A Unified U.S. Government HIV/AIDS Team
President Bush's Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan) is a bold call for action abroad and an equally bold call for a "new way of doing business" here at home. Under the leadership of the U.S. Global AIDS Coordinator, new structures and systems were established at every level of the U.S. Government working in international HIV/AIDS to ensure a unified strategic approach to combating the epidemic abroad. The primary implementing departments and agencies of the U.S. Government -- the Departments of State, Defense, Health and Human Services, Commerce, and Labor; the U.S. Agency for International Development; and the Peace Corps -- have heeded the Coordinator's call to "leave their uniforms at the door" and come together in the common cause of turning the tide against the HIV/AIDS pandemic. Although this is an ongoing process, the achievement of a single U.S. approach to global HIV/AIDS within the first year of implementation is extraordinary. It is a testament to the dedication and compassion of program and management technical experts and administrators throughout the implementing departments and agencies.
Strong leadership is required to ensure a unified U.S. approach to global HIV/AIDS. To that end, at the headquarters level the U.S. Global AIDS Coordinator chairs a weekly policy team of principals from the lead implementing agencies. The Assistant U.S. Global AIDS Coordinator chairs a weekly meeting of deputy principals to manage specifics related to program implementation. To ensure that the Emergency Plan incorporates the most advanced technical thinking, there are interagency technical working groups for care and treatment, prevention, orphans and vulnerable children, human capacity development, and strategic information, as well as a scientific steering committee. Although a Chief Operating Officer has not yet been named, technical working groups are already functioning in human resources and acquisitions and assistance. Each of the technical and operations working groups is co-chaired by representatives from various implementing agencies and includes field representatives. In addition to formulating technical guidance and providing direct support to field programs, these working groups have streamlined differences among agencies on reporting requirements, policies, and regulations.
In each focus country, the U.S. Ambassador leads an interagency HIV/AIDS team that includes all of the implementing departments and agencies in-country. This unified U.S. Government in-country team ensures a unified strategy and voice in working with host governments and local nongovernmental partners. In many of the focus countries, there are also interagency technical working groups that relate to host governments and nongovernmental partners. Thanks to the commitment of U.S. personnel in the field, the implementation of highlyfunctional interagency teams in-country has been a remarkable first-year achievement. Because the U.S. Government now speaks with one voice on HIV/AIDS, interactions with host governments and nongovernmental partners have become more efficient and effective. In many countries, high-level Emergency Plan advisory committees have been formed to ensure a close working relationship between the U.S. Government and host-country counterparts responsible for directing the national strategy. For example, in Nigeria, the Minister of Health and the U.S. Ambassador chair a joint Nigerian-U.S. Emergency Plan working group. In Uganda, the U.S. Ambassador has convened a multisector Emergency Plan advisory group chaired by a former Prime Minister. These relationships complement U.S. participation in donor groups that support national strategies and further ensure that the Emergency Plan is fully coordinated with the national HIV/AIDS strategy.
To ensure constant communication between interagency teams at headquarters and interagency teams in the field, the Office of the U.S. Global AIDS Coordinator (OGAC) has established feedback and exchange processes. An interagency Core Team, with a coordinator in OGAC, serves as a liaison between the field and headquarters. The Core Team structure contributes to the strategy of a unified U.S. Government approach to combating the HIV/AIDS pandemic. The Core Team is fully informed of OGAC policy as well as country programs, facilitating the flow of information between countries and headquarters. The Core Team also provides technical assistance and support in program and management areas, including the identification and provision of specialized technical assistance beyond the scope of the Team members.
In order to share learning and offer feedback across all levels of program implementation and management, country team representatives, led by their Ambassadors, and OGAC leaders met in Johannesburg, South Africa, in June 2004 to take stock and plan next steps. This forum provided the opportunity for a rich exchange on programmatic and management issues and enabled countries and headquarters to learn from each other. Several important actions to improve the Emergency Plan were instituted as a result of this meeting. Countries asked for clearer and more consistent communication from Washington on policy and implementation issues. This resulted in News to the Field, a weekly e-mail that provides the latest information, guidance, and news from headquarters. Issues addressed are often generated from questions from field missions which are raised through the Core Teams.
