al located to abstinence
and be aithul (AB) activities. Tis AB ear-mark became mandatory in 2006.11
AB unds or 2006 remained below the two-thirds earmark in most countries. Indeed, dur-
ing 2006, eight ocus countries requested andreceived an exemption rom the AB earmark on
the grounds that it did not make sense in their ep-idemiological conditions.12 Despite such exemp-
11. Te abstinence requirement, at rst only suggested,
became a mandatory requirement in scal 2006. Te congres-
sional earmark states that 33% o all prevention unds should
be devoted to abstinence-only activities. But the Ofce o theU.S. Global AIDS Coordinator released guidance or scal
2006 which asked country sta to meet this requirement by
ensuring that at least 50% o all prevention unds be used
or sexual transmission preventionand that 66% o sexual
transmission prevention unds be used or abstinence and be
aithul programs.
12. Country teams can apply or exemptions rom the AB
earmark by asserting a compelling justication. PEPFAR has
accepted all such applications to date. In 2007 and 2008, 11
countries applied and were exempted.
0
10
20
30
40
Zamb
ia
Vietna
m
Ugan
da
Tanz
ania
South
Afric
a
Rwan
da
Nigeri
a
Nami
bia
Moza
mbiqu
eKe
nya
Haiti
Guya
na
Ethiop
ia
Cte
dIvo
ire
Botsw
ana
0
10
20
30
Zamb
ia
Vietna
m
Ugan
da
Tanz
ania
South
Afric
a
Rwan
da
Nigeri
a
Nami
bia
Moza
mbiqu
eKe
nya
Haiti
Guya
na
Ethiop
ia
Cte
dIvo
ire
Botsw
ana
Funds obligated to prime recipients by strategic area for fiscal 2006 (percent)
Note: Average denotes the average percentage of funds obligated by country (not the average percentageof total PEPFAR obligations for the year).
Prevention
Care
0
10
20
30
40
50
60
70
Zamb
ia
Vietna
m
Ugan
da
Tanz
ania
South
Afric
a
Rwan
da
Nigeri
a
Nami
bia
Moza
mbiqu
eKe
nya
Haiti
Guya
na
Ethiop
ia
Cte
dIvo
ire
Botsw
ana
Treatment
Average
Average
Average
Earmark
Earmark
Earmark
Figure 1 PEPFAR unds have generally ollowedcongressional earmarks in 15 ocus countries
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8 the numbers behind the stories
tions, AB unding increased between 2005 and
2006 in all but our ocus countries (gure 3).13
Te increased unding or AB activities inmost ocus countries suggests the possible inu-
ence o the AB earmark, even in countries wherean exemption rom the earmark was granted.
Although the analysis in this report cannot de-termine whether the AB earmark caused the in-
creases in AB unding rom 2005 to 2006, theassociation between them is worth exploring in
urther research.
Recommendation: Remove
unding earmarks
Tis analysis supports the Institute o Medi-
cines conclusion that the congressional ear-
marks inuence allocations, reducing the ex-ibility o PEPFAR unds.
Greater unding lexibility could make
PEPFAR allocations more responsive to cir-cumstances in each country, more consistent
with national AIDS plans, better oriented tolocal epidemiological conditions, and better co-
ordinated with the activities o other stakehold-ers. Tereore, Congress should make PEPFAR
unds more exible by removing the earmarks.
13. Te Ofce o the U.S. Global AIDS Coordinator exam-ines countries planned obligations or each year to determine
whether the planned unding levels are consistent with the
AB earmark. Since the data in this report are on actual obliga-
tions, it is possible that some ocus countries planned to meet
the AB earmark. For example, PEPFARs planned unding in
Mozambique or 2006 was consistent with the AB earmark
but actual obligations ell short o it.
Average funds obligated to prime recipients by program area for fiscal 2006
Prevention23%
Care20%
Treatment44%
Other12%
Figure 2 Average unds or treatment have been arthestrom the congressional earmark o 55%
0
10
20
30
40
50
60
70
80
Funds obligated to prime recipients for abstinence and be faithful activities for fiscal 2005 andfiscal 2006, as a share of funds obligated for sexual transmission prevention
Earmark
200
5
200
6
Nami
bia
Rwan
da
Ethiop
ia
Zamb
ia
Botsw
ana
Tanz
ania
South
Afric
aKe
nya
Moza
mbiqu
e
Cte
dIvo
ire
Guya
naHaiti
Ugan
da
Vietna
mNig
eria
Figure 3 Funds or abstinence and be aithul activities have increasedin most countriesthough most are still less than the earmark
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pepfar funding for f iscal years 2004 to 20 06
Despite the controversy, little has been known
about how much money FBOs receive romPEPFAR or how it is spent.
FBOs have received a modest
share o PEPFAR unds
FBOs received on average 10% o 2005 obliga-
tions in the ocus countries (gure 4). Tat wasscarcely more than one-ourth the share obli-
gated to nongovernmental organizations (38%).And it was slightly smaller than the share obli-
gated to host country governments (13%), uni-versities (13%), or private contractors (12%).
