title: PEPFAR Investments In Governance And Health Systems Were One-Fifth Of Countries' Budgeted Funds, 2004-14.
abstract: Launched in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) is the largest disease-focused assistance program in the world. We analyzed PEPFAR budgets for governance and systems for the period 2004-14 to ascertain whether PEPFAR's stated emphasis on strengthening health systems has been manifested financially. The main outcome variable in our analysis, the first of its kind using these data, was the share of PEPFAR's total annual budget for a country that was designated for governance and systems. The share of planned PEPFAR funding for governance and systems increased from 14.9 percent, on average, in 2004 to 27.5 percent in 2013, but it declined in 2014 to 20.8 percent. This study shows that the size of a country's PEPFAR budget was negatively associated with the share allocated for governance and systems (compared with other budget program areas); it also shows that there was no significant relationship between budgets for governance and systems and HIV prevalence. It is crucial for the global health policy community to better understand how such investments are allocated and used for health systems strengthening.
authors.affiliation: Corrina Moucheraud (cmoucheraud@ucla.edu) is an assistant professor in the Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, at the University of California, Los Angeles.
authors.forename: Corrina
authors.initials: C
authors.lastname: Moucheraud
authors.affiliation: Susan Sparkes is a health economist in the Department of Health Systems Governance and Financing at the World Health Organization, in Geneva, Switzerland.
authors.forename: Susan
authors.initials: S
authors.lastname: Sparkes
authors.affiliation: Yoriko Nakamura is a senior program associate at the Results for Development Institute, in Washington, D.C.
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Anna Gage is a graduate student at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
authors.forename: Anna
authors.initials: A
authors.lastname: Gage
authors.affiliation: Rifat Atun is a professor of global health systems and director of the Global Health Systems Cluster at the Harvard T. H. Chan School of Public Health.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Thomas J. Bossert is a senior lecturer in global health policy and director of the International Health Systems Program at the Harvard T. H. Chan School of Public Health.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Bossert
mesh_terms: D002017:Budgets / Q000458:organization & administration; D003695:Delivery of Health Care / Q000191:economics*; D003906:Developing Countries; D014943:Global Health / Q000191:economics; D006078:Government Programs / Q000191:economics*; D015658:HIV Infections / Q000453:epidemiology*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007391:International Cooperation; D007449:Investments / Q000191:economics*; D008483:Medical Assistance / Q000191:economics; D014481:United States
keywords: AIDS/HIV; Financing Health Care; International/global health studies