Partnership Frameworks: a five-year path

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1 Partnership Frameworks: a five-year path to policy reforms in PEPFAR partner countries Andre Verani, JD, MPH Using Law, Policy, and Research to Improve the Public s Health: A National Conference Atlanta, GA - September 13-15, 2010 Center for Global Health Division of Global HIV/AIDS

2 Overview I. PEPFAR and Partnership Frameworks II. Policy reforms planned in Partnership Frameworks III. Future questions IV. Why this matters

3 I. PEPFAR and Partnership Frameworks Secretary Clinton and Angolan Minister of Exterior Relations exchange Partnership Frameworks in 2009

4 PEPFAR (President s Emergency Plan for AIDS Relief) Department of State, USAID, CDC, and others PEPFAR I ( ) Legislation (P.L ) authorized $15 billion for HIV/TB/Malaria Supported HIV treatment for ~ 2.5 million persons as of 9/30/09 / * Outcome evaluation found that in 12 countries over 3 years, about 1.1 million deaths were averted due to PEPFAR s activities. ** PEPFAR II ( ) Treat 4 million, Prevent 12 million infections, Care for 12 million Legislation (P.L ) authorized Partnership Frameworks Cornerstone of the Global Health Initiative * ** Ann Intern Med May 19;150(10): Epub 2009 Apr 6.

5 Partnership Framework (PF) is a 5-year joint strategic framework for cooperation between the USG, the partner government, and other partners to combat HIV/AIDS in the country through h technical assistance and support for service delivery, policy reform, and coordinated financial commitments. * * ttp://

6 Partnership Frameworks signed (May 2009 present) USG and 31 national governments have signed PFs 11African countries (6 in 2009) 1 Asian country 7 Central American countries (Regional) 12 Caribbean countries (Regional)

7 What is policy reform? Creating new policies Repealing existing policies Amending existing policies Better implementing/enforcing policies Policies listed in PFs include legislation, policies, guidelines...

8 From specific to general Malawi: MOH expects to implement HTC guideline 2.61 changing anonymous reporting to confidential reporting in order to permit a name-based referral system at all HTC sites to commence. Swaziland: improve the status and rights of women, people living with HIV and AIDS (PLWHA) and other vulnerable groups in Swaziland US/Malawi and US/Swaziland Partnership Frameworks

9 II. Analysis of policy reforms in 6 Partnership Frameworks signed in 2009 Review of publicly available documents 1. Mutual Accountability 2. Policy reforms by technical area & country

10 Mutual Accountability PF publicly lists expected contributions of participants (such as ) Kenya Government: increase general health budget 10% annually US Government: maintain support for full treatment costs for all those on US govt-procured ARVs as of 9/30/09 US/Kenya Partnership Framework

11 Policy reforms planned in 6 Partnership Frameworks Malawi Swaziland Angola Lesotho Ghana Kenya TOTAL HRH OVC Financing ARVs & Supplies HIV testing & counseling Other (stigma, nondiscrimination, gender, laboratory, MARPs, etc.) TOTAL

12 Key Findings Signatures show political will of partner governments, USG Many planned reforms (26 per PF on avg.) of various types Most active policy reform area is Human Resources, widely acknowledged as key barrier to progress in global health

13 III. Future Questions Were partner government laws and policies changed? Were laws and policies implemented and enforced? Were law/policy reforms associated with health impact?

14 IV. Why this matters Planned policy reforms could lead to: Improved public health (e.g. fewer new HIV infections) Increased protection for orphans and vulnerable children Improved governance through greater transparency (e.g. budgeting) Reduced d discrimination i i against women, PLHIV, and others Monitoring and evaluation is required to find out

15 Thank you Andre Verani, JD, MPH, Policy Analyst, Division of Global HIV/AIDS, Center for Global Health, CDC For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Center for Global Health Division of Global HIV/AIDS

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