Testimony
Ambassador Mark Dybul
House Committee on
Foreign Affairs
April 24, 2007
Mr. Chairman, Ranking Member Ros-Lehtinen, and Members of
the Committee: Thank you for this
opportunity to discuss President Bush’s Emergency Plan for AIDS Relief, or
PEPFAR. We are grateful for this committee’s longstanding, bipartisan support
of our nation’s commitment to fight HIV/AIDS in the developing world.
When the history of global public health is written, the launch of the
President’s Emergency Plan – both its size as the largest international health
initiative in history dedicated to a single disease and its focus on results
with ambitious goals for prevention, treatment and care – will be remembered as
one of the boldest and most important actions – ever.
But PEPFAR is part of a broad and bold development agenda. Not since the Marshall Plan has the world
seen such a massive commitment to international development. President Bush, with strong bipartisan
support, has doubled resources for development overall and with his 2008 budget
request, will have quadrupled them for
In
many ways, this new era is more ambitious than the Marshall Plan. Unlike the rebuilding of
Economic Impact of HIV/AIDS
The HIV/AIDS pandemic is unique in human history – not just
because it is so widespread and debilitating, but because it strikes at the
very heart of the population. Unlike
other epidemics, HIV does not attack the oldest, or the youngest, or the
weakest – it strikes people in the prime of life. This pattern has worsened in recent years. Since the 1990s, the single largest increase
in HIV/AIDS mortality has been among adults aged 20 to 49. In Sub-Saharan Africa, this age group accounted
for only 20 percent of all AIDS deaths from 1985 to 1990, but today it accounts
for nearly 60 percent.
Communities are being hobbled by the disability and loss of
the very segment of the population which is normally the backbone of any
society – consumers and workers at the peak of their productive, reproductive,
and care giving years. In the most
heavily affected areas, communities are losing a whole generation of parents,
teachers, laborers, healthcare workers, peacekeepers, and police.
Parents are dying from HIV/AIDS. Around the world, 14 million children under
age 15 have lost one or both parents to HIV/AIDS. By 2010, that number is expected to exceed 25
million. In sub-Saharan
Educators are dying from HIV/AIDS. Africa is seeing especially high HIV-related
mortality rates among teachers and school administrators; in
In HIV-affected households, the family’s earned income
drops while health costs rise. Extended
families and communities are faced with the financial burden of caring for an
increasing number of children who have been orphaned by AIDS.
Many children who have lost parents to HIV/AIDS are left
entirely on their own. When they drop
out of school to fend for themselves and their siblings they lose the potential
for economic empowerment that an education can provide. Alone and desperate, they often resort to
transactional sex or prostitution just to survive, and risk becoming infected
with HIV themselves.
The pandemic also affects the business sector – budgets are
being strained by rising health care costs, increased absenteeism, a shrinking
workforce, lost expertise, high turnover, and reduced productivity. In 2005 alone, more than three million
workers worldwide were partially or fully unable to work because of HIV-related
illness.
The ramifications for national economies are alarming. Between 1992 and 2004, HIV/AIDS caused 43 of
the most heavily affected countries to lose 0.3 percent per year in employment
growth and 0.5 percent in their annual rate of economic growth.
UNAIDS projects that, by 2020, HIV/AIDS will have caused GDP
to drop by more than 20 percent in the hardest-hit countries. The World Bank recently warned that, while
the global economy is expected to more than double over the next 25 years,
Public Health Implications of HIV/AIDS
HIV/AIDS has serious public health implications. An ever-expanding pool of immune-suppressed
people worldwide can more readily contract and spread disease, including
infectious diseases we cannot yet predict.
Take for example the recent rise in Extensively Drug
Resistant Tuberculosis (XDR-TB) among HIV-infected people. To date, there has been a significant spread
of XDR-TB in sub-Saharan
Security Implications of HIV/AIDS
HIV/AIDS is a threat to national and international security. It is limiting nations’ abilities to protect
their own citizens and to provide peacekeepers for other conflicts, fueling
national and regional instability, because it is taking a high toll on
militaries: HIV-related deaths have reduced the size of
By destroying the social fabric caused and leaving a
generation of orphans HIV/AIDS is creating a long term breeding ground for
radicalism. General Wald, the former Deputy Commander, Headquarters U.S.
