IX. Implementation and Management

“As Global AIDS Coordinator . . . he will coordinate all of our international HIV/AIDS activities for all of our government departments and agencies. He will oversee all resources of this program. And he will work with the faith-based and community groups to get the job done. He will report regularly to Congress on the progress and effectiveness of our efforts.” President George W . Bush, July 2, 2003

Meeting the challenge of the global AIDS crisis is a monumental task that will require – along with strong leadership and vision – robust and flexible administrative structures. This section describes the Office of the U.S. Global AIDS Coordinator’s organization and implementation strategy for President Bush’s Emergency Plan for AIDS Relief.

The implementation strategy of President Bush’s Emergency Plan is designed to meet the goals he set in his historic State of the Union message of 2003. The U.S Global AIDS Coordinator’s response must be rapid, effective, and evidence- based, and make efficient and focused use of all relevant government capabilities through coordination, collaboration, and cooperation across U.S. Government agencies. It must also reflect administration policy and statute; respond to the diverse needs of the various communities around the world in which the U.S. Government works; and account for progress toward achieving the President’s goals.

Additionally, as implementation moves forward, a growing number of public and private entities will become active partners in the United States’ fight against global AIDS. This is, in fact, a focus of this initiative – to bring the breadth and depth of American public and private talent to the fore to meet the challenge of global AIDS. Coordination of these activities will pose an ever-increasing challenge and will be taken into account as the Emergency Plan is implemented.

The Office of the U.S. Global AIDS Coordinator will lead an integrated U.S. Government global HIV/AIDS effort; provide a rallying point for private sector, FBO, and NGO efforts; and make necessary decisions and take actions to ensure that policies are harmonious, programs synergistic, and operations efficient and effective. An overarching objective is to create a single coordinated U.S. Government global AIDS response. The U.S Global AIDS Coordinator will lead a unified global projection of U.S. resources and talent to turn the tide against HIV/AIDS.

It is important that a consistent philosophy permeate all activities overseen by the U.S. Global AIDS Coordinator. The strategic guidance outlined at the beginning of this document applies to all U.S. bilateral activities. Across all programs, implementation efforts will follow the President’s vision for the Emergency Plan. They will focus on the urgency of response and the desire to seek new approaches and foster bold leadership. Reliance on evidence-based approaches and accountability, and the recognition that planning and implementation must be based on local conditions and follow the lead of local government, will inform program implementation. Bilateral programs outside of the focus countries will also experience dynamic improvements in their programs and activities as they will specifically benefit from strengthened management, coordination, and best practices identified through focus country activities.

The following sections describe broad categories of implementation and management activities that will drive President Bush’s Emergency Plan.

Coordination
The position of the U.S. Global AIDS Coordinator was specifically mandated to provide coordination and oversight across all U.S. international HIV/AIDS activities, including those run by specific U.S. agencies or through multilateral organizations. Coordination with other stakeholders, including national governments and nongovernmental service providers, is key to the amplified response expected under President Bush’s Emergency Plan. The U.S. Global AIDS Coordinator is thus responsible for both internal and external coordination of HIV/AIDS activities.

The U.S. Global AIDS Coordinator:  A New Leadership Model The U.S. Global AIDS Coordinator, Ambassador Randall L. Tobias, was appointed by President Bush and confirmed by the Senate to coordinate and oversee the U.S. global response to HIV/AIDS. Reporting directly to Secretary of State Colin Powell, the U.S. Global AIDS Coordinator will: Lead the U.S. Government’s international HIV/AIDS efforts; Ensure program and policy coordination among the relevant USG agencies and departments and nongovernmental organizations, avoiding duplication of effort; Pursue coordination with other countries and international organizations; Resolve policy, program, and funding disputes among the relevant USG agencies and departments; Directly approve all activities of the United States relating to combating HIV/AIDS in 15 focus countries; and Promote program accountability and monitor progress toward meeting the Emergency Plan’s goals. The U.S. Global AIDS Coordinator is particularly aware of the need for the Emergency Plan’s programs to be accountable to both the President of the United States and the Congress. Accordingly, the Global AIDS Coordinator is committed to regular communication and consultation about the Emergency Plan’s progress and achievements.