Although the share o unds obligated to
FBOs has been modest overall, it has variedconsiderably across countries, ranging rom0.2% in Botswana to 31% in Kenya (see gure
4). Te reason may be that PEPFAR provides alarger share o its unds or FBOs to countries
where FBOs already have the expertise and experience to handle PEPFAR unds. Supporting
this hypothesis, the two countries with by arthe greatest share o PEPFAR unds obligated
to FBOsKenya and Namibiaalso show a very large share o such unds going to loca
groups.
Almost hal o FBO unds have
been allocated to treatment
FBOs in the ocus countries have received, on
average, more unds or treatment than or careand prevention. reatment programs averagedalmost hal (46%) o obligations to aith-based
prime recipients in ocus countries in 2005compared with just one-h or prevention and
one-third or care (gure 5). But because FBOreceived just 12% o all PEPFAR unds, they
received only 16% o total treatment programobligations in 2005.
Obligations to FBOs by program area havealso varied widely among the ocus countries. In
ve countries the share o obligations to primerecipient FBOs going to treatment programs
exceeded 80%, while in our countries it waszero.
Te Bush administrations commitment to engage aith-based organizations (FBOs)
in its work has generated both ervent praise and erce criticism. Te role o FBOs in
PEPFAR program implementation has been particularly controversial. Some advo-
cates argue that PEPFAR should do more to engage FBOs, others that FBOs wield
too much inuence and limit the AIDS response.
W -z pepfar?IS
SUE2
0
10
20
30
40
Funds obligated to FBOs by country for fiscal 2005
Note: Average denotes the average percentage of funds obligated by country (not the average percentageof total PEPFAR obligations for the year).
Average
Botsw
ana
Vietna
m
Cte
dIvo
ire
Guya
na
Ethiop
ia
Tanz
ania
Rwan
da
Nigeri
a
Moza
mbiqu
e
South
Afric
a
Ugan
daHaiti
Zamb
ia
Nami
biaKe
nya
Figure 4 PEPFAR unds to FBOs have ranged widely
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10 the numbers behind the stories
Most prevention unds obligated
to FBOs have gone to abstinence
and be aithul activities
Te vast majority o PEPFAR unds obligatedto aith-based groups or prevention88% on
average in 2005has gone toward abstinenceand be aithul (AB) activities, a ocus remark-
ably consistent across countries. Indeed, ineight o the 13 countries where FBOs received
2005 unds or prevention, all obligations wenttoward AB activities.
Because obligations to FBOs made up just4% o total 2005 obligations or prevention, it is
possible that other entities programs balancedor outweighed the FBOs ocus on AB activities.
Still, FBOs have staked out an AB niche within
prevention programming. I the reauthoriza-tion o PEPFAR removes earmarks, it will beinteresting to see whether unding to FBOs or
abstinence and be aithul activities declines.
Most FBO unding has gone to
international groups, especially
Catholic Relie Services
A purported benet o unding FBOs is thatthey are locally based, with deep roots in the
communities they serve. PEPFAR documentsoen assume such a benet.14 But in only ve
countries did more than hal o the 2005 undsobligated to FBOs go to local groups. And o
all 2005 unds obligated to FBOs, just 38% on
average went to local groups (gure 6).15A single international FBO, Catholic Relie
Services (CRS), accounted or about $49 mil-
lion o 2005 PEPFAR unds, or 46% o totalobligations to FBOs.16 Te next largest FBO
recipients were the Kenyan-based Mission orEssential Drugs and Supplies ($20 million) and
the international organization World Vision($8 million).
Recommendation: Reevaluate
PEPFARs ocus on FBOs
PEPFAR oen deends its ocus on FBOs asa means o support or local groups with deep
roots in their communities. However, the
14. See or example PEPFAR (2005).
15. Since the authors lack inormation about subgranting
rom rack 1 grants, they lack complete in ormation about the
designation o rack 1 subgrantees. o estimate the amount o
unds going to local FBO subrecipients o rack 1 unds, they
have assumed that the same percentage o rack 1 unds as
country unds are subgranted to FBOs, and they have assumedthat the same percentage o rack 1 subgranted unds to FBOs
as country subgranted unds to FBOs go to local recipients.
16. Because CRS was the recipient o substantial rack 1
unding in 2005, and the authors lack inormation about the
proportion o rack 1 unding transerred to subrecipients,
they have estimated this proportion by taking the percentage
o CRSs country-managed unds that were subgranted and
applying that percentage to its rack 1 grants . Te net amount
o unding obligated to CRS is thereore an approximation
based on the best available inormation.
Average funds obligated to faith-based prime recipients by program area for fiscal 2005
Prevention
20.3%Care33.8%
Treatment45.7%
Other 0.1%
Figure 5 FBO prime recipients have received almosthal their unds or treatment programs
0
25
50
75
100
Funds obligated to local and international FBOs by country for fiscal 2005
Average
Unknown
L
ocalInternational
Tanz
ania
Nami
bia
South
Afric
aKe
nya
Nigeri
a
Rwan
da
Cte
dIvo
ire
Ugan
da
Zamb
ia
Ethiop
iaHa
iti
Moza
mbiqu
e
Vietna
m
Botsw
ana
Guya
na
Figure 6 Most countries have been providing less thanhal o their FBO unds to local groups
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pepfar funding for f iscal years 2004 to 20 06
authors nd that only a small share o PEPFAR
unding or FBOs goes to local groups. PEPFARshould reevaluate its policy o targeting FBOs asa way to reach local groups, and should instead
seek more eective strategies or achieving that
goal. Such strategies should reect individualcountry contexts and the variety o local actorsthat provide services.
