Fostering PEPFAR Sustainability through Leadership, Management, and Governance

By: Monica Biradavolu, Anupa Deshpande, Meghan Guida, and Megan Kearns

When it was launched in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) emphasized rapid implementation and scale-up to combat the global HIV epidemic. At that time there was limited direct mention of sustainability, as the focus was on addressing the immediate crisis situation. When PEPFAR was reauthorized in 2008, PEPFAR 2.0 specifically included activities intended to contribute to a more sustainable HIV response in and by partner countries. Therefore, beginning in 2009, PEPFAR’s focus shifted from an emergency response intended to slow the pace of the HIV epidemic to one that focused on developing a sustainable response that focused on building “collaborative planning and health systems strengthening activities with partner governments.”
The Office of HIV/AIDS (OHA) in the U.S. Agency for International Development (USAID) asked the Leadership, Management and Governance (LMG) Project to investigate how country-level stakeholders applied leadership, management and governance (L+M+G) practices to support national capacity to lead, implement, manage, monitor, and fund scaled-up HIV and AIDS interventions that successfully and seamlessly transitioned from PEPFAR support and continued to improve health outcomes. As part of this overall effort, the LMG Project conducted a literature review to identify a set of promising L+M+G practices to help advance the sustainability agenda.
The purpose of this literature review is twofold: (a) to understand how a L+M+G lens can be applied across the four domains of PEPFAR’s Sustainability Framework;1 and (b) to identify examples of L+M+G practices in the transition from donor-dependent to country-owned, sustainable national HIV programs.
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