PEPFAR’s Approach to Maximize
Efficiency, Effectiveness and Impact
Nalinee Sangrujee, PhD MPH
PEPFAR
20 April 2012
PEPFAR Smart Investments to Increase
Impact and Efficiency
1.
2.
3.
4.
5.
6.
7.
Strengthen use of economic and financial data to ensure
efficient use of resources
Incorporate innovations that promote efficiency and allocate
resources based on impact
Increase collaboration with governments, the Global Fund and
others to align programs and target investments
Reduce costs by streamlining USG operations and supporting
increased country ownership
Achieve best all-inclusive commodity pricing
Leverage creative mechanisms for healthcare finance to bring
additional resources to bear
Develop and evaluation research agenda that will show how to
improve efficiency and impact
Source: http://www.pepfar.gov/smart/index.htm
PEPFAR Finance and Economics Work Group
Using Cost Data to Increase Efficiency
PEPFAR is adapting to achieve more with
finite resources
 Need timely financial monitoring
data
 Identify efficient models of service
delivery that maximize value
PEPFAR programs typically had limited
program area-specific financial
data/indicators at their disposal for
decision-making
“PEPFAR is …identifying and implementing
efficiencies in its work”
PEPFAR Finance and Economics Work Group
PEPFAR Expenditure Analysis Initiative


Provide timely cost data and build capacity of USG teams to use
cost data for improved management and efficient operation of
programs
Understanding the full cost to support
Match achievements and actual
National HIV/AIDS Programs
expenditures to estimate USG
expenditure per beneficiary
 Country USG –level: inform program
planning (COP, GF rounds, MOH budgeting
cycle, identify efficiencies etc.)
 PEPFAR HQ-level: inform global
budgeting
 National – level: contribute to national
expenditure processes

National
Government
Expenditures
PEPFAR
Expenditures
Other External
Partner
Expenditures
Work with other stakeholders to ensure integration and use of
PEPFAR data in broader national cost analysis efforts
PEPFAR Finance and Economics Work Group
What is PEPFAR Expenditure Analysis?



Routine financial monitoring of PEPFAR programs
Provides annual data on expenditures by program area and cost
category
Not a panacea: Puts the “M” in financial M&E and highlights the
need for “E”
ART
PMTCT VMMC
……………
Investment
Site-level
Recurrent
Program Management
Above
Sitelevel
Monitoring and Evaluation
Health System Strengthening
Total PEPFAR Expenditures for Fiscal Year
PEPFAR Finance and Economics Work Group
Use of Expenditure Analysis Results for
Partner Management to Improve Efficiency
Goal to ensure IPs that are providing similar services/support are adopting
best practices and using PEPFAR resources optimally
Step 1: Identify outliers
Step 2: In–depth
analysis to identify
cost drivers
Step 3: Agreement to
lower UE by $X in
coming year by
decreasing
expenditures or
increasing targets
PEPFAR Finance and Economics Work Group
Trend Analysis
PEPFAR Finance and Economics Work Group
Evidence-Based Approach
to Increase Effectiveness



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Recent PEPFAR COP Guidance to focus on uptake of core
interventions
“E” dependent on good outcomes/output measures
PEPFAR is exploiting more
of its data to more effectively
allocate resources
PEPFAR continues to
support studies to evaluate
programs including multicountry randomized
community trial on
combination prevention
PEPFAR Finance and Economics Work Group
Use of Expenditure Analysis Data
to Inform Effective Programming
PEPFAR Finance and Economics Work Group
Leveraging PEPFAR’s Resources


Optimal use of PEPFAR resources to maximize the reach,
quality and impact of global HIV programs
 Strategic coordination of donors
 Crowding-in of internal and other external resources
 Recognizes that HIV programs may achieve greater scale
and reach with contributions from other sources
Partnership Frameworks is PEPFAR’s move towards a dialogue
of partnership including the development of strong financing
frameworks
 Promote national ownership
 Feasible, affordable, transparent, and sustainable
 Efficient and smart
 Easily implemented and monitored
PEPFAR Finance and Economics Work Group
Scale-Up of ART Access and Declining
PEPFAR Per-Patient Costs, 2004-2009
Note: Per-patient budget allocation is estimated as treatment allocation divided by lagged endof-reporting direct patients.
PEPFAR Finance and Economics Work Group
PEPFAR Continues to Develop Measures of
Efficiency and Effectiveness
Our ability to improve efficiency and effectiveness is correlated with
our ability to define and link interventions to measurable outputs
Number of Economic Studies
Treatment
PMTCT
Counseling
and Testing
OVC
Behavior Change
and
Communication
Health System
Strengthening
Clear service
delivery models
No standard
intervention models
PEPFAR Finance and Economics Work Group
THANK YOU!
Acknowledgements:
PEPFAR country teams and Implementing Partners for
participation in Expenditure Analysis Pilots
PEPFAR Finance and Economics Work Group
For additional information:
www.PEPFAR.gov