European Command, has called HIV/AIDS the third greatest threat to our national
security, behind only weapons of mass destruction and terrorism.
PEPFAR and the Transformational Development Agenda
The surest long-term strategy for addressing transnational
threats is to promote the health, stability, and economic well-being of
developing nations, and confronting HIV/AIDS is at the heart of this strategy.
The focus of PEPFAR is on prevention, treatment, and care of people living with HIV/AIDS, and I am pleased to report that we are on track to meet the President’s ambitious goals in these areas. Yet the impact of our program is not – and need not be – limited to HIV/AIDS. PEPFAR’s programs are increasingly linked to other important Presidential initiatives in other areas of health and development – the Millennium Challenge Corporation, the President’s Malaria Initiative, the African Education Initiative, the Women’s Justice and Empowerment Initiative and others. Together, they represent a renaissance in development.
Fundamentally, this new philosophy rejects the failed “donor-recipient”
approach developed during the Cold War and returns to the vision of the
Marshall Plan. It is a philosophy rooted in a hand-shake rather than a hand-out. It is
rooted in the power of partnership between people.
Just a few years ago, the success that PEPFAR’s partnerships have
achieved would have been unthinkable.
It is now clear that this hope and faith was justified – that the power
of partnership is “transformational,” as Secretary Rice would say.
Individuals,
communities and nations are taking control of their lives and are beginning to
turn the tide against the HIV/AIDS pandemic. This new model of partnership is already producing encouraging
results and is, as an Institute of Medicine (IOM) committee recently noted in
its review of the first two years of PEPFAR, “off to a very good start” and has
“demonstrated what many doubted could be done.”
Broader
Impacts of HIV/AIDS Interventions
According
to the World Health Organization’s most recent report, treatment coverage in
the developing world has increased by 54% in just three years, to 2.1 million
people. The
most dramatic expansion of treatment scale-up has been in sub-Saharan
There is no doubt that the support of the American people
has been the catalyst for this transformation.
The part that is sometimes missed is the broader impact of successful
HIV/AIDS interventions. People who
survive contribute to their society as teachers, workers, and peacekeepers. And one of the most important impacts is that
every parent kept alive prevents new orphans.
We have begun work with international partners to develop
models that quantify the impact of treatment and prevention in preventing
orphaning of children. These are
preliminary estimates at this point as we refine the methodology, but there is
no doubt that the impact is very great. We
estimate that PEPFAR support for treatment has averted the orphaning of 229,000
children to date, and through 2008 as we scale up to our treatment goal of 2
million, we estimate that that figure will grow to roughly 874,000.
Just as treatment of parents can prevent their children
from being orphaned, so too can effective prevention. If we meet our goal of 7 million infections
averted for this first phase of PEPFAR, our preliminary estimate is that up to
13.5 million children will be saved from orphaning or heightened vulnerability.
Strikingly, a recent study revealed that children who lose
a parent to HIV face a three times higher risk of death than other children –
and that’s true even if the child is not HIV-infected. Truly, preventing orphan hood is the best way
to ensure child survival and health – just another remarkable consequence of
the rapid growth of effective HIV/AIDS programs.
For children who do become orphaned or vulnerable due to
HIV/AIDS, PEPFAR includes services traditionally associated with the Child
Survival and Health program. Such
services include tuberculosis (TB) and malaria screening; provision of
antibiotics; education; and provision of food, nutrition, shelter, protection,
and psychosocial support.
Health Workforce and Systems
From its inception, the President’s Emergency Plan has been
focused on meeting the emergency of today while building capacity for a
sustainable response for tomorrow. When
we build capacity for HIV/AIDS services, we build the overall health systems of
nations for the long term.
At least one quarter of PEPFAR’s total resources are
devoted to capacity-building in the public and private health sectors –
supporting physical infrastructure, health care systems, and workforce
development. With support from our
Supply Chain Management System (SCMS), focus countries are putting in place
transparent and accountable delivery systems that ensure an uninterrupted
supply of high-quality and low-cost drugs, lab equipment, testing kits, and
other essential medical materials.
