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

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Presentation on theme: "PEPFAR’s Approach to Maximize Efficiency, Effectiveness and Impact Nalinee Sangrujee, PhD MPH PEPFAR 20 April 2012."— Presentation transcript:

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

2 1. Strengthen use of economic and financial data to ensure efficient use of resources 2. Incorporate innovations that promote efficiency and allocate resources based on impact 3. Increase collaboration with governments, the Global Fund and others to align programs and target investments 4. Reduce costs by streamlining USG operations and supporting increased country ownership 5. Achieve best all-inclusive commodity pricing 6. Leverage creative mechanisms for healthcare finance to bring additional resources to bear 7. Develop and evaluation research agenda that will show how to improve efficiency and impact Source: PEPFAR Smart Investments to Increase Impact and Efficiency PEPFAR Finance and Economics Work Group

3 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 Using Cost Data to Increase Efficiency “PEPFAR is …identifying and implementing efficiencies in its work” PEPFAR Finance and Economics Work Group

4  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 PEPFAR Expenditure Analysis Initiative PEPFAR Expenditures Other External Partner Expenditures National Government Expenditures Understanding the full cost to support National HIV/AIDS Programs  Provide timely cost data and build capacity of USG teams to use cost data for improved management and efficient operation of programs PEPFAR Finance and Economics Work Group  Work with other stakeholders to ensure integration and use of PEPFAR data in broader national cost analysis efforts

5 Total PEPFAR Expenditures for Fiscal Year  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” What is PEPFAR Expenditure Analysis? … … … … … … … … … … VMMC PMTCT ART Investment Recurrent Program Management Monitoring and Evaluation Health System Strengthening Site-level Above Site- level PEPFAR Finance and Economics Work Group

6 Use of Expenditure Analysis Results for Partner Management to Improve Efficiency PEPFAR Finance and Economics Work Group 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

7 Trend Analysis PEPFAR Finance and Economics Work Group

8  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 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 Finance and Economics Work Group

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

10  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 Leveraging PEPFAR’s Resources PEPFAR Finance and Economics Work Group

11 Note: Per-patient budget allocation is estimated as treatment allocation divided by lagged end- of-reporting direct patients. Scale-Up of ART Access and Declining PEPFAR Per-Patient Costs, 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 Clear service delivery models No standard intervention models Treatment PMTCT Counseling and Testing Health System Strengthening Behavior Change and Communication OVC Number of Economic Studies PEPFAR Finance and Economics Work Group

13 THANK YOU! For additional information: Acknowledgements: PEPFAR country teams and Implementing Partners for participation in Expenditure Analysis Pilots PEPFAR Finance and Economics Work Group


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