The Financial Flows of PEPFAR: A Profile

Little is known about the President’s Emergency Plan for AIDS Relief (PEPFAR) financial flows within the United States (US) government, to its contractors, and to countries. We track the financial flows of PEPFAR – from donor agencies via intermediaries and finally to prime partners. We reviewed and analyzed publicly available government documents; a Center for Global Development dataset on 477 prime partners receiving PEPFAR funding in FY2008; and a cross-country dataset to predict PEPFAR outlays at the country level. We present patterns in Congressional appropriations to US government implementing agencies; the landscape of prime partners and contractors; and the allocation of PEPFAR funding by disease burden as a measure of country need. We find that PEPFAR has led to substantial presence of US-based organizations operating in recipient countries. There were 477 PEPFAR prime partners in FY2008. 22 of the largest 25 recipients were based in the US. Only 8% of thetotal ($301 million) was allocated to developing country governments as prime partners. US Congress’s past designation of ‘focus countries’ is a major predictor of PEFPAR funding, though the rationale underlying the selection process for focus countries is unclear. When considering disease burdens, there are clear inconsistencies in the PEPFAR funding levels between comparably deserving countries. Further work is needed to quantitatively evaluate the extent of contractor proliferation and its effects on PEPFAR’s efficiency and long-term sustainability. The US government should disclose its contracts to prime partners and sub-partners in a machine-readable and open format consistent with the USG Open Data Policy. Moreover, PEPFAR can improve the allocation of its funding through a more explicit rationing mechanism.