Is there an association between PEPFAR funding and improvement in national health indicators in Africa? A retrospective study

Abstract

BackgroundThe US President's Emergency Plan for AIDS Relief (PEPFAR) was reauthorized in June 2008 with a three-fold increase in funds, and a broader, more explicit mandate to improve health in the low- and middle-income countries that it funded. However, the ability of a disease-specific, or vertical, programme to have a spill-over effect and improve health outcomes has been questioned. In this study, we sought to examine associations between being designated as a PEPFAR focus country (and receiving increased PEPFAR funding) and non-HIV-specific health outcomes in the World Health Organization (WHO) Africa Region, the area most affected by the HIV/AIDS epidemic.MethodsA retrospective analysis of publicly available health outcomes data published by the World Health Organization was performed for all countries in the WHO Africa Region. Fractional changes in health indicators between 2000 and 2006 were calculated, and PEPFAR focus and non-focus countries were then compared.ResultsOverall, countries in the WHO Africa Region showed a small worsening in health outcomes status when all indicators were analyzed together and weighted equally. However, more health indicators improved than worsened over this six-year period. A comparison of PEPFAR focus and non-focus countries found no significant difference in the fractional change among 13 of 14 health indicators during the study period.ConclusionsThis study suggests that vertical programmes, even one that is the scale of PEPFAR, may have little or no impact on health outcomes not explicitly targeted.

Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

“…Also, an ideological struggle seems to have arisen around whether GHIs have de facto strengthened health systems or had the opposite effect [44-48]. Answers to these questions will influence future HSS directions for GHIs and countries and caution is needed in interpreting them, since answers might differ depending on who the assessor is and what meaning is given to “HSS”.…”

Integrating Human Immunodeficiency Virus and Reproductive, Maternal and Child, and Tuberculosis Health Services Within National Health Systems

“…However, the ability of disease-specific program like PEPFAR or Global Fund to have a spill-over effect and improve health outcomes has been questioned. Duber et al found that vertical programs, even on the scale of PEPFAR, may not impact health outcomes that were not specifically targeted on a national level [12]. Attempts have been made to integrate donor-funded HIV prevention, care, and treatment programs into national health systems to ensure efficiency and sustainability, including: TB [13••, 14], maternal-child health (MCH) [15–20], cervical cancer screening [21], sexually transmitted infection (STI) [16, 22], and family planning [23, 24] programs.…”

A Critique of the Response by Global Health Initiatives to HIV/AIDS in Africa: Implications for Countries Emerging from Conflict

“…A few years later, President George W. Bush of the United States (US) introduced PEPFAR, the largest bilateral programme for a single disease to date. 3 Of PEPFAR's original priority countries, 12 out of 15 were in Africa. The United Nations also scaled-up its response, through the Joint UN Programme on HIV/AIDS (UNAIDS), involving an increasing number of co-sponsoring agencies.…”