It is the biggest global health initiative in the world, and arguably the most successful. That’s all the more reason that it’s too bad that how the U.S. President’s Emergency Plan For AIDS Relief accomplishes the successes it has achieved — in HIV infections prevented, lives saved and restored to health, and even how greater efficiencies have been built into the largest program ever devoted to a single disease — remains pretty much a secret.
The Aid Transparency Index 2013 from Publish What you Fund, the Global Campaign for Aid Transparency puts PEPFAR in the “Very Poor” category for the amount, accessibility, and usability of the information on how its money is being spent, and rates it the least transparent of all U.S. agencies. Ever hear of a state secret? PEPFAR’s transparency ranking is lower than that of the State Department. Military Security? The Department of Defense is better at sharing information than PEPFAR, according to the report’s findings. “Which is kind of surprising,” said Nicole Valentinuzzi from the London-based Publish What You Fund, today.
Of 67 aid-givers ranked, PEPFAR is ranked at No. 50. China is No. 67.
Why should we care? Valentinuzzi gives the example of the largest beneficiary of PEPFAR funding in 2011. That would also be the country slated soon to get the least PEPFAR funding — South Africa — now in the process of assuming “country ownership” of the response to the most severe HIV epidemic in the world. Information on how money was spent in 2011, though, was hard to find, buried in PDFs and heavily redacted, Valentinuzzi said. “This means a significant amount of money – $549 m, in fact – lacks accountability to the U.S. taxpayer,” a statement from Publish What You Fund that she sent over concludes.
The ripples of accountability go well beyond that, Valentinuzzi points out. It leaves the recipient government planning its budget in the dark. Which in the case of South Africa adds another hobble to the process of managing a response that is already challenged by staff shortages and the speed of the change. The lack of usable, comprehensible, and findable spending information, in forms that can be compared easily to other agencies’ information also leaves organizations on the ground wondering where they come in.
This leads to duplication of efforts, Valentinuzzi notes, “so resources can’t be allocated as they should be,” adding that this, too, is more important than ever at a time when resources are held close.
PEPFAR actually did better last year, when, ranked 29th out of 72 donors rated, the program received a moderate rating (it did better than the Department of Defense back then, as well as better than Unicef and China). So how is it that now, when PEPFAR has more to brag about than ever — with implementation science and cost effectiveness studies, and evidence-based action producing strategies that are reaching more people faster — it has its worst ranking since the pilot index in 2011? (It was ranked “poor” then, but still did better than the State Department, the Department of Defense, and the Department of the Treasury).
The criteria changed, is one reason, Valentinuzzi said, making it unfair to to make direct comparisons between ratings from last year to this year. That’s because donors have been responsive to calls for greater transparency, and have made more data available, she said. So this year the index focused on efforts to make the data usable and uniform — published in a format (spread sheets, rather than PDF’s) that users can search and use. “Anyone should be able to look at it and follow the money,” Valentin said.
But, Erin Hohlfelder, global health policy director of One, wrote back to Science Speaks today that PEPFAR information has become harder to find.
“Through its work over the last decade, PEPFAR has earned its reputation as an impressive, life-saving program,” she began, “But in recent years, it has become noticeably less transparent, falling behind its counterparts in the health aid world. PEPFAR can and should improve its transparency across the board—from detailing how it allocates its resources at the country level to how it accounts for its results—so that advocates, recipient governments, and US taxpayers alike can know in a timely way that PEPFAR is getting the biggest possible impact from its investments in the years ahead.”
The good news is that an excellent example isn’t far away — The U.S. Millenium Challenge Corporation is No. 1 on the index this year, with the highest transparency score of all (88.9), ahead, even of the famously open Global Fund to Fight AIDS Tuberculosis and Malaria (No. 6 this year, with a transparency score of 70.6).