Detailed Information on the
President's Emergency Plan For AIDS Relief: Other Bilateral Programs Assessment

Instituting Partnership Compacts to strengthen the performance and impact of PEPFAR programs and better engage host governments.

Develop and implement a distance-learning platform to improve training and knowledge sharing and increase the knowledge base of all staff and communications between HQ and the country teams.

Completing implementation of USAID's new financial management systems discussed above.

Instituting a system that Other Bilateral countries will use to plan future year programming and report on past year results.

Providing an agressive target for the program's long-term measure.

Improving data quality through workshops, TA, training, and tools to help country teams plan for investments in activities to strengthen results reporting.

Measure: Average cost (total dollars minus Management and Staffing costs) to the U.S. Government per prevention, care, treatment, or training activity in countries receiving $1 million or more in U.S.G. HIV/AIDS funding. (New measure, added August 2007)

Explanation:This measure evaluates the per activity cost of prevention, care, treatment, and training activities to the U.S. Government. Because most fiscal year funding is actually spent and results achieved in the following fiscal year, the numerator includes 80% of the funding from the previous fiscal year and 20% from the current fiscal year. Therefore, for the 2005 baseline actual, the numerator includes 80% of fiscal year 2004 funds and 20% of fiscal year 2005 funds. The denominator is equal to the sum of individual activities from 16 prevention, care, treatment, and training indicators. The average cost is calculated by country and then averaged to identify overall efficiency. We expect that the average cost per activity will decrease over time.

Measure: Number of individuals provided with general HIV-related palliative care (including TB/HIV)

Explanation:This measure is an example of a program level indicator and is standardized for use across all other bilateral countries receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. The data from 2004 and 2005 are from HHS/CDC only and were not under the guidance of PEPFAR reporting. 2006 is the first reporting cycle that PEPFAR guidance is in effect for the countries receiving $1 million or more in USG HIV/AIDS funding.

Measure: Number of individuals receiving antiretroviral therapy at the end of the reporting period (includes PMTCT+ sites)

Explanation:This measure is an example of a program level indicator and is standardized for use across all other bilateral countries receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. Countries receiving between $1-10 million in funding will report on male and female subsets only and are not required to break male and female into the age categories as are the focus and 5 new COP countries. The data from 2004 and 2005 are from USAID and HHS/CDC and were not under the guidance of PEPFAR reporting. 2006 is the first reporting cycle that PEPFAR guidance was in effect for the countries receiving $1 million or more in USG HIV/AIDS funding.

Measure: Number of OVC being served by an OVC program

Explanation:This measure is an example of a program level indicator and is standardized for use across all other bilateral countries receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. OVC programs are administered by USAID, thus this measure will be reported on by USAID only. The data from 2004 and 2005 is from USAID and was not under the guidance of PEPFAR reporting. 2006 is the first reporting cycle that PEPFAR guidance was in effect for the countries receiving $1 million or more in USG HIV/AIDS funding.

Measure: Number of individuals who received counseling and testing for HIV and received their test results

Explanation:This measure is an example of a program level indicator and is standardized for use across all other bilateral countries receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. The data from 2004 and 2005 are from USAID and HHS/CDC and were not under the guidance of PEPFAR reporting. 2006 is the first reporting cycle that PEPFAR guidance was in effect for the countries receiving $1 million or more in USG HIV/AIDS funding.

Measure: Number of individuals trained in the provision of laboratory-related activities

Explanation:This measure is an example of a program level indicator and is standardized for use across all other bilateral countries receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. This activity is run by CDC and thus will be reported on by CDC only. The data from 2004 and 2005 is from HHS/CDC and was not under the guidance of PEPFAR reporting. 2006 is the first reporting cycle that PEPFAR guidance is in effect for the countries receiving $1 million or more in USG HIV/AIDS funding.

Measure: Number of HIV-positive 15-24 year olds living in the other bilateral countries (39 as of FY 2006).