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12 the numbers behind the stories
ISSUE3
As the worlds largest AIDS donor, PEPFAR
should be especially sensitive to the possible
advantages and disadvantages o sending moneythrough government. I it provides unds to thegovernment, PEPFAR must seek ways to pre-
vent the delays that have aected other donorsunding. I its money is not channeled through
the government, PEPFAR must nonethelesshelp the government to steward the national
AIDS response.1718
17. Te importance o government stewardship in coor-
dinating the AIDS response is widely accepted. See WHO
(2000).
18. Oomman, Bernstein and Rosenzweig (2007).
Many donors channel their AIDS unding through the government, believing that
such disbursement will build public capacity and support government stewardship.17
Despite these potential benets, some host country governments have been slow to
use the AIDS unds they receive.18
W v pepfar?
A modest share o PEPFAR unds
has been obligated to host country
governments
O all the 2005 money obligated to prime recip
ients in ocus countries, just 13% went to hostcountry governments (gure 7). Only Botswa
nas government (with 41%) received signi-cantly more than one-quarter o the unds obli
gated to its country.19
Although the share o PEPFAR unds going
to governments has been small, PEPFARs sheersize means that the absolute amount a govern
ment receives rom PEPFAR can rival the amounit receives rom other donors. For example, PEP
FAR gave 11% o its 2005 unds or Uganda tothe Ugandan governmentan absolute amount
o $14.5 million. In 2005 the Global Fund orAIDS, uberculosis and Malaria disbursed abou
$20 million to the Ugandan government.
More than hal o host country
government unds have been
allocated to prevention
On average, more than hal (57%) o the
amount obligated to host country governments as prime recipients has been provided
or preventionmuch o it or blood saety
19. Governments receive PEPFAR unds as both prime recip
ients and subrecipients. Some, such as Botswana, receive mos
or all o their unds as prime recipients. Others, such as Nige
ria, receive the vast majority o their unds as subrecipients.
0
10
20
30
40
50
Funds obligated to host country governments by country for fiscal 2005
Average
Zamb
ia
Ethiop
ia
South
Afric
aHa
iti
Keny
a
Rwan
da
Ugan
da
Guya
na
Nami
bia
Nigeri
a
Cte
dIvo
ire
Moza
mbiqu
e
Tanz
ania
Vietna
m
Botsw
ana
Figure 7 Host country governments have received on average13% o PEPFAR unds obligated to their countries
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pepfar funding for f iscal years 2004 to 20 06
Governments have also received modest but
signicant unding or treatment and care.
Botswana is an exception
Botswana is the one major exception to the pat-
terns just described. O all 2005 PEPFAR undsobligated to Botswana, 41% went to the govern-
ment. A large share o that amount was allocatedto two program areas that PEPFAR rarely unds
or governments: antiretroviral drugs (38%) andcondoms and other prevention (43%).20
Botswana has an innovative public-privatepartnership to ght HIV/AIDS. Its government
is oen credited with an unusually high capac-ity, compared with its neighbors, or stewarding
a national AIDS response. Do these acts help to
explain why the Botswana government receivedsuch a high share o its countrys 2005 PEPFARunds? Further investigation is needed.
Recommendation: Make the
government a true partner
in PEPFAR programs
Although PEPFAR need not channel a large share
o its unds through governments, it should ensurethat its programming helps the government ulll
its role as steward o the national AIDS response.Because most PEPFAR unds go to nongovern-
mental entities, coordination between PEPFARand the government is critical.
PEPFAR should work closely with hostcountry governments, enabling them to help
20. Only two other host country governmentsSouth
Arica and anzaniareceived PEPFAR unding or either
antiretroviral drugs or condoms and other prevention. Com-
pared with Botswana, they received a much smaller share o
their overall PEPFAR unds or these program areas.
plan and oversee PEPFAR-unded activities.
And it should provide governmentsas well
as other key stakeholderswith up-to-dateinormation on its programs. imely inorma-tion sharing and joint planning will help gov-
ernments coordinate their PEPFAR programswith the myriad other AIDS activities in their
countries.21
21. PEPFAR country teams work with host country gov-
ernments. Te Ofce o the U.S. Global AIDS Coordinator
encourages PEPFAR country teams to include host country
government sta in program planning. Te Country Opera-
tional Plan also must be approved by the host country gov-ernment beore it can be submitted to the Ofce o the U.S.
Global AIDS Coordinator. Nevertheless, research by the
authors o this report in three countriesMozambique,
Uganda and Zambiaindicates that, despite the best inten-
tions o PEPFAR sta, host country governments are rarely
included in PEPFAR planning and that their approval o the
annual Country Operational Plans is mostly symbolic. Te
authors believe that PEPFAR could go much urther in mak-
ing the government a true partner. PEPFAR has told them
that one way PEPFAR plans to strengthen partnerships with
governments over the next ve years is by developing com-
pacts meant to ormalize the relationship between PEPFAR
and other country-level stakeholders.
