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PEPFAR’s Approach to Maximize Efficiency, Effectiveness and Impact

PEPFAR’s Approach to Maximize Efficiency, Effectiveness and Impact. Nalinee Sangrujee , PhD MPH PEPFAR 20 April 2012. PEPFAR Smart Investments to Increase Impact and Efficiency. Source: http://www.pepfar.gov/smart/index.htm.

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PEPFAR’s Approach to Maximize Efficiency, Effectiveness and Impact

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  1. PEPFAR’s Approach to Maximize Efficiency, Effectiveness and Impact NalineeSangrujee, PhD MPH PEPFAR 20 April 2012

  2. PEPFAR Smart Investments to Increase Impact and Efficiency Source: http://www.pepfar.gov/smart/index.htm • Strengthen use of economic and financial data to ensure efficient use of resources • Incorporate innovations that promote efficiency and allocate resources based on impact • Increase collaboration with governments, the Global Fund and others to align programs and target investments • Reduce costs by streamlining USG operations and supporting increased country ownership • Achieve best all-inclusive commodity pricing • Leverage creative mechanisms for healthcare finance to bring additional resources to bear • Develop and evaluation research agenda that will show how to improve efficiency and impact PEPFAR Finance and Economics Work Group

  3. Using Cost Data to Increase Efficiency PEPFAR is adapting to achieve more with finite resources • Need timely financial monitoring data • Identify efficient models of service delivery that maximize value PEPFAR programs typically had limited program area-specific financial data/indicators at their disposal for decision-making “PEPFAR is …identifying and implementing efficiencies in its work” PEPFAR Finance and Economics Work Group

  4. PEPFAR Expenditure Analysis Initiative • Provide timely cost data and build capacity of USG teams to use cost data for improved management and efficient operation of programs • Match achievements and actual expenditures to estimate USG expenditure per beneficiary • Country USG –level: inform program planning (COP, GF rounds, MOH budgeting cycle, identify efficiencies etc.) • PEPFAR HQ-level: inform global budgeting • National – level: contribute to national expenditure processes Understanding the full cost to support National HIV/AIDS Programs • Work with other stakeholders to ensure integration and use of PEPFAR data in broader national cost analysis efforts PEPFAR Finance and Economics Work Group

  5. What is PEPFAR Expenditure Analysis? • Routine financial monitoring of PEPFAR programs • Provides annual data on expenditures by program area and cost category • Not a panacea: Puts the “M” in financial M&E and highlights the need for “E” ART PMTCT VMMC … … … … … Investment Site-level Recurrent Program Management Above Site-level Monitoring and Evaluation Health System Strengthening Total PEPFAR Expenditures for Fiscal Year PEPFAR Finance and Economics Work Group

  6. Use of Expenditure Analysis Results for Partner Management to Improve Efficiency Goal to ensure IPs that are providing similar services/support are adopting best practices and using PEPFAR resources optimally Step 1: Identify outliers Step 2: In–depth analysis to identify cost drivers Step 3: Agreement to lower UE by $X in coming year by decreasing expenditures or increasing targets PEPFAR Finance and Economics Work Group

  7. Trend Analysis PEPFAR Finance and Economics Work Group

  8. Evidence-Based Approach to Increase Effectiveness • Recent PEPFAR COP Guidance to focus on uptake of core interventions • “E” dependent on good outcomes/output measures • PEPFAR is exploiting more of its data to more effectively allocate resources • PEPFAR continues to support studies to evaluate programs including multi- country randomized community trial on combination prevention PEPFAR Finance and Economics Work Group

  9. Use of Expenditure Analysis Data to Inform Effective Programming PEPFAR Finance and Economics Work Group

  10. Leveraging PEPFAR’s Resources • Optimal use of PEPFAR resources to maximize the reach, quality and impact of global HIV programs • Strategic coordination of donors • Crowding-in of internal and other external resources • Recognizes that HIV programs may achieve greater scale and reach with contributions from other sources • Partnership Frameworks is PEPFAR’s move towards a dialogue of partnership including the development of strong financing frameworks • Promote national ownership • Feasible, affordable, transparent, and sustainable • Efficient and smart • Easily implemented and monitored PEPFAR Finance and Economics Work Group

  11. Scale-Up of ART Access and Declining PEPFAR Per-Patient Costs, 2004-2009 Note: Per-patient budget allocation is estimated as treatment allocation divided by lagged end-of-reporting direct patients. PEPFAR Finance and Economics Work Group

  12. PEPFAR Continues to Develop Measures of Efficiency and Effectiveness Our ability to improve efficiency and effectiveness is correlated with our ability to define and link interventions to measurable outputs Treatment Number of Economic Studies PMTCT Counseling and Testing Behavior Change and Communication OVC Health System Strengthening Clear service delivery models No standard intervention models PEPFAR Finance and Economics Work Group

  13. Acknowledgements: PEPFAR country teams and Implementing Partners for participation in Expenditure Analysis Pilots PEPFAR Finance and Economics Work Group For additional information: www.PEPFAR.gov Thank you!

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