Explanation:This measure is an international surveillance measure, which is a joint effort of WHO and UNAIDS and is published in the annual UNAIDS HIV/AIDS Reports. UNAIDS collects HIV prevalence estimates for 15-24 year olds by country in sub-Saharan Africa; while UNAIDS does not report HIV prevalence estimates for 15-24 year olds in countries outside of sub-Saharan Africa, the total number of HIV-positive adult males and females are reported for each country. Using these population totals, it is possible to estimate the number of HIV-positive 15-24 year olds by multiplying the adult totals by a ratio that represents the number of HIV-positive 15-24 year olds.

Is the program purpose clear?

Explanation: The purpose of the President's Emergency Plan for AIDS Relief, a five-year, $15 billion initiative, is to turn the tide against the global AIDS pandemic. Within the Emergency Plan, the purpose of the effort in other bilateral programs outside of the focus countries is strengthening and leveraging resources to scale up the quality and capacity of national HIV/AIDS prevention, treatment, and care programs and advance policy initiatives that support effective HIV/AIDS programs. Given the magnitude of the resources of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) in many of these countries compared to U.S. Government (USG) resources, it is expected that USG resources will be used to help bring to scale national prevention, treatment and care programs through the Global Fund. The program is implemented through several USG departments and agencies; however, this PART only examines the roles of the U.S. Departments of State, Health and Human Services/ Center for Disease Control (HHS/CDC) and the U.S. Agency for International Development (USAID). The other departments and agencies are reviewed in separate assessments.

Evidence: Evidence includes authorizing legislation, annual report purpose statements of the Office of the Global AIDS Coordinator (OGAC) and HHS/ CDC/ Global AIDS Program (GAP) and the USAID congressional budget justification.

Does the program address a specific and existing problem, interest, or need?

Explanation: The Emergency Plan recognizes the global HIV/AIDS pandemic as one of the greatest health challenges of our time. In 2004, an estimated 38.4 million adults and children were living with HIV/AIDS; an estimated 4.9 million people were newly infected with HIV; and more than 3 million died of AIDS - or over 8,000 a day, each day for an entire year. Of the 14,000 infected daily, about 12,000 are people aged 15 to 49 years. USAID and HHS/CDC follow a methodology for establishing an HIV/AIDS program within other bilateral countries based on: the magnitude and severity of the disease, population size, extent to which there is an enabling environment for a rapid response, and special circumstances including foreign policy interests. With some exceptions (e.g., India, Russia, Malawi, Cambodia, Zimbabwe, Lesotho, and Swaziland), other bilateral countries are in the early phases of the HIV/AIDS epidemic with the potential for substantial increases in infection rates due to the magnitude of high-risk behavior. Both USAID and HHS/CDC expect to continue prevention programs at on-going levels while introducing other interventions as the situation requires and if program performance merits it.

Evidence: Statistical information on the HIV/AIDS epidemic reported by UNAIDS and WHO. USAID and HHS/CDC both use the WHO and UNAIDS standards and reports as input when establishing their bilateral programs. Data and methodology sources used by the program include: www.epidem.org/publications.htm, specifically, methods and tools for HIV/AIDS estimates and projections; a special supplement of Sexually Transmitted Infections with papers documenting the methods and software used by UNAIDS to produce HIV estimates for the Report on the Global AIDS Epidemic 2004, published July 2004; sti.bmjjournals.com/content/vol80/suppl_1/; and for an explanation of the methodology used to determine HIV/AIDS estimates, www.unaids.org/Unaids/EN/Resources/Epidemiology/How+do+UNAIDS_WHO+arrive+at+estimates/Epi_Methods.asp

