PEPFAR: Exploring Co-Financing as a Tool for Domestic Resource Mobilization
Issue Brief
In addition to financial, PEPFAR’s sustainability framework also includes political and programmatic domains. See, PEPFAR, FY 2024 Technical Considerations, available at: https://www.state.gov/wp-content/uploads/2023/07/FY-2024-PEPFAR-Technical-Considerations.pdf.
See, for example: The Future of Global Health Initiatives, 2023, The Lusaka Agenda: Conclusions of the Future of Global Health Initiatives Process, available at: https://d2nhv1us8wflpq.cloudfront.net/prod/uploads/2023/12/Lusaka-Agenda.pdf; Collins, Téa E et al., 2024, “Converging global health agendas and universal health coverage: financing whole-of-government action through UHC+”, The Lancet Global Health, Volume 11, Issue 12, e1978 - e1985, available at: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(23)00489-8/fulltext.
See, for example: Millennium Challenge Corporation, Principles for Country Contributions, available at: https://www.mcc.gov/resources/doc/policy-country-contributions/#:~:text=Corporation%27s%20Accountable%20Entities.-,Principles%20for%20Country%20Contributions,-The%20following%20principles; Gavi Alliance, Co-Financing Policy, available at: https://www.gavi.org/sites/default/files/programmes-impact/Gavi-Co-financing-Policy.pdf; Global Fund, Sustainability, Transition, and Co-Financing Policy, available at: https://www.theglobalfund.org/media/14383/core_sustainability-transition-cofinancing_policy_en.pdf.
The Foreign Assistance Act of 1961, as amended, Section 110, available at: https://www.usaid.gov/sites/default/files/2022-05/faa.pdf#page=64.
Over M, Glassman, A, “Strengthening Incentives for a Sustainable Response to AIDS: A PEPFAR for the AIDS Transition”, in The White House and the World 2016, Center for Global Development. Available at: https://www.cgdev.org/sites/default/files/whw-pepfar.pdf; Meisburger T, Reassessing America’s $30 Billion Global AIDS Relief Program, Heritage Foundation, May 2023. Available at: https://www.heritage.org/sites/default/files/2023-05/BG3765.pdf.
A recent analysis from the Center for Global Development also explored different agency co-financing models and assessed their relationship to spending patterns. See, Center for Global Development, 2024, Conditioned Domestic “Co-financing” Policies in Global Health: A Landscape Analysis, available at https://www.cgdev.org/sites/default/files/conditioned-domestic-co-financing-policies-global-health-landscape-analysis.pdf.
The Foreign Assistance Act of 1961, as amended, available at: https://www.usaid.gov/sites/default/files/2022-05/faa.pdf.
The Foreign Assistance Act of 1961, as amended, Section 110, available at: https://www.usaid.gov/sites/default/files/2022-05/faa.pdf#page=64.
While data on the value of cost-sharing by countries are not available, KFF analysis of PEPFAR obligations in FY 2022 (the most recent complete year available) finds that $216.6 million, or 3% of total PEPFAR obligations, went to governments. A 25% cost-sharing match would represent $54 million.
Dimitrios Gouglas, Klara Henderson, Jens Plahte, Christine Årdal, John-Arne Røttingen. 2014. Evaluation of the GAVI Alliance Co-financing Policy. Report commissioned by the GAVI Alliance. Norwegian Institute of Public Health, Oslo.