As the IOM committee noted, health workforce shortages are
a severe problem in the developing world – one we take very seriously. To date, PEPFAR has supported the training or
retraining of 1.7 million workers. We
are working with the World Health Organization (WHO) on task-shifting, to
expand the available workforce through the use of community health workers and
other health professionals. Also, in
2008 we will triple our allocation for pre-service training of doctors, nurses
and other health professionals.
In addition, PEPFAR works closely with indigenous faith- and
community-based organizations – supporting their efforts to grow their capacity
to lead their nations’ response to HIV/AIDS.
Eighty-three percent of our partners are local organizations, and the
successes are primarily theirs, not ours.
When such organizations expand their capacity in order to meet USG
fiduciary accountability requirements, they are in a better position to support
them in the future.
PEPFAR’s capacity-building initiatives have positive
spillover effects: Whenever a country upgrades its health systems and
strengthens the health workforce it improves overall healthcare delivery. In a recent study conducted at 30
primary health centers in
As IOM committee Chairman Dr.
Jaime Sepulveda said, “[O]viral, PEPFAR is contributing to make health
systems stronger, not weakening them.”[1]
In addition to strengthening health systems, building
infrastructure, expanding health services, increasing capacity and stimulating
economic growth, such improvements enable developing countries to cultivate
good governance and build freer and more stable societies.
PEPFAR
is a dynamic program that is continually being expanded, evaluated, and
reshaped in real time. As the IOM Committee noted, “Beginning
with its strategy, PEPFAR has been committed to learning, and the program has
displayed many of the characteristics of a successful learning
organization.” With each year, PEPFAR is
expanding its knowledge base of best practices and lessons learned, sharing
them globally and having an impact far beyond PEPFAR programs. In fact, long
before the IOM committee report was released, we had already taken action to
address the issues identified in the report – and we will continue to draw on its
input to further strengthen the program.
Now let me offer a brief overview
of PEPFAR’s progress toward supporting treatment for 2 million HIV-infected
people, prevention of 7 million new infections, and care for 10 million people
infected with or affected by HIV/AIDS, including orphans and vulnerable
children.
Treatment
Through the end of fiscal year 2006, PEPFAR partnered with
host nations to support antiretroviral treatment for 822,000 people in the 15
focus nations.
By September 2006 in PEPFAR’s focus countries, approximately 50,000 more
people were being put on life-saving treatment every month. The number of PEPFAR-supported treatment
sites increased by 139 percent over 2005, with 93 new sites coming on line each
month. Of those for whom PEPFAR provided
site-specific treatment support, almost nine percent were children, and
approximately 61 percent were women. We
also supported training or retraining of approximately 52,000 people in the
provision of antiretroviral treatment.
In order to deepen our understanding of the impact of
treatment, we have worked with the WHO and other international partners to
develop a methodology for estimating years of life added by treatment. We estimate that over 3.4 million life-years
will be added by PEPFAR support for treatment as we reach our goal of 2 million
people on treatment – and that’s just through Fiscal Year 2009. If we were to look beyond that timeframe, of
course, the numbers would be far higher.
PEPFAR also has increased the availability of safe,
effective, low-cost generic antiretroviral drugs (ARVs) in the developing world. 43 generic ARV formulations have been
approved or tentatively approved by the U.S. Department of Health and
Human Services/Food and Drug Administration (HHS/FDA)
under the expedited review process established in 2004, including eight
fixed-dose combination formulations. Three
of these are triple-drug combination tablets and ten are double combinations,
of which five are co-packaged with a third drug. In addition, eight oral solutions or
suspensions appropriate for pediatric use have been approved. In 2006, there was a significant increase in
the use of generic products, and in 2007 we will continue to work with partners
to utilize the safest, cheapest drugs wherever possible. As a side benefit, the process has also
expedited the availability in the
PEPFAR has also achieved significant progress in reducing the cost of ARVs through its Supply Chain Management System, or SCMS. We have determined that SCMS secured better purchase prices on 72 percent of first-line ARVs and 40 percent of second-line ARVs compared with other selected benchmark pricing sources and buyers. SCMS has achieved savings by purchasing generic medicines whenever possible, pooling procurement (such as consolidating multiple orders to buy in larger volumes), and establishing long-term, indefinite quantity contracts (IQCs) with manufacturers, thereby leveraging lower prices through bulk purchases. SCMS has signed IQCs with two producers of the same generic ARV, thereby bringing down prices through competition between the two and ensuring a reliable supply by having more than one supplier. During IQC negotiations, the price of the drug was reduced by 7 percent with one supplier and by 23 percent with the other. SCMS’s purchase of Didanosine 200 mg and Efavirenz 200mg, two generic drugs recently approved by HHS/FDA, resulted in cost savings of more than $46,000 (53 percent) and $116,000 (52 percent) respectively, compared with the Accelerated Access Initiative (AAI) Unit Price. From January to March 2007, SCMS saved more than $30 million (70 percent). SCMS has increased its share of ARV purchases that are generics from 72 percent in April to September 2006 to 88 percent (by volume) in January to March 2007.