Average funds obligated to host country governments by program area for fiscal 2005
Prevention57%
Care14%
Treatment18%
Other11%
Figure 8 Host country governments have received morethan hal their unds or prevention programs
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14 the numbers behind the stories
Discussions o PEPFARs commitment to capac-
ity building have oen suered rom the absence
o inormation about how PEPFAR interactswith local organizations. Although the Ofce othe U.S. Global AIDS Coordinator publishes its
obligations or each country by prime recipient,it does not publicly disclose the amounts obli-
gated to subrecipients. Without such inorma-tion it has been impossible to know how much
money was reaching local organizations.22
22. []he continuing challenge or the U.S. Global AIDS
Initiative is to simultaneously maintain the urgency and
intensity that have allowed it to support a substantial expan-
sion o HIV/AIDS services in a relatively short time while
also placing greater emphasis on long-term strategic planning
and increasing the attention and resources directed to capac-
ity building or sustainability (Institute o Medicine 2007).
PEPFAR has made considerable progress toward meeting its ve-year targets by rap-
idly scaling up services. However, as the Institute o Medicine argued in its 2007
evaluation, PEPFARs next phase must work to build local capacitymoving rom
an emergency response to a sustainable response.22
h pepfar ?IS
SUE4
In the dataset accompanying this report
amounts obligated to PEPFAR subrecipients
are being published or the rst time. Tis per-mits an analysis o all unds obligated to localas opposed to international, recipients.
O total obligated PEPFAR unds,
30% on average has gone to local
recipientsbut with considerable
variation across countries
O total 2005 PEPFAR unds, 30% on average was obligated to local recipients (gure 9).2
Tat percentage is strikingly low.24
But the shareo unds going to local recipients has varied by
country. In 11 countries no more than onethird o 2005 PEPFAR unds were obligated
to local groups, with Zambia (13%) and Ethio-pia (6%) at the low end o the range. Yet in our
countriesBotswana, South Arica, Namibiaand Ugandabetween 45% and 55% o PEPFARunds were obligated to local organizations.
23. Since the authors lack inormation about subgrantin
rom rack 1 grants, they lack complete inormation abouthe designation o rack 1 subgrantees. o estimate the
amount o unding going to local subrecipients o rack 1
unds, they have assumed that the same percentage o rack
1 unds as country unds are subgranted, and that the same
percentage o subgranted rack 1 unds as subgranted coun
try unds go to local recipients.
24. PEPFAR oen cites the act that 87% o its partner
are local groups. But the authors calculations here make the
point that 87% o partners receive roughly 29% o total unds
obligated to the ocus countries.
0
25
50
75
100
Funds obligated to local and international recipients by country for fiscal 2005
Average
Unknown
Domestic
Internationa
l
Nami
bia
South
Afric
a
Ugan
da
Botsw
ana
Keny
a
Vietna
mNig
eria
Haiti
Tanz
ania
Rwan
da
Guya
na
Moza
mbiqu
e
Cte
dIvo
ire
Zamb
ia
Ethiop
ia
Note: Average denotes the average percentage of funds obligated by country (not the average percentageof total PEPFAR obligations for the year).
Figure 9 PEPFAR unds to local recipients range rom 6% to 55%
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pepfar funding for f iscal years 2004 to 20 06
PEPFARs initial mandate suggests a pos-
sible explanation or the large share o undinggoing to international organizations. PEPFARwas designed in 2003 to respond to the emer-
gency created by rapid HIV/AIDS transmis-sion. In the rst ew years o unding its sta
channeled money to organizations that couldquickly begin implementing programs. Te
bulk o early unds thereore went to interna-tional organizations that had already made
unding agreements with the U.S. governmentand knew how to comply with its procedures. 25
I new recipients were engaged, PEPFAR sta preerred those that had demonstrated their
ability to manage and use large sums o money.In many countries most o the organizations
that met these criteria were international
groups.In some countries PEPFAR channels a sig-
nicant share o its unds to local organizations,
likely because o those countries higher localcapacity. In Uganda unding was almost evenly
split between local and international organi-zations. As detailed in a previous HIV/AIDS
Monitor analysis,26 Uganda has many local or-ganizations with high capacity or using AIDS
unding and with U.S. government connectionsthat preceded PEPFAR. Such groups were well
positioned to receive signicant amounts romthe new program.
Circumstances in Uganda may help to ex-plain the overall pattern. Te three other coun-
tries where roughly hal o PEPFAR undinggoes to local groupsBotswana, South A-
rica, and Namibiaare all thought to havelocal organizations with strong capacity orimplementing AIDS programs. PEPFAR doc-
uments explain the correlation between thecapacity o local organizations and their abil-
ity to obtain PEPFAR unds. One PEPFARdocument notes that many local indigenous
organizations have limited technical expertisein accounting, managerial and administrative
skills, auditing practices and other activitiesrequired to receive unding directly rom the
25. Oomman, Bernstein, and Rosenzwei g (2007).
26. Oomman, Bernstein, and Rosenzwei g (2007).
U.S. Government.27 A closer examination o
the issue would provide more conclusive evi-dence about PEPFARs approach to support-ing local capacity where it exists, or building it
where it does not.
O unds obligated to subrecipients,
more than hal on average has gone
to local organizationsbut local
and international subrecipients
combined have received just
19% o total obligated unds28
o increase the capacity o local organizations
as part o an overall eort to make programunding more sustainable, PEPFAR encourages
its current prime recipients to work with localsubrecipients and to build their capacity so that
they can become recipients.29 One part o thisstrategy seems to be working: a signicant share
27. PEPFAR (2008), p. 6.
28. Since the authors lack inormation on subgranting rom
rack 1 grants, all analysis o subgranting is based solely oncountry-managed unds (see annex A, note 35).
