1. © 2005, CARE USA. All rights reserved. CARE’s experience with the President’s Emergency Plan For AIDS Relief (PEPFAR) Madhu Deshmukh Director, HIV/AIDS Unit CARE

2. © 2005, CARE USA. All rights reserved. CARE’s experiences with PEPFAR  Issues raised are a result of multiple conversations with CARE Country offices as they roll out PEPFAR funded activities  Issues are raised from practical experiences and need to be further explored and validated

3. © 2005, CARE USA. All rights reserved. CARE’s HIV/AIDS Capacity and Experience  CARE implements more than 120 HIV/AIDS projects in 39 countries around the world  CARE’s HIV/AIDS objectives:  reduce the number of new infections  mitigate the impact of HIV/AIDS on economic development  increase access to high-quality care and support for affected families  CARE programs are comprehensive and multisectoral, working with at-risk groups

4. © 2005, CARE USA. All rights reserved. CARE’s HIV/AIDS Experience, cont’d  CARE works with governments as well as civil society including CBOs and FBOs  CARE’s HIV/AIDS responses include Hope for African Children Initiative (HACI), the CORE Initiative and the CARE-CDC Health Initiative (CCHI) in addition to the projects at the country level  CARE’s HIV/AIDS programs receive funding from a wide variety of sources

5. © 2005, CARE USA. All rights reserved. CARE’s Involvement With PEPFAR  CARE is currently implementing PEPFAR-funded programs totaling an investment of approximately $40 million  CARE has completed PEPFAR-funded programs totaling an investment of $8.6 million  CARE has a number of PEPFAR-funded programs that are about to begin and has submitted proposals for PEPFAR-funded projects in Africa, Asia and the Caribbean

6. © 2005, CARE USA. All rights reserved. Involvement With PEPFAR, cont’d  CARE’s PEPFAR-funded programs work with a variety of affected groups including OVC  These programs promote positive changes in individuals, organizations and society

7. © 2005, CARE USA. All rights reserved. Achievements Under PEPFAR  PEPFAR is an unprecedented investment and commitment by the US government.  PEPFAR has:  a sense of urgency  made HIV/AIDS a less taboo subject  enabled successful efforts to be scaled up  enhanced coordination  sharpened the focus on treatment

8. © 2005, CARE USA. All rights reserved. CARE’s Achievements Under PEPFAR  Scaling up successful models  The Nkundabana Approach in Rwanda  Community-based care for child-headed households  Mobilizing and training of mentors  Children’s participation is key

9. © 2005, CARE USA. All rights reserved. CARE’s Achievements Under PEPFAR  Building local capacity  The CORE Initiative – Uganda  Improving government capacity (i.e. Ministry of Gender, Labor and Social Development)  Improving local organizations’ capacity

10. © 2005, CARE USA. All rights reserved. CARE’s Achievements Under PEPFAR  Integrating a multi-sectoral perspective into HIV/AIDS efforts  Local Links (Kenya and South Africa)  Enhanced income for families  Strengthen the capacity of local organizations  Reduce stigma and discrimination  Kenya: work in 13 villages, with 13 civil society organizations, and train 415 caregivers

11. © 2005, CARE USA. All rights reserved. Challenges Under PEPFAR  The “emergency mindset” sometimes sacrifices sustainability.  Example of Rwanda: Building sustainable community capacity and responses takes time and resources.  The short RFA process is not conducive to forging strong partnerships and assembling a high-quality team.

12. © 2005, CARE USA. All rights reserved. Challenges Under PEPFAR, cont’d  Pressure to “show big numbers rapidly” creates incentives for pursuing quantity over quality.  Example of building local capacity: Capacity cannot be equated with the dollar amount of sub- grants made to local organizations  Strengthening existing capacities of local organizations takes time, commitment, resources and technical review process

13. © 2005, CARE USA. All rights reserved. Struggles Under PEPFAR, cont’d  Funds tend to be focused too narrowly  The focus on treatment is welcome and needed, but it sometimes comes at the expense of prevention, care and support.  An apparent focus on A and B over C  Programs that target non-OVC groups are not as comprehensive.

14. © 2005, CARE USA. All rights reserved. Recommendations  Questions for IOM exploration:  What kind of programs and approaches has PEPFAR funded thus far? Do they reach the most vulnerable groups? How sustainable are these efforts?  Do short funding cycles and the pressure to show quick results affect the quality and sustainability of its investments?  Is PEPFAR measuring impact as well as output? How are implementing agencies managing reporting requirements?

15. © 2005, CARE USA. All rights reserved.  Information sources for IOM:  PEPFAR implementers – HQ and field staff  Local NGOs and CBOs – staff at all levels  Groups of people living with HIV/AIDS (PLWHA)  Community and religious leaders