The Global AIDS Coordinator recognizes that clear and transparent communication outside the U.S. Government is also essential. During fiscal year 2004, OGAC worked with departments and agencies to overcome technical and administrative obstacles to developing a comprehensive, transparent Web site fully accessible to all, with the expectation that the site will be functional in the third quarter of 2005.
A Unified U.S. Government Strategy
On February 23, 2004, one month after the first congressional appropriation of resources for the President's Emergency Plan, the Coordinator submitted to Congress the U.S. Five-Year Global HIV/AIDS Strategy. The Strategy set forth in detail the goals of the Emergency Plan and strategies for achieving those goals, and it guided the Emergency Plan activities in fiscal year 2004 described throughout this report. All U.S. embassies have received the Global Strategy, and the Coordinator has sent cables to the U.S. Ambassador in every country with a bilateral HIV/AIDS program requesting that their programs be aligned with the five-year strategy. Guidance has also been provided to all bilateral programs to facilitate the incorporation of Emergency Plan goals and strategies in the Department of State Mission Performance Plans.
In addition, the U.S. Ambassador in each of the 15 focus countries led country teams in the preparation of a five-year country strategy, submitted in October 2004, to guide country operational plans toward the Emergency Plan's five-year goals. These results-oriented strategies are based on the Five-Year Global Strategy, and were developed with U.S. partners in-country so that they 1) reflect unique challenges and opportunities for each focus country; 2) ensure support of host-country HIV/AIDS strategies; 3) effectively build on the comparative advantage of U.S. Government expertise; and 4) complement other donors' programs.
Now that the Emergency Plan is well into its first year of program implementation, OGAC plans to hire a contractor to provide an independent non-financial audit and evaluation of in-country implementation of select programmatic aspects of the Emergency Plan. This audit will help the Coordinator determine how well Emergency Plan strategy and policy guidance is being implemented in the field and identify what additional support OGAC can provide to implementing agencies and other partners to assist them in implementation of the Emergency Plan. The programmatic aspects that will be examined include the delivery of HIV/AIDS treatment, care, and prevention assistance, including implementation of the ABC approach to HIV/AIDS prevention. The contractor will also examine the involvement of host governments, the private sector, and nongovernmental entities, including faith-based organizations, in the design and delivery of Emergency Plan assistance.A Unified U.S. Government Operational Plan in Each Focus Country
A comprehensive COP review process was also established for fiscal year 2005 based on lessons learned from the review process for fiscal year 2004. This well-defined interagency process incorporates technical, management, and policy analysis and strong communication with field programs. The relevant areas of each COP were reviewed initially by the interagency technical review teams according to previously established criteria they had developed. This assured consistency between the Global Strategy and the country five-year strategy, as well as adherence to sound technical approaches for both program areas and management. The entire COP was then reviewed more broadly by a programmatic team, according to previously established review criteria, chaired by a member of the interagency deputy principals. Following intensive discussions of the findings of the technical and programmatic reviews with the country teams, the programmatic review teams submitted standardized recommendations and comments to a principals review committee chaired by the Coordinator and with participation from principals of the implementing departments and agencies. The Coordinator made final decisions regarding funding of country program activities under the COPs and communicated these to the Ambassadors. These comprehensive reviews have significantly broadened and deepened the unity of the U.S. Government's strategy for HIV/AIDS. They also served to outline the priority technical and management issues to be addressed in the upcoming year.
A Unified Reporting Mechanism for Performance-Based Assessments
A fundamental aspect of the Emergency Plan is results-based programming and funding. Decisions regarding annual country allocations and approval for continued funding of individual partners and activities will be made based on performance against the targets set by the country teams and partners in the COP and approved by the Coordinator in consultation with principals from the implementing departments and agencies. An important innovation for facilitating such performance-based management has been the development and implementation of a fully electronic Web-based COP (see appendix VI). Developed following an evaluation of experiences with the fiscal year 2004 COPs, the electronic COP was first used for fiscal year 2005 COPs. The electronic COP feeds into a comprehensive database also developed as a result of the fiscal year 2004 COP process, with significant input from implementing agencies. The database is a powerful tool that enables both countries and headquarters to manage, track, and adjust program activities and resource allocation to maximize results.