Prevention
Turning to prevention, according to
UNAIDS, there were approximately 4.3 million new HIV infections in 2006. There can be no doubt that prevention is the
most imperative mission in the global fight against HIV/AIDS. When we prevent
an infection, we keep one person alive and healthy, but we do so much more. We keep that person’s spouse from being
infected, and his or her children from being orphaned. We keep that person’s community intact, and
keep a worker in the workforce. Finally, we keep scarce resources from having
to be directed to that person’s treatment and care. If the number of people newly infected
continues to increase, the growing number of people in need of treatment and
care will overwhelm the world’s ability to respond and to sustain its response.
In recent years, in a growing number of nations, we have
seen clear evidence of declining HIV prevalence as a result of changes in
sexual behavior. In addition to earlier
dramatic declines in HIV infection in
PEPFAR supports the most comprehensive, evidence-based
prevention program in the world, targeting interventions based on the
epidemiology of HIV infection in each country. We support prevention activities that focus on
sexual transmission, mother-to-child transmission, the transmission of HIV
through unsafe blood and medical injections, and greater HIV awareness through
counseling and testing.
Long before PEPFAR was initiated, many nations with
generalized epidemics had already developed their own national HIV prevention
strategies that included the “ABC” approach to behavior change (Abstain, Be
faithful, correct and consistent use of Condoms where appropriate). The new data – from time periods that
pre-date PEPFAR scale-up – link adoption of all three of the ABC behaviors to
reductions in prevalence.
Learning from this evidence, PEPFAR will continue to
support all three elements of the evidence-based ABC strategy in ways that are appropriate
to the epidemiology and national strategy of each host nation. In focus countries during fiscal year 2006,
approximately 61.5 million people were reached by community outreach programs
promoting ABC and other related prevention strategies.
The vast majority of focus countries have generalized
epidemics, meaning that HIV infection is not concentrated in specific and
identifiable groups, but touches the general population. However, PEPFAR also operates in countries with
concentrated epidemics where, for example, 90 percent of infections are among
persons who participate in prostitution.
Hence, the epidemiology in these nations dictates a response more
heavily focused on B and C interventions.
The U.S. Government has supplied 1.3 billion condoms from 2004 to 2006, lending support to comprehensive ABC approaches based on the epidemiology of each country. As UNAIDS Executive Director Dr. Peter Piot recently observed, the U.S. is by far the biggest supplier of condoms to the developing world, providing more than all other sources combined.
Prevention of mother-to-child transmission (PMTCT) is a key
element of our host nations’ prevention strategies, and PEPFAR is supporting
their efforts. UNAIDS estimates that in
2006, 12 percent of all new HIV infections occurred among children, and more
than 90 percent of these were due to mother-to-child transmission. Since PEPFAR’s inception, we have supported
PMTCT services for women during more than 6 million pregnancies. Through Fiscal Year 2006, there are 4,863
PEPFAR-supported PMTCT service outlets in the focus countries, and PEPFAR has
supported ARV prophylaxis for HIV-positive women during 533,700 pregnancies. This has saved an estimated 101,500 infants
from HIV infection.
In addition, by promoting the routine, voluntary offer of
HIV testing to women who visit antenatal clinics, host nations have increased
the rate of uptake among pregnant women from low levels to around 90 percent at
many sites.
There are 3,846 PEPFAR-supported blood safety service
outlets, and we have supported training or retraining of 6,600 people in blood
safety and 52,100 in medical injection safety.