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: An overarching objective of the Emergency Plan is to create a single, coordinated USG response to global HIV/AIDS. All countries receiving USG bilateral resources for HIV/AIDS, regardless of program size or funding account resources, are expected to follow the policies of the Emergency Plan as outlined in the U.S. Five-year Global HIV/AIDS Strategy as well as in associated policy documents. Coordinated and collaborative programming of HIV/AIDS activities across USG agencies and departments is an essential standard of practice. Notably, HHS and USAID have established an HIV/AIDS Monitoring and Evaluation Field Corps to build capacity in surveillance and in monitoring and evaluation (M&E) as well as to assist in establishing and implementing standardized program management, evaluation and reporting on major HIV/AIDS programs. The USG is clearly committed to implementing the principles of the "Three Ones" (one agreed national strategy; one national AIDS coordinating authority; one agreed country-level monitoring and evaluation system). The "Three Ones" recognize the urgent need for greater collaborations in HIV impacted countries to avoid duplication and fragmentation of resources. In purpose, there are many domestic and international duplications of HIV/AIDS programs, however, in practice the USG is working both internally and externally to eliminate redundant efforts.

Evidence: The U.S. Five-Year Global HIV/AIDS Strategy contains the following statement highlighting the non-duplicative design of USG HIV/AIDS programs: "The Office of the U.S. Global AIDS Coordinator will lead an integrated USG global HIV/AIDS effort; provide a rallying point for private sector, faith based organizations (FBO), and non-governmental organizations (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 USG global AIDS response."

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: One strength of the Emergency Plan is the decision to build programs on existing operations, structures and relationships in the implementing agencies, both in headquarters (HQs) and in the field. Moreover, USAID and HHS are working together to better understand each other's administrative processes and to make necessary and feasible changes both at HQs and in the field so that the agencies are better able to work as one USG team and are a model of coordination and synergy. Within HHS, relevant agencies and offices (e.g., CDC, the Health Resources and Services Administration (HRSA) and the Office of Global Health Affairs (OGHA)) meet regularly across operating divisions to improve the efficiency of human resources, budgets and acquisitions.

Evidence: Evidence includes the annual report to Congress, agency budget justifications and planning documents, and the web sites of the Coordinator and implementing agencies.

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: Through OGAC, the Emergency Plan has provided program and policy guidance to all USG HIV/AIDS programs urging them to adopt integrated interagency strategies wherever USG resources are used. In addition, Country and Assistance Checklists are completed to ensure that USG assistance is targeted at eligible countries and organizations. Moreover, USAID and HHS prevention programs are specifically designed in-country in coordination with the host government and are generally targeted at high-risk populations. Most studies on the cost-effectiveness of HIV prevention emphasize the superior efficiency of targeting high-risk groups over non-targeted interventions. Finally, in middle-income countries-which typically have the institutional capacity (if not the policies) for sustained progress-USAID and HHS/CDC make a more concerted effort to phase out development resources and promote graduation in developmental terms, while encouraging a greater role for private flows and nongovernmental actors through the Global Development Alliance freeing resources for more resource constrained beneficiaries.

Evidence: Adoption of the OGAC leadership model creates interagency teams under embassy management leadership, developing integrated strategies with specific and accountable goals, and fostering the development of sustainable health care networks.

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: The program has adopted a set of standardized measures to be used beginning in the FY06 reporting cycle across agencies and countries in all bilateral programs receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. The measures are program level indicators and service delivery indicators that allow countries to set targets and report results on an annual basis in the areas such as PMTCT, counseling and testing, laboratory infrastructure, strategic information and training. The 5 countries receiving $10 million or more in U.S.G. HIV/AIDS FY05 funding report on a subset of the focus country indicators, but all indicators are standardized. Beginning with the FY06 reporting cycle 11 bilateral countries are required to set long-term goals in a five-year country strategy, under the direction and approval of OGAC. Those goals will be available by the end of February 2006.

