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CARE's Experience with PEPFAR: Achievements, Challenges, and Recommendations

This article discusses CARE's experiences with the President's Emergency Plan for AIDS Relief (PEPFAR). It highlights achievements, challenges, and provides recommendations for improving PEPFAR-funded programs. The article draws on CARE's extensive HIV/AIDS capacity and experience, highlighting successful models, building local capacity, and integrating a multi-sectoral perspective. It also explores challenges related to sustainability, forging strong partnerships, and balancing quantity with quality.

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CARE's Experience with PEPFAR: Achievements, Challenges, and Recommendations

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  1. CARE’s experience with the President’s Emergency Plan For AIDS Relief (PEPFAR) Madhu Deshmukh Director, HIV/AIDS Unit CARE

  2. CARE’s experiences with PEPFAR • Issues raised are a result of multiple conversations with CARE Country offices as they roll out PEPFAR funded activities • Issues are raised from practical experiences and need to be further explored and validated

  3. CARE’s HIV/AIDS Capacity and Experience • CARE implements more than 120 HIV/AIDS projects in 39 countries around the world • CARE’s HIV/AIDS objectives: • reduce the number of new infections • mitigate the impact of HIV/AIDS on economic development • increase access to high-quality care and support for affected families • CARE programs are comprehensive and multisectoral, working with at-risk groups

  4. CARE’s HIV/AIDS Experience, cont’d • CARE works with governments as well as civil society including CBOs and FBOs • CARE’s HIV/AIDS responses include Hope for African Children Initiative (HACI), the CORE Initiative and the CARE-CDC Health Initiative (CCHI) in addition to the projects at the country level • CARE’s HIV/AIDS programs receive funding from a wide variety of sources

  5. CARE’s Involvement With PEPFAR • CARE is currently implementing PEPFAR-funded programs totaling an investment of approximately $40 million • CARE has completed PEPFAR-funded programs totaling an investment of $8.6 million • CARE has a number of PEPFAR-funded programs that are about to begin and has submitted proposals for PEPFAR-funded projects in Africa, Asia and the Caribbean

  6. Involvement With PEPFAR, cont’d • CARE’s PEPFAR-funded programs work with a variety of affected groups including OVC • These programs promote positive changes in individuals, organizations and society

  7. Achievements Under PEPFAR • PEPFAR is an unprecedented investment and commitment by the US government. • PEPFAR has: • a sense of urgency • made HIV/AIDS a less taboo subject • enabled successful efforts to be scaled up • enhanced coordination • sharpened the focus on treatment

  8. CARE’s Achievements Under PEPFAR • Scaling up successful models • The Nkundabana Approach in Rwanda • Community-based care for child-headed households • Mobilizing and training of mentors • Children’s participation is key

  9. CARE’s Achievements Under PEPFAR • Building local capacity • The CORE Initiative – Uganda • Improving government capacity (i.e. Ministry of Gender, Labor and Social Development) • Improving local organizations’ capacity

  10. CARE’s Achievements Under PEPFAR • Integrating a multi-sectoral perspective into HIV/AIDS efforts • Local Links (Kenya and South Africa) • Enhanced income for families • Strengthen the capacity of local organizations • Reduce stigma and discrimination • Kenya: work in 13 villages, with 13 civil society organizations, and train 415 caregivers

  11. Challenges Under PEPFAR • The “emergency mindset” sometimes sacrifices sustainability. • Example of Rwanda: Building sustainable community capacity and responses takes time and resources. • The short RFA process is not conducive to forging strong partnerships and assembling a high-quality team.

  12. Challenges Under PEPFAR, cont’d • Pressure to “show big numbers rapidly” creates incentives for pursuing quantity over quality. • Example of building local capacity: Capacity cannot be equated with the dollar amount of sub-grants made to local organizations • Strengthening existing capacities of local organizations takes time, commitment, resources and technical review process

  13. Struggles Under PEPFAR, cont’d • Funds tend to be focused too narrowly • The focus on treatment is welcome and needed, but it sometimes comes at the expense of prevention, care and support. • An apparent focus on A and B over C • Programs that target non-OVC groups are not as comprehensive.

  14. Recommendations • Questions for IOM exploration: • What kind of programs and approaches has PEPFAR funded thus far? Do they reach the most vulnerable groups? How sustainable are these efforts? • Do short funding cycles and the pressure to show quick results affect the quality and sustainability of its investments? • Is PEPFAR measuring impact as well as output? How are implementing agencies managing reporting requirements?

  15. Information sources for IOM: • PEPFAR implementers – HQ and field staff • Local NGOs and CBOs – staff at all levels • Groups of people living with HIV/AIDS (PLWHA) • Community and religious leaders

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