29. PEPFARs 2008 guidance to its country teams or devel-
oping Country Operational Plans states that: Eorts should
be made to support and provide technical assistance to assist
these indigenous organi zations [local subrecipients] to gradu-
ate to ull partner status and enable them to be direct recipi-
ents o PEPFAR unds. Te duciary accountability o local
organizations is essential to building sustainable capacity;
technical assistance in this area should be made available to
partner organizations. PEPFAR (2008), p. 6.
Average country-managed funds obligated to local and international subrecipients in the focus countriesfor fiscal 2005
Local55%
International42%
Unknown 3%
Figure 10 O subgranted unds, 55% on average hasbeen obligated to local subrecipients
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16 the numbers behind the stories
o unding to subrecipients, well over hal (55%)
has gone to local organizations (gure 10). 30But unding data alone cannot tell whether
PEPFAR is building local capacity. Only 19%
o PEPFAR unds have been subgranted atall, meaning that local subrecipients have re-
ceived on average just 11% o PEPFAR undsin the ocus countries (gure 11). So, even i
30. Althoug h on average 55% o subgranted unds are going
to local subrecipients, there is strong variation between coun-
tries. In Namibia 95% o subrecipient unds went to local
organizations, in Guyana only 10%.
subgranting has been building the capacity o
subrecipients, it seems unlikely, given the mod-est amounts they are receiving, that they willsoon be ready to receive a signicant share o
the PEPFAR unds now provided to interna-tional recipients.
Recommendation: Expand eorts to
build the capacity o local groups
Although PEPFAR already invests signicantsums in capacity building activities, it should
reexamine those eorts. It should seek waysto build the capacity o local organizations so
that they can receive greater shares o PEPFARunding.31
PEPFARs current approach to capacity
buildingengaging local subrecipientsisnot sufcient, since only a small share o totalunds is being subgranted. Building the capacity
o local organizations is a critical sustainabilityaim, as important as achieving PEPFARs global
targets.
31. PEPFAR gures indicate that $638 million o the money
it obligated in 2007 was devoted in ull or in part to capac-
ity building activities. Personal communication with U.S.
Ofce o the Global AIDS Coordinator ofcial, February 15,
2008.
Average country-managed funds obligated to prime recipients and subrecipients in the focus countriesfor fiscal 2005
Prime recipients81%
Subrecipients19%
Figure 11 O total country-managed unds, just 19%on average has been subgranted
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pepfar funding for f iscal years 2004 to 20 06
PEPFAR should begin to regularly disclosemore data about its unding awards, including
the type o data used or this report. PEPFARalready collects a wide range o valuable data
(see annex C). Such data should be publiclydisclosed.
Not only PEPFAR, but also other AIDS do-nors should disclose more o their unding data.3
Such disclosure could clariy important policydebates, strengthen coordination among various
AIDS stakeholders, and improve assessments oprogram impact to make aid more eective.
32. For more detailed recommendations about what und
ing data PEPFAR, the Global Fund, and the World Bank
Arica Multi-Country HIV/AIDS Program (World Bank
MAP) should release, see Oomman, Bernstein and Rosenz
weig (2007).
Tis report has analyzed unding data related to PEPFAR grants and contracts. It
has used these unding data to discuss our issues pertaining to PEPFARs eec-
tiveness and sustainability. And it has recommended actions to improve PEPFAR
programming. Te authors o the report hope that other researchers and interested
parties will use the data presented here and in the accompanying dataset to urther
clariy key issues.
f
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18 the numbers behind the stories
Te data here are drawn rom the Coun-
try Operational Plan and Reporting System(COPRS), an accounting and program moni-
toring system maintained by the Ofce o theU.S. Global AIDS Coordinator. Te dataset
includes amounts obligated to prime recipi-ents and subgranted to subrecipients, with
inormation on recipient type (government,
nongovernmental, aith-based, private or-prot), unding year (year o appropriations), year o obligation, and program area (treat-
ment services, blood saety, or the like) oreach recipient, except that obligations to sub-
recipients do not include inormation aboutprogram area.
Te dataset was originally obtained romthe State Department by the Center or Public
Integrity through several Freedom o Inorma-tion Act requests and a lawsuit against the U.S.
Government, settled out o court.33
Noticingsome errors in the dataset, the Center or Public
Integrity was hesitant to release it publicly, butgenerously agreed to share it with the authors
o this report.Aer investigating the possible causes o
errors (see data limitations below), the Cen-ter or Global Development was satised thatthe overall quality o the dataset had not been
compromised. Individual errors in the data werenot signicant enough to inuence the overall
unding patterns described and analyzed in thisreport.