Evidence: Evidence includes the following documents: "The President's Emergency Plan for AIDS Relief: Minimum Indicator Reporting for Designated Countries with Other Bilateral HIV/AIDS Programs, Guidance for FY 2006 Reporting", August, 2005, "The President's Emergency Plan for AIDS Relief General Policy Guidance for All Bilateral Programs", Office of the U.S. Global AIDS Coordinator, October 2005.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: The set of indicators standardized across the other bilateral countries receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05 were finalized in August 2005. 11 countries will set long-term and annual targets in a five-year strategy to be submitted by February 2006. The remaining countries receiving $1 million or more in FY05 U.S.G. HIV/AIDS funding will continue to set targets according to their implementing agency standard, with OGAC guidance. Reporting on the standardized indicators will begin in the FY2006 reporting cycle.

Evidence: Refer to evidence in Answer 2.1.

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: The program has adopted a set of standardized measures to be used beginning in the FY06 reporting cycle across agencies and countries in all bilateral programs receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. The measures are program level indicators and service delivery indicators that allow countries to set targets and report results on an annual basis in the areas such as PMTCT, counseling and testing, laboratory infrastructure, strategic information and training. The 5 countries receiving $10 million or more in U.S.G. HIV/AIDS FY05 funding report on a subset of the focus country indicators, but all indicators are standardized. Beginning with the FY06 reporting cycle 11 bilateral countries are required to set long-term goals in a five-year country strategy, under the direction and approval of OGAC. Those goals will be available by the end of February 2006. Annual goals will be set under Emergency Plan guidance for the first time in FY2006.

Evidence: Refer to evidence in Answer 2.1.

Does the program have baselines and ambitious targets for its annual measures?

Explanation: The program is working to establish baselines and targets for new annual measures.

Evidence: Refer to evidence in Answer 2.1.

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: The program works with governmental and nongovernmental partners to achieve goals. These partners commit to the goals through contracts, cooperative agreements and grants to fund research and non-research activities. The program also monitors partner contributions to goals through program reviews and research consultations to determine progress and regular meetings with contractors, cooperative agreement recipients, grantees and other government partners. For example, HHS awards to these partners includes language specifying that funded activities will align with the program's performance goals and includes guidance on measures that are specific, measurable, ambitious and relevant. The Coordinator meets regularly with Ambassadors and other government officials from countries with bilateral HIV/AIDS programs.

Evidence: Evidence includes partner guidance for annual reports and evaluation criteria for grants, annual reports, the HHS/CDC planning and reporting system, sample of USAID's Strategic Objective Agreements, and sample requests for proposals. HHS maintains an on-line reporting system with country-specific data that reflects progress of each country's program activities annually. USAID uses Strategic Objective Agreements with host governments that specify shared goals with counterpart ministries.

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: Evaluations of portions of the program have been completed by various agencies and outside auditors. However, together they do not meet the criteria for being comprehensive in scope or in some cases not enough information has been assessed to fill gaps in performance information. Also, no comprehensive evaluations are planned at this time. GAO conducted a review in 2001 of USAID's other bilateral programs in Africa, a review of the joint UNAIDS program which is funded in part through the other bilateral activity and a review of global disease surveillance that notes HHS/CDC and USAID roles. A GAO review of the Emergency Plan describes additional contributions of the other bilateral programs, including HHS's CDC, NIH, HRSA and USAID. The report also highlights the difficulties of coordinating the Emergency Plan due to the different approaches of the implementing agencies that were established prior to the Emergency Plan. The IG for USAID has conducted evaluations on HIV/AIDS prevention programs in six countries.

Evidence: Evidence of related efforts includes GAO-01-449, GAO-01-625, GAO-01-722, GAO/T-NSIAD-00-99, the National Academy of Sciences Institute of Medicine (IOM) entitled "Scaling up treatment for the global AIDS pandemic: Challenges and opportunities", HHS' multiple independent evaluations of the global AIDS working environment and publications in peer-reviewed scientific journals, reports of USAID related activities conducted by the Population Council, six IG audits of USAID HIV/AIDS prevention programs, and research in Epidemiology and Social Science, AIDS Care and the British Medical Journal. The 2004 report from IOM laid out challenges and objectives for ramping up the Emergency Plan in the focus countries, but did not evaluate the other bilateral programs.