Last month, in light of compelling evidence that medical male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60 percent, the WHO and UNAIDS recommended that circumcision be included as part of a comprehensive HIV prevention package. Male circumcision does not provide complete protection against HIV infection, and additional research still needs to be conducted, but since WHO and UNAIDS have endorsed and provided normative guidance for it, if any host nations would like to add safe medical male circumcision to their prevention programs, PEPFAR will support their efforts.
In regard to circumcision and any other new prevention
methods and technologies – such as an HIV vaccine or topical microbicide –
PEPFAR will incorporate these new approaches, as the evidence is accumulated
and normative guidance is provided.
Care
Through Fiscal Year 2006, PEPFAR supported care for nearly
4.5 million people, including two million orphans and vulnerable children
(OVCs) . PEPFAR has scaled up HIV/AIDS
programs for OVCs on a larger scale than had ever been attempted. In fiscal year 2006, PEPFAR also began
requiring OVC programs to report on how many of six key services they provide –
food/nutrition; shelter and care; protection; health care; psychosocial
support; and education.
To date, we have counted both OVC care programs and
pediatric AIDS treatment programs toward the Congressional directive that 10
percent of program funds be devoted to programs for OVCs. Beginning in Fiscal Year 2008, we plan to
meet the directive with care programs alone, reflecting our deepening knowledge
base of best practices for OVC care.
As noted, PEPFAR now covers many services that were
traditionally part of Child Survival and Health programs. In Fiscal Year 2003, just prior to PEPFAR,
USAID provided $34.3 million for services for orphans and vulnerable children;
$26.8 million of this came from the Child Survival and Health fund. In Fiscal Year 2006, PEPFAR provided
approximately $213 million to support focus country programs that are providing
care for two million orphans and vulnerable children.
PEPFAR also has increased support for national efforts to
provide high-quality care for opportunistic infections related to HIV/AIDS,
especially TB. I will discuss this in more detail momentarily.
We also have developed ‘preventive care packages’ for HIV-infected
children and adults, to help keep them healthy and delay the need for treatment. Care packages can be adapted to local
circumstances, and we are working to disseminate them broadly.
Knowing one’s HIV status provides a gateway for critical prevention,
treatment, and care. To date, PEPFAR has
supported more than 18 million counseling and testing encounters – close to a
third of these were with women seeking PMTCT services.
To increase the number of people being tested for HIV, PEPFAR
is working with host nations to implement routine, provider-initiated “opt-out”
HIV testing, in selected health care settings.
We also are supported the use of rapid HIV tests to improve the
likelihood that those who are tested will actually receive their results.
In 2006, PEPFAR also supported training or retraining of
approximately 143,000 individuals in providing care for orphans and vulnerable
children; nearly 94,000 in providing care for people living with HIV/AIDS; and
more than 66,000 in providing counseling and testing services.
PEPFAR
as a Foundation to “Connect the Dots” of Development
PEPFAR’s prevention, treatment and care results, as
important as they are, are only part of the story. At this point, I would like to highlight some
specific areas in which PEPFAR is “connecting the dots” of development,
leveraging HIV/AIDS investments to achieve a broader, transformational impact.
Fighting Tuberculosis
Since TB is the number one killer of HIV-infected people,
it has always been an integral part of PEPFAR and will continue to be an area
of increasingly high priority. Before
PEPFAR, total
There is growing concern about the advent of drug-resistant
strains of TB among people who are HIV-positive. We are working closely with the U.S. Federal
TB Task Force to develop a concerted U.S. Government response to TB. We are working with international partners
such as the Global Fund and WHO, to strengthen laboratory systems, establish
infection-control measures, and expand programs to prevent, diagnose, and
manage drug-resistant TB in people living with HIV/AIDS.
Fighting Malaria
PEPFAR continues to partner with the President’s Malaria
Initiative (PMI) in countries that are targeted by both programs. In 2008, as PMI expands, 15 countries (7
PEPFAR focus countries and 8 other bilateral) will be jointly sponsored by the
two Presidential initiatives. The
collaboration of PEPFAR and PMI has already enabled countries to provide
comprehensive services for some of the most vulnerable groups for both
diseases, including pregnant women, people living with HIV/AIDS, and orphans
and vulnerable children under age five.