Te dataset being released in conjunctionwith this report builds on the Center or Public
Integrity data in three ways. First, the majorityo prime recipients and subrecipients have been
classied as either local or international,based on whether their headquarters are in the
33. See Bengtsson and Morera (2006).
host country or abroad. 34 Tese classication
were made through research by Center oGlobal Development sta and consultations
with in-country experts.Second, data on centrally awarded, or
rack 1, unding have been added.35 Te centrally awarded unding gures or 2004 and
2005 come rom data previously published by the
Center or Public Integrity, which had obtainedthem rom the State Department.36 Using thosedata, the authors o this report estimated cen
trally awarded unding gures or 2006 based onpast unding trends and the amounts allocated
to each ocus country or 2006.37
Finally, the authors used the program areas
listed in COPRS to deduce classications byPEPFAR strategic area. Users can now search
34. Almost all organizations that received unds in sca2004 through 2006 were classied by geographic origin. Fo
a ew countries, however, classications were made only o
recipients and subrecipients receiving unds appropriated in
2005 (the year o most o the data examined or this report).
35. Centrally managed (rack 1) undi ng is granted directly
rom the Ofce o the U.S. Global AIDS Coordinator in
Washington to organizations to implement programs in
country. It diers rom country-managed unding, which i
granted to recipient organizations through the eld ofce
o PEPFAR-implementing agencies in the host country. Te
great majority o PEPFAR unds are country-managed.
36. Tis dataset can be downloaded rom Bengtsson and
Morera (2006).
37. Te authors estimated the total amount obligated to each
ocus country or 2006 by taking the average ratio between
obligations and allocations or 2004 and 2005, then multiply
ing this ratio by the 2006 allocation gures or each country
Using this estimated obligation amount or 2006 they cal
culated the percentage increase in total obligations to each
country between 2005 and 2006. Finally, they applied the
percentage increase or each country to calculate the tota
estimated amount obligated to each individual rack 1 und
ing recipient or 2006.
d AnnEx
a
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pepfar funding for f iscal years 2004 to 20 06
or unds going to prevention, treatment, care,
and other costs.
Data limitations
Te dataset has several limitations. First, it
contains data on obligations (commitments),not outlays (expenditures). So, it shows how
much was available to recipients to implementprogramsbut not how much money was actu-
ally spent.38
Second, because o time lags in the appropria-
tions process, the data do not necessarily reectthe total amount obligated to each recipient using
2006 unds. A signicant part o PEPFAR moneyappropriated in a given year is not obligated until
the ollowing yearsometimes even later. Be-
cause the dataset continues only through 2006,the authors lack data on unds appropriated byCongress in 2006 but obligated by PEPFAR in
2007. Te data thereore underestimate total obli-gations made using money appropriated in 2006.
Because some unds are not obligated until two ormore years aer the appropriation year, the data-
set also misses some obligations o unds appro-priated in 2004 and 2005. Te amount o such
delayed obligations is very small, however, com-pared with the amount that is obligated in the ap-
propriation year and the year ollowing it.39
Tird, since inormation on unding by pro-
gram area is available only or prime recipients,it is not always possible to know exactly how
much subrecipients plan to spend in particularprogram areas (though educated guesses can be
made rom the data listed or prime recipients).40
38. For details on the dierences between obligations and
outlays, see Bernstein and Sessions (2007).
39. Te percentage o money appropriated in 2004 and 2005
and obligated in 2007 or later would be very small because
almost al l unding appropriated in one year is obligated by theconclusion o the subsequent year. For example, data obtained
by the HIV/AIDS Monitor rom PEPFAR shows that 99% o
2004 unds were obligated by the end o 2005.
40. Tis limitation applies to scenarios in which a prime
recipient has been unded or multiple program areas. For
example, Catholic Relie Services received unding in 2005
or programs that would provide palliative care and support
or orphans and vulnerable children in Ethiopia. We cannot
disaggregate the unding provided by Catholic Relie Services
to its subrecipients by these two program areas.
It is principally or this reason that parts o the
analysis are ocused exclusively on unding toprime recipient organizations, without includ-ing subrecipient organizations.
Fourth, although PEPFAR requires primerecipients to report on all o their subrecipients,
several ormer PEPFAR ofcials shared their be-lie that some prime recipients do not always do
so. Since it is unclear whether prime recipientshave reported comprehensively on all subrecipi-
ents, some subrecipients may not be listed in thedataset.
Fih, three data elds are unavailable orcentrally awarded (rack 1) unds: Obligation
Year, MechID, and OrgID (see annex B ordetails on each data eld). o remedy this, the
Center or Global Development is working to
include OrgIDs or rack 1 unds in uture ver-sions o the database. For this report the authorsassume that rack 1 unds were obligated in the
year they were appropriated.Sixth, the dataset is limited to obligations
to the 15 ocus countries. Tese countries col-lectively receive the vast majority o PEPFAR
unding. But according to the U.S. Global AIDSCoordinator, more than 100 other countries
benet rom the PEPFAR program, togetherreceiving roughly 12% o PEPFAR unds.41
Data errors
Te data contain some easily detected errors.
