title: Past and Future Performance: PEPFAR in the Landscape of Foreign Aid for Health.
abstract: This review traces the course of the US President's Emergency Plan for AIDS Relief (PEPFAR) as a foreign aid program. It illustrates how the epidemiologic and geopolitical environments of the early 2000s influenced PEPFAR's early directions and contributed to its successes. In addition to scaling up infrastructure and care delivery platforms, PEPFAR led to large increases in the number of people receiving antiretroviral therapy and reductions in mortality. These successes, in turn, have brought its principal challenges-its outsized budget, narrow focus, and problem of entitlement-into sharp relief. PEPFAR's recent evolution, then, has been in response to these challenges. This review suggests that PEPFAR's early formulation as an emergency response relieved it from a need to articulate clear goals, and that this freedom is now leading to new challenges as it struggles to identify priorities in the face of expectations to do more with a flat budget.
authors.affiliation: Division of General Medical Disciplines, Stanford University, Stanford, CA, 94305, USA. ebd@stanford.edu.|Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA. ebd@stanford.edu.
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
mesh_terms: D019380:Anti-HIV Agents / Q000600:supply & distribution*; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006284:Health Plan Implementation / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007391:International Cooperation; D015397:Program Evaluation; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; Foreign aid; HIV/AIDS; PEPFAR; President’s Emergency Plan for AIDS Relief; Sub-Saharan Africa; Sustainability