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PathwaystoIndigenousPartnersSustainingEpidemicControl

Polly Dunford Director, Office of HIV/AIDS, USAID PEPFAR Annual Meeting July 20, 2018

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EPIDEMIC CONTROL

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AmbassadorBirxPrincipal’sPresentationApril2018

“Move to local partners is critical and must be at 25% by the end of FY18,

40% at the end of FY19, and 70% by the end of FY20”

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WHERE HAVE WE BEEN?

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PEPFAR’s evolution of work with Indigenous Partners

Implemented by international partners to achieve rapid scale

PEPFAR 1.0 2003-2008 ●  Track 1

●  Building programs around indigenous talent

Emphasis on country ownership and capacity-building of Indigenous Partners

PEPFAR 2.0 2009-2013

●  Track 1 Transition ●  Partnership

Frameworks ●  NPI (2009-2012) ●  USAID Forward

90-90-90 goals, emphasis on Epidemic control/ maintenance

PEPFAR 3.0 2014- 2018

●  Partner Performance ●  Sustainable Financing

Initiative (SFI) ●  Indigenous Partner

Funding Targets

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PEPFAR HHS Track 1.0

●  Track 1: In 2004, CDC and HRSA competitively selected four US-based academic and nongovernmental organizations (NGOs) to provide HIV care and treatment services in 13 PEPFAR “focus” countries.

●  Track 1 Transition: In 2008, HHS mandated the transition of HIV care and treatment programs from US-based implementing partners to host governments and indigenous local partners.

●  PEPFAR and Track 1 implementing partners worked closely with host governments to strengthen indigenous partners' capacity to provide sustainable care and treatment programs.

USAID accelerated its push for local initiatives with ambitious goals to partner directly with local governments, the private sector, civil society, and academia to ensure that local systems own, resource, and sustain the development results. Metric: 30% of USAID mission program funding go to local organizations by the end of FY2015 (tripling the baseline rate in 2010) Result: •  27% of USAID mission program funding to local organizations

(includes Cash Transfer (CT) and Qualifying Trust Funds (QT) at end of FY15

•  Developed rigorous approaches to assess government and local partner capacity

•  Used international and private sector through Development Credit Authority (DCAs) and PPPs to increase and diversify investments

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USAID Forward / Local Solutions: 2010-2016

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New Partner Initiative (2009- 2014)

2009-2012: New Partner Initiative (NPI) worked with local civil society and faith-based partners

•  Provided grants for HIV/AIDS prevention and care in 14 of 15 focus countries.

•  Built capacity among 55 prime partners and over 200 sub-

partners in 14 countries

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Sustainability Action Agenda: 2015- Present: Sustainable Finance Initiative (SFI):

•  Draws upon USG expertise in health financing and economics, democracy

and governance, and the economic growth disciplines

•  Leverages other agencies (U.S. Treasury) and Multilateral stakeholders

•  Increase domestic resources for HIV service delivery

•  Development of government systems to finance local CSOs (social contracting) and promoting private sector growth

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Sustainability Action Agenda:

2014-Present: Local Capacity Initiative (LCI): •  Support advocacy and strengthen civil society networks

•  Increase accountability

•  Reduce policy structural and social barriers to a quality HIV response

•  Promote an enabling environment for civil society organizations

–  All direct recipients of LCI funding were local partners

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USAID Journey to Self Reliance: 2018- Support the ability of a country to plan, finance, and implement solutions to its own development challenges May, 2018: Metrics launched to measure Self Reliance: •  Impartially track a country’s progress towards self-reliance, •  inform our strategies and programmatic approaches •  inform decisions related to transition •  monitor country progress post-transition.

May, 2018 - Present: Local Capacity Development (LCD) and Capacity 2.0 •  Build performance to achieve technical outcomes

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WHERE ARE WE NOW?

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PEPFAR Overall Local Partner Funding

Note: Agency data was supplied by S/GAC from FACTSInfo on May 7, 2018; USAID data has been verified through an internal USAID process as of June 6, 2018.

COP 18 USAID Local Partner Funding by Partner type *with verified USAID data/unverified CDC data

Local Partners

USAID CDC

Local NGOs

# Mechanisms 79 36

Range $290K- $24 million

$50K- $64 million

Average $1.1 million

$11.5 million

Host Country Governments

# Mechanisms 5 31

Range $300K- $3.5 million

$138K- $16 million

Average $1.56 million

$2.89 million

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Note that a small number of data in the categories TBD and Local Joint Venture/Consortium are excluded here.

USAID,InternationalandLocalPerformancePerformancein23Countries,FY18Q2%AchievementforTESTINGandTREATMENTIndicators

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Local Sub Partners

LINKAGES example: 40% of LTS OU funding goes to local subs, ranging from 25-80% depending on country context, with 2-90+subs in each OU

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HOW WILL WE GET IT DONE?

Track 1 Transition-type models

(Local prime/ Intl sub)

HRH - Funds directed through local human resource firms to fill key staffing gaps

DifferentModelsforLPTransition

Transition Awards

G2G or Parastatal

•  National •  Sub-national

PSI Phased Transition Model-

Strategic independence, followed by financial independence

KEMSA model-

Transition commodities procurement to National Medical authority MCC model

Local enterprise to manage Local Partner awards Local Private Sector

Partnerships

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Expenditure Analysis- a strategic approach

HRH and Commodities make up more than 50% of all USAID funding and are an intense area of focus for Local Partner Transition strategies

●  Mission managed bilateral contact

●  Procured, warehoused, distributed RTKs, ART, OI drugs and Lab reagents

●  Primarily hub/spoke model (ordering sites)

●  Transitioned to bilateral contract with KEMSA

●  Procures, warehouse, distributes all products

●  Gov. of Kenya and Global Fund procurement agent

●  One stream of procurement

●  Initiated fixed-amount agreement with KEMSA ○  Identified what

products needed to be procured

○  Had clear visibility on costs

●  Kenya Pharma running in background/stopgap

KEMSA: The Journey from International Partner to Host Country Management

Kenya Pharma (bilateral contract with International IP)

KEMSA (FARA/HCC)

Kenya Pharma

KEMSA Contract (host country)

2008-2013 2014-2015 2015- Current

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USAIDADS303.6.5b.(3)TransitionAwards

USAID may restrict eligibility when awarding to a local entity that has been a subrecipient under a USAID prime award (the “initial award”)

●  The initial award contains: ○ Criteria for the prime recipient to identify and qualify a

sub-recipient for a direct award ○ Procedures for making the direct award ○ A timeframe for when the direct award will be considered

•  Maintaining performance and PEPFAR results

•  Local Partner organizational capacity •  USG staffing to support transition/oversight •  Timeline to build capacity, do new

procurements

Common Concerns

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●  Targeted technical assistance ●  Financial oversight and

accountability ●  Shifting partnership structures

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Critical Role of International Partners

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