For example, some recipients have been clas-sied under the wrong organization type. In
one instance the United Nations DevelopmentProgramme in Vietnam was classied as a non-governmental organization rather than a multi-
lateral agency. Such misclassications, probablyreecting simple human error, seem to have
occurred only in a small number o cases.Another problem, originally pointed out by
the Center or Public Integrity, is that subrecipi-ents occasionally are listed as having been sub-
granted more money under an individual grantthan was obligated to their respective prime re-
cipients. For example, in 2005 in Nigeria, thedataset shows that John Snow International, a
41. Dybul (2007).
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20 the numbers behind the stories
prime recipient, was obligated $490,000 under
a particular grant, while its subrecipients arelisted as receiving $1,515,682 under the samegrant. Such errors seem to have occurred in only
a small number o cases, representing roughly3% o the grants in the dataset.42 Tey may arise
partly rom simple human errorand other ex-planations are possible. Prime recipients may be
covering the immediate costs o subgranting byborrowing unds rom other grants. Or prime
recipients may be subgranting beore they areobligated the ull value o a particular grant,
42. In a dataset containing inormation about more than
2,600 grants over three years, the authors ound just 76
errors o this type.
in the expectation that they will receive the re-
mainder in uture years.Whatever the cause o each error identied,
the authors o this report deem the datasets
overall quality and reliability high enough toallow or useul, in-depth analysis o unds ob-
ligated to the ocus countries. Te authors havenot attempted to correct any possible dataset
errors. Instead they have denoted the placeswhere errors might exist by adding a column to
the dataset in Microso Excel. Te authors en-courage people amiliar with grants identied
as having possibly erroneous gures to contactthem with inormation that might clariy the
gures. Te dataset will be updated to reectany new inormation.
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pepfar funding for f iscal years 2004 to 20 06
Te database o PEPFAR unding or scal
20042006accessible at http://www.cgdev.org/hivmonitor/PEPFARdataprovides pre-
viously unknown details about how PEPFARmoney is allocated in the 15 ocus countries.
Tese data reveal many interesting acts aboutPEPFAR programming.
o understand the data one must have a
basic knowledge o key steps in the PEPFARbudget process (gure B1).43 o begin that pro-cess PEPFAR submits an annual budget request
to Congress or the next scal year. Aer Con-gress approves a unding amount, the Ofce o
the U.S. Global AIDS Coordinator nalizesits annual budget or country-managed unds
as well as centrally managed unds. (Country-managed unding is money distributed rom
U.S. Government in-country eld ofces to prime recipient organizations to operate pro-
grams in PEPFAR countries. Centrally man-aged, or rack 1, unding is money granted to
prime recipient organizations directly rom theOfce o the U.S. Global AIDS Coordinator in
Washington.)Aer a PEPFAR scal year budget is nal-
ized, the money must be obligated to PEPFAR
43. For more inormation, see Bernstein and Sessions (2007).
u AnnEx
b
recipients. Tis may or may not occur in the year
a grant is approved. An obligation is denedas money available to a recipient organization
either or withdrawal in advance o projecexpenditures (in a grant or cooperative agree
ment) or as reimbursement or expenditureswithin 30 days o submitting an invoice (in a
contract). PEPFAR obligations are technically
legal commitments to pay now or in the utureBut because the unds are made available or useby prime recipients as soon as they are needed
the obligations are in practice less like commitments than like disbursements rom other
unding agencies.Tis database provides inormation on PEP
FAR obligations or unding approved in scayears 2004, 2005, and 2006 and obligated in
scal years 2004, 2005 or 2006.Te database has several elds that allow
users to analyze the data along several dimensions. able B1 denes and describes each data
eld.Te issues discussed in this report are just
a ew o those that can be explored using thedata, which can be cut in many other ways to
clariy how PEPFAR money is allocated in itsocus countries.
Given the multiplicity o elds, investiga
tors can sort the data by any combination ocountry, unding year, obligation year, recipi
ent organization, organization type, programarea, geographic origin (domestic or interna
tional), individual grant, or individual recipient. For example, one could lter the data to
learn how much money was obligated to aith-based organizations in Uganda in 2005 or to
locally based nongovernmental organizationin Haiti in 2006. One could learn how much
money has been obligated to John Snow Inter-national or antiretroviral treatment. Or one
1
Congress appropriatesmoney to particular agencies or programs as part of the annual federal budget
2
PEPFAR implementing agencies (such as USAID) obligatemoney to prime recipientorganizations; prime recipients then obligate funds to subrecipient organizations
3
The U.S. Treasury outlaysmoney to recipient organizations
4
Prime recipients expendmoney or subgrantto subrecipients
This report
analyzes data
on obligations
Figure B1 Legal processes or transerring PEPFAR unds
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22 the numbers behind the stories
could compare the unds obligated to Zambia
in 2006 or treatment with the unds obligatedor prevention.
We hope that examining the data in these
and other ways will prove useul to various au-diences including researchers, donors, undingrecipients, and advocacy groups.
Data feld Description
Funding year The U.S . Government fscal year ( rom October 1 t o September 30) when unding was approved by the U .S .
Congress.
Obligation yeara The year when unding was obligatedusually the same as the unding year, but sometimes a later year.
Funding source The und ing mechani sm ob li ga ting the unds. PEPFAR unds are ob li ga ted by e it her feld t eams ( country funds)or the Washington-based PEPFAR team (central funds, synonymous with Track 1 funds). PEPFAR dierentiates
between these two sources in most or all o its documentation.
Country name Country receiving a PEPFAR unding obligation.
MechIDb Unique ID given to a particular grant mechanism in the PEPFAR COPRS database. The MechID denotes a single
grant to a prime recipient and any subgrants associated with it.
OrgIDc Unique ID given to a particular prime recipient or subrecipient.
Prime partner name Name o t he pr ime rec ip ient associated wi th the grant mechan ism.