Some of the key areas currently being supported through
PEPFAR/PMI collaboration include:
Finally, through this collaboration, PMI has the opportunity
to build on the foundation of community-based structures and programs developed
under PEPFAR. For example, in
Supporting Nutrition
Although addressing the broad issue of food insecurity is
beyond the scope of PEPFAR, we do support limited food assistance for specific,
highly vulnerable populations. In a
pilot program in
For the most part, however – in order to remain focused on
HIV/AIDS – PEPFAR maximizes leverage with other partners that provide food
resources. In collaboration with interagency partners, we are engaging on food
and nutrition issues with six focus countries in a pilot program. For example, PEPFAR Ethiopia contributes to
the World Food Program (WFP), and Food for Peace supports some HIV/AIDS
programs. In fiscal year 2006, PEPFAR
Ethiopia and the WFP collaborated to provide food resources to more than 20,000
beneficiaries, including orphans and vulnerable children, adult patients on treatment,
and care givers. In
Key partners in our Food and Nutrition Strategy include,
among others, the USDA’s Foreign Agriculture Service, USAID’s Food for Peace
office, and the World Food Program – a key international partner. In Fiscal Year
2006, PEPFAR allocated $2.45 million to World Food Program initiatives, and
that will increase to $4.27 million in fiscal year 2007.
Supporting Clean Water
In September 2006, First Lady Laura Bush announced a
groundbreaking public-private partnership called the PlayPump Alliance. This $60 million alliance between PlayPumps
International, the Case Foundation, USAID, PEPFAR, and other private sector
partners will bring the benefits of clean drinking water to up to 10 million
people in sub-Saharan
Supporting Education
Although education per se is beyond the scope of
PEPFAR’s mission, we do support OVC attendance programs which include providing
school fees, books and uniforms, as well as HIV prevention and life skills
programs. We also leverage our
comprehensive OVC care program, to “wrap around” other programs that provide
educational access to children who are infected with and affected by HIV/AIDS.
A key example is PEPFAR’s coordination with the President’s
African Education Initiative (AEI), implemented through USAID. Over the next four years, the
Addressing Gender Inequities
Around the world, girls and women are contracting HIV at an alarming rate. The reasons are complex, but they are invariably tied to pervasive, powerful, and often brutal gender inequities. In many of the most heavily affected countries, women and girls are simply powerless to protect themselves against contracting HIV/AIDS.
Because
of this, PEPFAR places a priority on gender. Our program is the only
major international initiative to require data reporting by gender. We do so to track whether girls and women are receiving the
services they need, and we know that girls comprise 51% of the more than 2
million orphans and vulnerable children receiving PEPFAR-supported care.
The authorizing legislation for PEPFAR specifies that we
will support five high-priority gender strategies:
These five strategies are monitored annually during the
Country Operational Plan (COP) review process.
In fiscal year 2006, a total of $442 million supported more than 830
interventions that included one or more of these gender strategies, including $104
million for activities specifically addressing gender-based violence and sexual
coercion.
In addition, last year we convened some 120 experts and stakeholders to discuss the latest findings on gender and HIV/AIDS, and to clarify programming priorities. Two months later, PEPFAR allocated an initial $8 million in central funding to launch new, gender-specific initiatives in the high-priority areas that had been identified. Beginning in fiscal year 2007, an increased number of programs will seek to change male norms, respond to gender-based violence, and address adolescent vulnerability.
Supporting Technology to Expand Health Workforce and
Systems
I have noted PEPFAR’s commitment to health workforce and
systems development. We are using
technology to do more than build health information systems and foster two-way
communication with our partners. We
recently announced the $10 million public-private partnership, Phones For
Health. It brings together mobile phone
operators, handset manufacturers, and technology companies, working closely
with Ministries of Health, global health organizations, and other partners to
strengthen healthcare services and monitoring systems through mobile phone
technology. As with the development of
national health information systems, the Phones for Health network will have
applications for more than just HIV/AIDS. In the event of an outbreak of bird
flu, XDR TB, or any other suddenly arising epidemic, this system and others
like it will prove to be invaluable.