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: The budget submissions for HHS and USAID have typically provided a high level of detail and analysis, including outputs tables and descriptions of main activities. However, the other bilateral program does not yet have an integrated budget and performance presentation that meets the criteria set out in the guidance. The program will for the first time in FY06 have a core set of performance indicators shared by HHS/CDC and USAID that can be used by each country program above a certain funding level. The establishment of these performance measures will further enable the program to tie budget requests to the achievement of specific annual and long-term performance goals. The internal interagency Emergency Plan strategic planning process requires country budget requests to tie explicitly to the strategic performance planning process. This process can also help the program show the impact of resources on expected performance.

Evidence: Evidence includes the FY 2006 Congressional Budget Justifications from the implementing agencies and information on the strategic planning process.

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: The program is undergoing significant and meaningful changes in strategic planning and is addressing the deficiencies highlighted in this section. The program is building on an established record of performance measures by the implementing agencies to establish long-term measures, targets and timeframes and annual performance measures, baselines and targets that cut across both agencies and address all of the other bilateral country activities. The program, including the two implementing agencies, has made progress in tying budget requests to the accomplishment of the annual and long-term performance goals and is considering a more integrated display that addresses resources and expected performance across the implementing agencies.

Evidence: Evidence includes the FY 2005 and FY 2006 Congressional Budget Justifications, the activities and efforts of a performance measure workgroup established by the Coordinator to reach agreement on common performance measures.

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: The program's implementing departments and agencies (USAID, HHS, the Deptartments of Defense, State and Labor and the Peace Corps) all regularly collect high-quality performance data annually through reviews of continuation applications and progress reports. This data is used by the program and its partners to improve the programs', and grantees', performance. Program partners are responsible for achieving the target levels of the program goals, objectives and performance measures established in their funded applications. If they fail to achieve their targets, the USG works with the grantee to identify barriers that are preventing the grantee from achieving its established goals.

Evidence: 1) The President's Emergency Plan for AIDS Relief. U.S. Five-Year Global HIV/AIDS Strategy, Chapter 9, February 2004. 2) HHS/CDC Monitoring the Global AIDS Program Indicator Guide for Annual Reporting 2004, Version 3. 3) HHS/CDC - Brazil Cooperative Agreement Progress Report 4) USAID ADS 202.3.6 Monitoring Quality and Timeliness of Key Outputs, 3/19/2004 5) USAID ADS 303 - Grants and Cooperative Agreements to Non-Governmental Organizations, 7/23/2002, page 45. 6) 8 HHS/CDC/GAP Brazil Country Assistance Plan for FY04-FY05, September 2003. 7) USAID/ Ghana: Health Status Improved: Performance Management Plan, September 2004.

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: Senior Executive Service (SES) and other senior program managers for the program have performance-based work plans. As noted in Section I, program design is strong in the reliance on existing structures and implementing agencies. Appropriations for the other bilateral program are provided through multiple accounts. This arrangement requires additional efforts to coordinate oversight of performance and financial data that will require continued effort. The program is working to establish clearly defined and quantifiable performance standards for the majority of program managers within the State Department, HHS and USAID. The program establishes performance standards for partners, including grantees and country level teams. Project officers receive annual reports documenting progress that could be the basis for not extending additional funding due to poor performance. Program staff review country spending trends and, where indicated, request additional justification or reallocate funds. Past performance is a criterion in the awards from both implementing agencies.

Evidence: Evidence includes copies of workplans for SES and senior managers, technical reviews, grant program announcements, and administration manuals. For the next General Service (GS)/Foreign Service (FS) rating period, HHS and USAID will update these work plans so that they are performance based and tie directly to relevant staff roles and responsibilities.

