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PEPFAR Should Consider Performance-Based Financing

“The recent IOM evaluation of PEPFAR made clear that a key challenge for the program moving forward will be to get country governments to effectively assume primary responsibility of AIDS programs in their countries, both in terms of finances and ‘leadership,'” Victoria Fan and Jenny Ottenhoff of the Center for Global Development (CGD) write in the center’s “Global Health Policy” blog. “But seeing that most PEPFAR funds are channeled through U.S.-based contractors — and not country governments — it seems impractical to expect countries to be able to take real leadership and accountability for AIDS spending,” they add, continuing, “[A]s PEPFAR transitions from an emergency response to a more sustainable country-led approach, it should consider making some portion of funds conditional on achieving performance objectives and benchmarks in AIDS treatment and service delivery — that is, employing the explicit use of performance-based financing (PBF) instruments between PEPFAR and country government” (3/6).