Supporting Systems for Accountability
In
order to ensure quality and sustainability of its programs, the Emergency Plan
is committed to the strategic collection and use of information for program
accountability and improvement. The so-called “burden of reporting” is
actually a foundational feature of transformational development. Reporting is
one of the principal means of establishing effective systems for transparency
and accountability. PEPFAR’s rigorous
reporting requirements serve a number of purposes. First and foremost, they are building an
ever-increasing body of empirical data from which to develop, evaluate, and
improve evidence-based HIV/AIDS interventions – and to do it in real time, as
we go along, thus creating a culture of accountability that has impact beyond
HIV.
Secondly, our reporting system is fostering the
establishment of national health information systems in partner countries, many
of which had weak or nonexistent systems prior to PEPFAR. Working with UNAIDS, WHO, Health Metrics
Network, the World Bank, the Global Fund, and others, PEPFAR is expanding each
country’s reporting infrastructures and increasing the number of personnel who
are trained in the field of strategic information.
Supporting countries as they develop accurate and
sustainable reporting systems is not about creating bureaucratic paperwork. It is about enabling these developing nations
to construct a solid framework for a more equitable and transparent society. As one young Namibian told me: “PEPFAR is
actually building democracy through its accountability systems focused on
country ownership and good governance.”
In this and other ways, PEPFAR is serving as a fulcrum for international
development. Entire regions of the world
that had been devastated by HIV/AIDS are regaining hope and building a
foundation for freedom and opportunity – in much the same way the Marshall Plan
enabled
Consistent with the model of accountability, PEPFAR strives
to be transparent and forthcoming. We
communicate regularly with the American people, through our Annual Report to
Congress and the www.PEPFAR.gov
website, where users can find everything from individual Country Reports to our
program’s legislative guidance. We also
keep in touch with our program implementers, through a private “Extranet” website,
which provides current research, best practices, reporting guidelines, and
other programmatic information on a continually updated basis.
Supporting Public-Private Partnerships
Through PEPFAR’s growing network of public-private
partnerships, we are working with businesses to bring their distinctive
strengths to the fight. In 2006, PEPFAR
invested $13.25 million in public-private partnerships, leveraging $59.25
million in additional resources for programs including PlayPumps and Phones for
Health, previously mentioned in this testimony.
Also in 2006, smaller scale public-private partnerships were developed
in the field and launched in
Conclusion
As we move forward, the ways in which we leverage
HIV/AIDS does not exist in a vacuum. It is inextricably tied to other threats to
public health, and it has ramifications for a wide range of development-related
issues. Thus, PEPFAR’s efforts to
“connect the dots” of international development are integral to the larger
picture of
Today, the Emergency Plan is on track to exceed its original commitment of $15 billion over five years. By the end of fiscal year 2008, the American people will have invested $18.3 billion in the global fight against HIV/AIDS.
In addition, PEPFAR amplifies the effects of other
international HIV interventions by working with and contributing to the Global
Fund to Fight AIDS, Tuberculosis and Malaria.
PEPFAR is set to more than double its original commitment to the Global
Fund, and has provided nearly $2 billion to date. The U.S. Government is the largest
contributor to the Fund, providing approximately one-third of all its
resources.
PEPFAR’s other
key international partners include the World Bank; United Nations agencies, led
by UNAIDS; other national governments; and – with growing commitment – the
businesses and foundations of the private sector.
As the IOM committee report observed, PEPFAR and its partners have successfully demonstrated that HIV/AIDS
programs can be implemented, even in under-resourced settings. Millions of people are receiving life-saving
care in many of the world’s most challenging settings. Hope is being restored through the power of
partnerships.
The people of severely affected nations have accomplished so
much in their fight against HIV/AIDS, and the American people are privileged to
partner with them through PEPFAR. Yet, the HIV/AIDS pandemic remains an
emergency, and so any challenges still lie ahead. We are on a long journey. The
American people must continue to stand with our global sisters and brothers as
they take control of the pandemic and restore hope to individuals, families,
communities and nations.
Mr. Chairman, once again, I am deeply grateful for our
strong partnership with this Committee. I
believe PEPFAR is a truly historic initiative, and one in which every American
can take pride. With that, let me turn
to your questions.
[1] From March 30, 2007 IOM Report Press Briefing – Online via National
Academies of Science Web cast Archives (Audio location: 57:41) : www.nap.edu/webcast/webcast_detail.php?webcast_id=337