Are funds (Federal and partners') obligated in a timely manner and spent for the intended purpose?

Explanation: The program obligates funds in a timely manner and for the intended purpose. Funds are largely obligated according to planned schedules with a limited amount of program funds remaining at the end of the year. The funding plans at the headquarters level emphasize rapid distribution of funds to the field. In the field, country programs may obligate funds more slowly depending on the maturity and position of the country program.

Evidence: Evidence includes The Emergency Plan for AIDS Relief Summary of Allocations and Obligations as of June 30, 2004, and well as the Emergency Plan Summary Financial Status reports (by agency and account) as of September 30, 2004. Additional evidence includes the USAID Flash Report Sample of Estimated Available Funds and Current Program As of September 30, 2003 and HHS/CDC Financial Status Report, March 2005.

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: The program has an approved efficiency measure with baselines and targets that would allow it to measure its progress in achieving efficiencies and cost effectiveness in the program's operations. The program, and its implementing agencies, are also in the process of adopting new grant management systems and have been consolidating information technology (IT) infrastructure services that they predict will enable implementing agencies to process data and grant information more quickly and efficiently.

Evidence: The approved efficiency measure is the ratio of management and staffing (operational) costs to total program costs in countries receiving $1 million or more in U.S.G FY05 HIV/AIDS funding. Evidence also includes documents provided by the program for grants management and IT improvements.

Does the program collaborate and coordinate effectively with related programs?

Explanation: All three components of the Emergency Plan, including the other bilateral countries, are implemented under the leadership of the U.S. Global AIDS Coordinator (GAC) who is authorized to provide leadership and coordination for all USG agencies and departments working on international HIV/AIDS. The program also coordinates with other donors on the ground, including the WHO, UNAIDS and the World Bank. In April 2004, the USG, UNAIDS, WHO, the World Bank and the United Kingdom co-hosted a high-level meeting at which key donors endorsed the "Three Ones" principles, to achieve the most effective and efficient use of resources and to ensure rapid action and results-based management. The "Three Ones" facilitate complementary and efficient action in support of host nation HIV/AIDS policy and program implementation. The "Three Ones" will help improve the ability of donors and developing countries to work more effectively together, on a country-by-country basis.

Evidence: USG agencies, under the direction of the OGAC, work in close collaboration with the Global Fund, country governments, universities, and non-governmental organizations (including FBOs and CBOs). As an example of this collaboration, HHS/CDC India regularly participates in technical review meetings and panels related to India's Global Fund proposals and activities. Another example of USG collaboration with other international partners: HHS/CDC, in close collaboration with the World Health Organization, developed the Prevention of Mother-to-Child Transmission (PMTCT) Generic Training Package. Recognizing that building human capacity requires collaboration at multiple levels and across organizations, the curriculum is designed to support the scale up of PMTCT services and assist in unifying and strengthening existing PMTCT training efforts.

Does the program use strong financial management practices?

Explanation: The program has mechanisms for financial accountability and control, but does not yet meet the standards of this question for strong financial management practices. As is described further below, HHS/CDC has implemented a new financial management system that is designed to eliminate previously identified weaknesses in the legacy system. USAID is also working to adopt a new financial management system in all overseas missions and headquarters. When all systems are in place and evidence is available that the new systems have strengthened financial management for the agencies and are resolving previously identified weaknesses the response to this question will be yes.

Evidence: Evidence includes prior year performance and accountability reports, financial management reports and financial management procedures.

Has the program taken meaningful steps to address its management deficiencies?

Explanation: The program has taken several steps to address its program management deficiencies, one of which was to create a new office within OGAC, the Office of Program Management Systems, that will focus on addressing these types of issues across all countries. Also, HHS/CDC has plans to develop standard financial management procedures that can be used by each of its four regional and 25 country field offices. USAID also has plans to expand the financial system that the agency currently uses in Washington and Latin America, to cover its bilateral work in the other bilateral Emergency Plan countries.