Internal Coordination.  The Office of the U.S. Global AIDS Coordinator will undertake an ongoing planning, policy development, and program implementation process that involves all relevant U.S. Government departments and agencies and draws on the technical strengths of central and in-country staff. The U.S. Global AIDS Coordinator’s office will conduct regular intergovernmental program and policy meetings and will support collaborative planning, implementation, and objective review processes that will involve bringing in-country staff to headquarters for short-term technical exchanges.

Country-specific response teams composed of agency and U.S. Global AIDS Coordinator staff have been organized for the focus countries. These teams provide each U.S. Mission with a consistent, competent, and informed point of contact in the central office and ensure that central office staff are aware of specific issues, situations, and factors that influence implementation in the field.

At the same time, staff will coordinate with U.S. Government agencies or offices that are not specifically involved in HIV/AIDS efforts but promote initiatives supportive of the fight against HIV/AIDS in important additional areas, such as food and other development assistance programs, research activities, and faith-based initiatives.

External Coordination.  Coordination with local policies, programs, and strategic plans is crucial to the sustainability of programs and efficient use of resources. Coordination with other donors and contributors is also crucial to combating HIV/AIDS. In order to work smoothly in the target countries, the

U.S. Global AIDS Coordinator will task field offices toensure that donors with significant equities are included in the local planning process. On the multilateral level, the U.S. Global AIDS Coordinator will liaise with representatives in multilateral institutions to avoid conflicts and duplication of efforts. Again, coordination with multilateral institutions and international organizations is intended to mobilize a comprehensive response to global HIV/AIDS that capitalizes on the expertise of various groups.

It is also important that the Coordinator learn from the experiences of others working in this arena. Close proactive liaison with private sector organizations, businesses, and faith-based and other organizations involved in global HIV/AIDS will help to support an environment that strengthens and fosters innovation.

Country Planning
At the core of the implementation strategy is a robust ongoing in-country planning effort. This will begin in the focus countries where the U.S. Global AIDS Coordinator will ask each Chief of Mission to undertake a strategic planning process to develop a five-year plan for strengthening the quality, availability, and sustainability of treatment, prevention, and care services. The planning process will include all relevant USG entities as well as the host-country government, the NGO sector, people living with AIDS, other bilateral and multilateral donors, and additional stakeholders. The plan will identify relevant U.S. Government agencies, existing resources, needs, gaps, partners, programs, objectives, performance measures, staffing, and technical assistance requirements. Coordination will thus be improved and resources best matched to local needs and conditions.

The in-country strategic planning process is critical to the success of the Emergency Plan and will be strongly supported by technical assistance from the Office of the U.S. Global AIDS Coordinator and other federal agencies. Plans will be submitted to the Coordinator for review, in consultation with field offices, technical experts, and agency officials. Final approval by the Coordinator will ensure consistency with congressional intent, administration policy, and program objectives.

Limitation on the Use of Funds P.L. 108-25 includes certain restrictions on the use of international HIV/AIDS funds and requires recipients of those funds to have certain policies in place. The Office of the Global AIDS Coordinator is committed to ensuring that the following provisions are incorporated into program implementation efforts: SEC. 301, Assistance to Combat HIV/AIDS (e) Limitation.–No funds made available to carry out this Act, or any amendment made by this Act, may be used to promote or advocate the legalization or practice of prostitution or sex trafficking. Nothing in the preceding sentence shall be construed to preclude the provision to individuals of palliative care, treatment, or post-exposure pharmaceutical prophylaxis, and necessary pharmaceuticals and commodities, including test kits, condoms, and, when proven effective, microbicides. (f) Limitation.–No funds made available to carry out this Act, or any amendment made by this Act, may be used to provide assistance to any group or organization that does not have a policy explicitly opposing prostitution and sex trafficking.

Planning for services is critical in every U.S. mission and for every country, be it a focus country or not. Increasing attention will be directed to non-focus countries in the months and years ahead. Staff in non-focus countries will work with local governments to develop national strategic plans for prevention, treatment, and care. Best practices in the focus countries will be emphasized and technical assistance from USG staff and relevant experts in focus countries will be facilitated by the U.S. Global AIDS Coordinator.

