PEPFAR FAQs

PEPFAR is the President’s Emergency Plan for AIDS Relief, the U.S. Government initiative to help save and improve the lives of those suffering from or at risk of contracting HIV/AIDS around the world. PEPFAR is the largest commitment by any nation in history to combat a single disease internationally, and its investments also help build strong health systems to prevent and alleviate suffering from other diseases. PEPFAR is driven by a shared responsibility among donor and partner nations to make smart investments to save and improve lives.

With U.S. leadership and support, tremendous progress has been made in the fight against global AIDS. As of September 2012, PEPFAR had directly supported life-saving antiretroviral treatment for more than 5.1 million men, women, and children, up from 1.7 million in 2008 – a three-fold increase in only four years. PEPFAR directly supported more than 15 million people with care and support programs last year, including more than 6 million orphans and vulnerable children. PEPFAR’s efforts to prevent mother-to-child HIV transmission last year allowed 230,000 babies of HIV-positive mothers to be born HIV-free. For more information about PEPFAR efforts around the world, please visit www.PEPFAR.gov, http://twitter.com/PEPFAR, or www.facebook.com/PEPFAR.

In Côte d’Ivoire, PEPFAR provides trusted procurement of 75% of national antiretroviral medications and laboratory commodities, brings technical expertise to all major HIV-related forums, and supports technical assistance and direct services through three Ivoirian ministries, 40+ implementing partners (IPs), and more than 200 local sub-partners.

During its first five years (2004-2008), PEPFAR concentrated most of its resources on 15 “focus” countries: Côte d’Ivoire, Botswana, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. During Phase 2 (2009-2013), PEPFAR is working in more than 100 countries around the world, with an emphasis on high-prevalence, low-resource countries where external funding can make a significant impact.

In Côte d’Ivoire, PEPFAR has invested more than $900 million since 2004. PEPFAR is by far the largest donor to the Ivoirian HIV/AIDS response.

In addition to providing about 75% of external HIV/AIDS funding through PEPFAR, the U.S. government provides one-third of the funding contributed by the second-largest donor, the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM). Other donors include the United Nations (UNAIDS, the World Health Organization, UNICEF, UNFPA, etc.), the French Development Agency (AFD), and the European Union. The Government of Côte d’Ivoire funds the Ministry of Health and AIDS (MSLS) and other ministries, including personnel and overhead costs at public health facilities, where HIV/AIDS services are integrated into a “national package” of regular health services. Under MSLS leadership, PEPFAR collaborates with all donors to avoid duplication, fill gaps, and maximize synergies.

PEPFAR funds are used to prevent and treat HIV/AIDS, to improve the lives of adults and children living with or affected by HIV, and to build strong systems to support sustainable national responses to the HIV/AIDS pandemic. To achieve its objectives, PEPFAR funds support activities in the following program areas: prevention of sexual transmission and mother-to-child transmission of HIV, HIV testing and counseling, blood safety, injection safety, management of medical waste, adult and pediatric care and treatment of HIV and of HIV/TB co-infection, care and support for orphans and vulnerable children, procurement of medications and commodities, and strengthening of laboratory, strategic information, and other health systems.

The PEPFAR team in Côte d’Ivoire is led by the U.S. Ambassador. Most funds are administered by the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID), with smaller projects administered by the Department of Defense (DoD), Department of State (DoS), Health Resources and Services Administration (HRSA), and National Institutes of Health (NIH).

Each year, the Office of the Global AIDS Coordinator (OGAC) in Washington, D.C., proposes budget levels for each country program. All funding must be approved by the U.S. Congress, and thus can be affected by U.S. economic/political considerations. Based on OGAC’s budget proposal, each country team – consisting of all in-country U.S. government agencies active in HIV/AIDS – works with host-country counterparts, other donors, and implementing partners to develop an annual Country Operational Plan (COP) describing its priorities, strategies, and planned activities. Once this COP is reviewed and approved by OGAC and Congress, funds are administered through U.S. government agencies (CDC, USAID, etc.), which award funds to implementing partners through cooperative agreements or contracts.

Any legal entity (government, private sector, civil society, etc.) capable of contributing to the achievement of PEPFAR goals is eligible to receive PEPFAR funding. In practice, PEPFAR Côte d’Ivoire currently provides direct funding for three Government of Côte d’Ivoire ministries (Health and AIDS; Education; and Families, Women, and Children) and about 27 international NGOs/universities and eight Ivoirian NGOs. Many of these direct partners also provide subgrants of PEPFAR funding to local community- and faith-based organizations. In PEPFAR Côte d’Ivoire’s FY 2013 budget, five of the 10 largest recipients (including our largest clinical-services partner) are Ivoirian entities, and 30% of all program funds are allocated to Ivoirian recipients.

In general, USG agencies award grants and contracts through a competitive process. The agency describes the scope of work that it would like to fund and posts a funding opportunity announcement (known variously as an FOA, RFA, RFP, etc.) on FedBizOpps (www.fbo.gov). After reviewing applications/proposals, the agency selects one or more awardees. This process is labor-intensive and highly competitive, difficult for new or inexperienced organizations.

Most host-country NGOs that have become PEPFAR partners first gained experience and expertise through years of high-quality work with their own resources and then as sub-partners to direct PEPFAR partners. For a young local organization, perhaps the best strategy is to do good work with available resources, to document your efforts and results, and to make them known to other organizations working in the same field.

You can write to the PEPFAR Country Coordinator at the U.S. Embassy, 01 BP 1712 Abidjan 01, or call (+225) 22.49.41.16.

In addition to many evaluations demonstrating the achievements – and sometimes the failures and lessons learned – of individual projects and programs funded by PEPFAR, the Institute of Medicine of the National Academy of Sciences has twice conducted major evaluations of the overall PEPFAR program. In its latest report, issued in early 2013 (available athttp://www.iom.edu/Reports/2013/Evaluation-of-PEPFAR.aspx), the IOM described PEPFAR as “globally transformative” in saving and improving the lives of millions of people and helping build stronger health systems. “Across partner countries, PEPFAR was described as a lifeline, and people credit PEPFAR for restoring hope,” the IOM says, while noting continuing challenges such as focusing on outcomes rather than activities, improving efficiency, and shifting to host-country ownership of sustainable responses to HIV/AIDS.

We don’t know. Every indication from leaders such as President Barack Obama, former Secretary of State Hillary Clinton, and U.S. Global AIDS Coordinator Eric Goosby is that the United States continues its unwavering and bipartisan commitment to helping achieve an “AIDS-free generation.” (See  the PEPFAR Blueprint: Creating an AIDS-free Generation at http://www.pepfar.gov/documents/organization/201386.pdf. (PDF 2.83 MB)