Evidence: Evidence includes internal planning documents and implementation plans for the financial management systems. HHS's financial management guide will address budget management, travel approvals and vouchers, grants management, ICASS and securing of assets.

Are grants awarded based on a clear competitive process that includes a qualified assessment of merit?

Explanation: Both USAID and HHS have a competitive process in place that includes the development of a program announcement, receipt of applications, programmatic and objective review of applications, funding of grants and cooperative agreements, and briefly, post-award administration of grants and cooperative agreements. Grants are largely awarded according to a competitive process based on merit. The program uses independent review and ranking of applicants to make award decisions.

Evidence: Both HHS and USAID announce competition for global AIDS funds by placing program announcements in the Federal Register: (www.gpoaccess.gov/fr/index.html) and the Catalogue of Federal Domestic Programs: (www.cfda.gov/public/faprs.html).

Does the program have oversight practices that provide sufficient knowledge of grantee activities?

Explanation: The program, in general, has an understanding of how its funds are utilized by grantees. The program tracks progress through required reports, site visits and audits. The program is beginning to monitor the largest country programs more closely. The program described a process whereby program managers track expenditures regularly as part of their responsibilities and conduct field visits to ensure that funding is being used for its intended purposes. Field audits also focus on whether funding was used for its intended purposes.

Evidence: Evidence includes the USAID Performance and Accountability Report, FY 2004, pages 1-49, the Progress Report on the University of North Carolina at Chapel Hill - CDC/GAP Activities June - December 2004, and the USAID ADS 303 - Grants and Cooperative Agreements to Non-Governmental Organizations, 7/23/2002, page 4.

Does the program collect grantee performance data on an annual basis and make it available to the public in a transparent and meaningful manner?

Explanation: The program makes country level data on services provided and on the HIV/AIDS burden available to the public via the internet as well as in annual reports to Congress. HHS and USAID do not publish grantee specific data. In addition, health data is often only available to collect every two to five years in the majority of the countries the USG has HIV/AIDS programs. Due to the data collection limitations of the international setting, there may be a lag between real time and information available to the public. In light of these difficulties, the program's ability to make country specific performance data available to the public is deemed acceptable to receive a yes to this question.

Evidence: Evidence includes the annual report to Congress and the web sites of the Coordinator and implementing agencies.

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: Historically both USAID and HHS/CDC have had performance measures for HIV/AIDS programs in the other bilateral countries. However, the measures were not consistent across agencies and countries and did not, in all cases, include baseline and target information allowing for the analysis of achievement. The program has adopted a set of standardized measures to be used beginning in the FY06 reporting cycle across agencies and countries in all bilateral programs receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. Annual results data for FY05 from USAID and HHS/CDC on the standard indicators provided in the measures tab will be provided to OMB in January 2006.

Evidence: Evidence includes the following documents: "The President's Emergency Plan for AIDS Relief: Minimum Indicator Reporting for Designated Countries with Other Bilateral HIV/AIDS Programs, Guidance for FY 2006 Reporting", August, 2005, "The President's Emergency Plan for AIDS Relief General Policy Guidance for All Bilateral Programs", Office of the U.S. Global AIDS Coordinator, October 2005.

Does the program (including program partners) achieve its annual performance goals?

Explanation: Historically both USAID and HHS/CDC have developed performance measures for HIV/AIDS programs in the other bilateral countries. However, the measures were not consistent across agencies and countries and did not, in all cases, include baseline and target information allowing for the analysis of achievement. The program has adopted a set of standardized measures to be used beginning in the FY06 reporting cycle across agencies and countries in all bilateral programs receiving $1 million or more in U.S.G. HIV/AIDS funding in FY05. Annual results data for FY05 from USAID and HHS/CDC on the standard indicators provided in the measures tab will be provided to OMB in January 2006.