Recipient name Name o the obligation recipient. I the prime recipient is the recipient, the prime partner name and recipient
name will be the same or a particular obligation. I the obligation is to a subrecipient, the recipient name will be
the name o the subrecipient.
Recipient origin Geographic origin o the obligation recipient (domest ic or internat ional). The Center or Global Development has
researched the origins o recipients that were obligated unds in 2005 and o some that were obligated unds in
2004 and 2006.
Recipient type Category o the recipient receiving the obl igat ion (such as nongovernmental organizat ion, universi ty, ai th-based
organization, or private contractor).
P rimeOrSub Method by which sa id recipi en t recei ves the obl igat ion (pr ime = di rect ly rom a U.S. Government agency;
sub = subgrant rom a prime recipient that received the unds rom a U.S. Government agency).
Obligated amount Amount obligated to the recipient organization.
Net obligation Amount obligated to the recipient organization net o subgrants.
Strategic aread The PEPFAR strategic area (prevention, care, treatment or other) under which an obligation alls.
P rog ram a rea Prog ram a rea tha t the obliga tion t arge ts (one o 15 PEPFAR p rogram a reas ).
MechID with errors? This feld denotes possible errors that CGD has identifed in the data, such as grant mechanisms where the
amount obligated to subrecipients exceeds the amount obligated to the prime recipients under this mechanism.
See annex A or details and a discussion o the possible errors.
a. Not available or Track 1 grants. This report assumes that the obligations to Track 1 partners are made in the year when unds are appropriated.
b. Not available or Track 1 grants.
c. Track 1 unds in the database are not tagged with an OrgID. The Center or Global Development is working to include OrgIDs or Track 1 grants in the uture.
d. Program area and strategic area are available only or grants to prime recipients. The database does not have this inormation on subrecipients.
Source:Authors analysis o data as described in text.
Table B1 Data felds used
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pepfar funding for f iscal years 2004 to 20 06
able C1 presents all o the unding data,and related inormation about grants and
contracts, that PEPFAR or other parts o theU.S. government have collected. It presents
each type o data in a new row. Te threetable columns describe whether data were
publicly available prior to the release o thisreports dataset, whether they are contained
in the dataset, and where to nd them.
Boxes shaded in yellow show data that were not previously
public but that were released in the dataset accompanying
this report.
Boxes shaded in green represent data available in this
reports dataset that were publicly available beore the
release o this report, but were difcult to access and use,
being presented as part o the thousands o pages o PDF
documents that make up annual country operational plans.
Boxes shaded in grey represent data that are publicly
available but difcult to access and use, and that are not
presented as part o the dataset accompanying this report.
Boxes shaded in blue represent data that were available
beore this report and are easily accessed on the PEPFAR
website.
Boxes shaded in red represent data that continue to be
publicly unavailable, despite being collected by the U.S.
Government.
f pepfarAnnEx
c
Publicly available rom PEPFAR beore the
release o this report and its accompanying
dataset or fscal 2004 to 2006?
Released as part o this report
and its accompanying dataset
or fscal 2004 to 2006? Where to fnd the data
General information about grants or contracts
Type o recipient (aith-based
organization, nongovernmental
organization, government, and so on)
Yes Yes Dataset released with this report, available at
[http://www.cgdev.org/hivmonitor/PEPFARdata]
Funding source (country unded
or centrally unded)
Yes Yes Dataset released with this report, available at
http://www.cgdev.org/hivmonitor/PEPFARdata
Geographic origin o organization
(local or international)
Yes Yes Dataset released with this report, available at
http://www.cgdev.org/hivmonitor/PEPFARdata
Program area (treatment, abstinence,
home-based care, and so on)
Yes Yes PEPFAR website at http://www.PEPFAR.gov
Activity area ( training, logistics,
human resources, and so on)
Yes No Country operational plans or each country
available at http://oia.state.gov/COP.asp
Regions and provinces covered
by each grant and contract
Yes No Country operational plans or each country
available at http://oia.state.gov/COP.asp
Planned indicators and targets or
each grant and contract
Yes No Country operational plans or each country
available at http://oia.state.gov/COP.asp
Regular updates on progress made toward
indicators and targets or each grant and contract
No No Semiannual and annual reports submitted by
PEPFAR country teams to the Ofce o the U.S.
Global AIDS Coordinator (not publicly available)
Target population (pregnant women,
health care workers, and so on)
Yes No Country operational plans or each country
available at http://oia.state.gov/COP.asp
Obligations
To each ocus country Yes Yes PEPFAR website at http://www.PEPFAR.gov /partners/
To each prime recipient Yes Yes PEPFAR website at http://www.PEPFAR.gov /partners/
To each prime recipient,
disaggregated by program area
No Yes Dataset released with this report, available at
http://www.cgdev.org/hivmonitor/PEPFARdata
To each subrecipient No Yes Dataset released with this report, available at
http://www.cgdev.org/hivmonitor/PEPFARdata
Outlays
To each prime recipient No No PSC 272 orms submitted to the U.S. Treasury
by each recipient [not publicly available]
Expenditures
To each prime recipient No No PSC 272 orms submitted to the U.S. Treasury
by each recipient [not publicly available]
Source:Authors analysis o data as described in text.
Table C1 Funding data collected by PEPFAR and where to fnd it
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