Allocation of Funding
The President’s Emergency Plan relies on a variety of funding allocation mechanisms in order to maximize flexibility and encourage innovation while responding to specific country needs.

Allocations by Country.  Funding levels for focus countries will be allocated on the basis of five-year strategic plans, and funds will be released upon approval of annual country operational plans by the U.S. Global AIDS Coordinator. The Coordinator will not predetermine annual funding levels agency by agency but will instead consult with the agencies and Chiefs of Mission to determine the optimal mix of

U.S. Government agency support appropriate for localconditions, capabilities, and needs. This process will leverage the comparative advantages of various USG organizations, ensure coordination, and stimulate innovation. An annual review will be conducted for other ongoing HIV/AIDS bilateral programs.

Central Funding Mechanisms.  Some resources will be disbursed through central office initiatives. Some NGOs have existing capacity to respond quickly and effectively in more than one country, making it more efficient to fund multiple country projects. In other cases, the U.S. Government will seek out organizations that can provide technical assistance and support for activities such as professional training or twinning programs on a regional basis. In both cases, these organizations will be included in local strategic plans and subject to approval by the Chiefs of Mission in the targeted countries so that, if performance is acceptable, they will receive ongoing support through field mechanisms. This process will ensure efficiency as well as policy consistency and coherency.

In the case of central funding mechanisms, the U.S. Global AIDS Coordinator will assign implementation responsibility to the central office of a U.S. Government agency. In consultation with the Office of the U.S. Global AIDS Coordinator, the agency will solicit proposals, conduct reviews, and award grants, contracts, or cooperative agreements through a transparent competitive process.

Evidence-Based Allocations. The U.S. Global AIDS Coordinator’s funding decisions will be evidence-based. A strong monitoring and evaluation function will be established (see chapter X) with the goal of gathering strategic information necessary to allocate resources for maximum impact and ensure accountability to American taxpayers and their congressional representatives. Allocations of funds among and within the focus countries will be based upon performance in reaching treatment, prevention, and care targets. These targets will be derived from the “2-7-10” goals set by President Bush in his 2003 State of the Union address – 2 million people in treatment, 7 million infections prevented, and 10 million people provided with care.

Allocation of Funds In P.L. 108-25, the “United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003,” Congress provided recommendations for an effective distribution of funds appropriated under the Act and specified out-year allocations. SEC. 402 SENSE OF CONGRESS (b) Effective Distribution of HIV/AIDS Funds.–It is the sense of Congress that, of the amounts appropriated pursuant to the authorization of appropriations under section 401 for HIV/AIDS assistance, an effective distribution of such amounts would be– (1) 55 percent of such amounts for treatment of individuals with HIV/AIDS; (2) 15 percent of such amounts for palliative care of individuals with HIV/AIDS; (3) 20 percent of such amounts for HIV/AIDS prevention consistent with section 104A(d) of the Foreign Assistance Act of 1961 (as added by section 301 of this Act), of which such amount at least 33 percent should be expended for abstinence-until-marriage programs; and (4) 10 percent of such amounts for orphans and vulnerable children. SEC. 403. ALLOCATION OF FUNDS. (a) Therapeutic Medical Care.–For fiscal years 2006 through 2008, not less than 55 percent of the amounts appropriated pursuant to the authorization of appropriations under section 401 for HIV/AIDS assistance for each such fiscal year shall be expended for therapeutic medical care of individuals infected with HIV, of which such amount at least 75 percent should be expended for the purchase and distribution of antiretroviral pharmaceuticals and at least 25 percent should be expended for related care. For fiscal years 2006 through 2008, not less than 33 percent of the amounts appropriated pursuant to the authorization of appropriations under section 401 for HIV/AIDS prevention consistent with section 104A(d) of the Foreign Assistance Act of 1961 (as added by section 301 of this Act) for each such fiscal year shall be expended for abstinence-untilmarriage programs. (b) Orphans and Vulnerable Children.–For fiscal years 2006 through 2008, not less than 10 percent of the amounts appropriated pursuant to the authorization of appropriations under section 401 for HIV/AIDS assistance for each such fiscal year shall be expended for assistance for orphans and vulnerable children affected by HIV/AIDS, of which such amount at least 50 percent shall be provided through non-profit, nongovernmental organizations, including faith-based organizations, that implement programs on the community level.

