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Home » Technical Note on PEPFAR's Reporting Methodology

-- FY 2009 PEPFAR Results
-- Detailed PEPFAR Program Results through FY 2008

Technical Note: Transitioning PEPFAR's reporting methodology to focus on its role in supporting national programs, and FY 2009 'transition year' direct and indirect treatment results by country

Summary: The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) is moving to a new approach that monitors and reports on partner countries' national achievements in terms of people receiving services and health systems indicators, as well as improved measures of PEPFAR's direct contributions to those same service delivery and systems achievements. In terms of health systems, PEPFAR is working with technical experts, as well as country and international counterparts, to identify, develop, and harmonize new indicators (such as number of laboratories or health workers, or functionality of national health information systems). Fiscal Year (FY) 2009 is a transition year, and from FY 2010 onward, PEPFAR will report on these national service delivery and system strengthening results in addition to direct USG-supported results.

This approach will be applied across the range of prevention, treatment, and care programs. As one example of an existing service delivery indicator, PEPFAR directly supported 2,329,400 individuals on antiretroviral treatment in the former focus countries as of 9/30/09; outside those countries, PEPFAR provided direct support for 155,900 additional people on treatment. The total directly supported number of people on treatment was thus over 2.4 million (2,485,300). Direct results for the prevention and care service areas are provided in the accompanying Fact Sheet, with additional information to follow in the Annual Report in January 2010.

Background.

As PEPFAR enters its next phase, it is streamlining reporting to emphasize support for country ownership and sustained national responses. PEPFAR is thus moving from the use of direct/indirect results to a direct/national methodology. This shift will more accurately document PEPFAR's support for partner government efforts to combat HIV, and strengthen partner government work to sustainably achieve national targets.

The direct/indirect approach was useful in the early emergency phase of the program, as it allowed PEPFAR country teams to report on program progress while programs were rapidly expanding. During this phase, PEPFAR monitoring and evaluation systems were constantly adapting to the increasing number and type of service delivery sites, and PEPFAR reported against indicators capable of reflecting short-term returns and program inputs. This was also a suitable approach in countries with limited capacity for data collection and reporting.

While PEPFAR's direct results have captured program outputs based upon counts at service delivery points, indirect results have been harder to quantify. USG country teams negotiated indirect result counts with partner governments, identifying the proportion of those supported nationally that should be attributed to USG support for national health systems strengthening and capacity-building. Because of the challenges faced in negotiating indirect results with partner governments, particularly where USG investments where a relatively small share of total country programs, for FY 2007 and 2008 PEPFAR limited this reporting to the original 15 focus countries, where investments were concentrated.

Improvements to methodology. In 2009, PEPFAR released its Next Generation Indicators (NGI), which refine data collection around quality and coverage of service delivery and around data regarding PEPFAR's support for capacity-building, policy development, and systems strengthening. The NGI also advance PEPFAR's progress in support of the UNAIDS Monitoring and Evaluation Reference Group (MERG) goal to harmonize indicators across governments and donors alike.

The NGI continue the collection of direct service delivery data, and will replace indirect reporting with a national focus that more appropriately captures PEPFAR activities in support of national programs. PEPFAR also will collect nationally reported data for select indicators to monitor country accomplishments relative to technical assistance, training, infrastructure improvements, and other types of system strengthening. The shift from indirect to national represents a more accurate portrayal of the breadth of PEPFAR work. It is also consistent with PEPFAR and larger multilateral objectives to support country ownership and health system sustainability. PEPFAR will continue to work with experts, as well as country and international counterparts, to harmonize these new measures.

FY 2009 indirect results by country. As noted, FY 2009 was a transition year in which countries submitted indirect counts for the last time. The number of people receiving indirect treatment support reported by the 15 original focus country programs was approximately 539,700. Of these, the vast majority (approximately 404,400) are in 2 countries, South Africa and Botswana, which have large government-led treatment programs. Data reflecting indirect support to care and prevention will be presented in the Annual Report in January 2010.

Notes:  All numbers greater than 100 have been rounded off to the nearest 100.

Botswana results are attributed to the National HIV Program. Beginning in FY2005, USG direct  contribution in Botswana are embedded in the indirect numbers, following a consensus reached between the USG and the Government of Botswana to report single indirect figures for each relevant indicator.

Results of USG Global Fund Contributions

There are currently 4 million individuals in low and middle-income countries who receive antiretroviral treatment for HIV/AIDS. Of this number, nearly 3.7 million are supported by PEPFAR, the Global Fund, or both. The Fund has reported that 2.5 million people worldwide are supported on treatment through the Fund. Approximately 1.3 million people are among both the over 2.4 million receiving direct treatment support through PEPFAR bilateral programs and the 2.5 million receiving support through the Fund, and thus are counted in the totals for each organization. These numbers reflect the strong country-level partnership between PEPFAR and the Fund.

The USG remains the largest contributor to the Global Fund. Through its investments in this multilateral mechanism, the USG supports services in more than 140 countries, impacting the 1.2 million people who receive treatment support through the Fund and not through PEPFAR. The American people have provided approximately 28 percent of all Fund resources to date, and thus have contributed significantly to all the results achieved through the Fund.

As the USG intensifies its collaboration with the Global Fund during the second phase of PEPFAR, the USG will work with the Fund to further refine attribution methodologies.