Evidence: Evidence includes the following documents: "The President's Emergency Plan for AIDS Relief: Minimum Indicator Reporting for Designated Countries with Other Bilateral HIV/AIDS Programs, Guidance for FY 2006 Reporting", August, 2005, "The President's Emergency Plan for AIDS Relief General Policy Guidance for All Bilateral Programs", Office of the U.S. Global AIDS Coordinator, October 2005.

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: The program has adopted an efficiency measure in 2005 and has set baselines and targets. 2006 will be the baseline year and targets are set for 2007 and 2008. The program receives a small extent because it has the approved measure in place but has not yet reported on it. Overall, as is noted in the evidence, the program has controlled administrative expenses and the implementing agencies have achieved other savings in execution.

Evidence: HHS and USAID have largely maintained their headquarter costs at FY 2004 levels despite the dramatic increase of program dollars in the focus countries. Cost effectiveness studies from the program indicate the cost effectiveness of supported interventions in the field. HHS/CDC consolidated all 13 IT infrastructure services, with reduced operating costs of 21 percent and redeployment of 18 percent of staff to mission direct duties into the Information Technology Services Office in December 2003. HHS/CDC consolidated over 40 hotlines to one, which it projects will expand services and save about $35 million over seven years. USAID saved five staff positions and $60,000 in other costs in the Caribbean and a staff position in Central America by consolidating accounting functions.

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: A large extent is given because, while technically feasible, there are no available evaluations that allow a comparison of programs with similar purpose and goals. There is, however, evidence indicating the program has performed well in meeting the program purpose for this type of activity. The other bilateral country programs are the foundation for the Emergency Plan. While varying approaches by HHS/CDC and USAID presented initial challenges (see for example GAO-04-784), the strength of these programs enabled the Emergency Plan to scale-up rapidly in key areas using existing mechanisms, grant structures and relationships already established on the ground. GAO noted that HHS/CDC is the single greatest source of technical expertise and resources for international disease surveillance (GAO-01-722). With the field presence and flexible programming, the program has been cited by others for its ability to respond quickly and for its leadership of country program coordination with other donors.

Evidence: Examples include GAO documentation that program efforts have helped slow the spread of the disease and have made important contributions to the fight against the epidemic (GAO/T-NSIAD-00-99). In 2001, the Government of Honduras credited USAID for its leadership role among the donors. HHS/CDC has provided strong guiding leadership to the Chinese Minister of Health while collaborating with the Global Fund through the Chinese Government's CHINA Comprehensive AIDS Response System and assisted with the application process, implementation plans, and set up of CHINA CARES. In terms of successful expansion, there are ten other bilateral countries in Africa, Asia, and the Caribbean that have launched USG financed treatment programs since the beginning of the Emergency Plan. More than 135 service outlets in these countries are providing treatment where none previously existed.

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: A small extent is given because there has not yet been conducted an independent evaluation of sufficient scope that could provide information as to the overall effectiveness or impact of the Emergency Plan's other bilateral country programs. However, the USAID Inspector General's Office has, in the past, evaluated the program's performance within specific countries (Uganda, Guinea, Zambia, The Democratic Republic of Congo and India) and has documented the program's progress in achieving many, if not all, of its countries' specific performance objectives. While these audits do not provide up-to-date information on the overall effectiveness of the other bilateral country programs, they do demonstrate that progress was being achieved prior to their adoption into the Emergency Plan.

Evidence: The GAO documented that USAID efforts have helped slow the spread of the disease and have made important contributions to the fight against the epidemic. An example of a recent evaluation, conducted by the Population Council, is the September 2002 final evaluation of Nicaragua's Child Survival project, which confirmed that program goals have been achieved. The USAID Office of the Inspector General Reports: Audits of USAID/Zambia, Uganda, Guinea, Democratic Republic of Congo and India on the Monitoring and Reporting of Health Programs in these nations.