Fiscal Controls
Congress has entrusted the U.S. Global AIDS Coordinator with unprecedented resources to fight global HIV/AIDS. Utilizing existing capabilities and processes within U.S. Government agencies, the U.S. Global AIDS Coordinator has established mechanisms to track funds accurately and control disbursements so that resources will be correctly directed to their intended use and will be deployed rapidly. Careful attention will be paid to distinguish obligations from expenditures in order to make realistic budget projections to fund services for those in need as aggressively as possible.

Communications/Liaison
Transparency in implementation is critical. Over half of all international assistance donated to fight global HIV/AIDS comes from U.S. taxpayers, and they, as well as the people and communities being served, should be able to readily understand how funds are allocated, distributed, and used; what impact they are having; and who is benefiting from them.

Communication is therefore another key element of implementation. The U.S. Global AIDS Coordinator will ensure that the public is given timely, accurate, and complete information regarding the President’s Emergency Plan for AIDS Relief. A variety of mechanisms, including Web technology, reports to Congress, and media outreach will serve this purpose.

Office of the U.S. Global AIDS Coordinator
With the authority to act internationally, to transfer and allocate funding to executive branch agencies, and to contract with NGOs, including faith- and community-based programs, the U.S. Global AIDS Coordinator has been given the necessary tools to lead a unified, coordinated U.S. Government global AIDS response. As champion of the vision and strategic direction of the President’s Emergency Plan, the U.S. Global AIDS Coordinator will also determine resource allocation and program effectiveness.

In broad terms, the Office of the U.S. Global AIDS Coordinator will be organized to provide strategic and policy direction as well as technical and program management to oversee global HIV/AIDS program activities. In addition, the Office of the Coordinator will provide communications, administrative, and diplomatic resources for managing bilateral and multilateral activities. Recognizing that the implementation of the Emergency Plan will be carried out largely by other departments and agencies (centrally and in the field), the Office will be a small organization focused on leadership, coordination, learning, and oversight, and will strive to remain flexible and innovative in its approaches.

Functions of the Office of the U.S. Global AIDS Coordinator
The Office of the Global AIDS Coordinator is organized and will be staffed to lead the implementation of President Bush’s Emergency Plan for AIDS Relief. The Office is organized into units of specialized function as follows:

• The Leadership of the Office is responsible for overseeing all activities and ensuring that the programs and activities of the Emergency Plan are accountable to the President and the Congress.

• The Program Services unit is responsible for development and compliance monitoring of implementation plans for each of the Emergency Plan’s focus countries. This unit will also serve as a technical and clinical support resource for the focus countries and all other activities conducted by the U.S. Global AIDS Coordinator. It will also serve as a technical resource for human capacity development activities and will develop, implement, and monitor programs that respond to training needs.

• The Strategic Information and Evaluation unit will be responsible for gathering the information necessary to ensure that Emergency Plan goals are reached and that those goals have the expected impact. This unit will work with the international community to harmonize strategic information collection and will also serve as a liaison to the research community as well as the research and information components of implementing agencies.

• The Management Services unit will provide operational support to the Office and will track the disbursement of program funds.

• The Diplomatic Liaison unit is responsible for strategic planning and activities to foster leadership and develop a coordinated international response on HIV/AIDS by working with international institutions, foreign governments, NGOs, and others.

• The Government and Public Liaison unit will have the responsibilities of responding to congressional requests for data and information and communicating policy to Congress. It will prepare congressional reports and compliance documents. It serves as the technical resource for the U. S. Global AIDS Coordinator on budget and appropriations issues. The unit is also responsible for developing the annual budget and will serve as the liaison to the White House and to administration departments and agencies and their budget offices.

• The Public Affairs and Communications unit will plan and implement domestic and foreign communications in support of Emergency Plan activities and will conduct outreach activities to promote involvement of various public and private organizations that could be beneficial in the fight against HIV/AIDS.

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