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PEPFAR will need leadership and signposts on its path to sustainability

Thursday, January 21st, 2016
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Please see below for a guest post from Dr. Tessie San Martin, President and CEO of Plan International USA and MFAN Executive Committee member.


PEPFAR’s success as an emergency health program is unquestionable and (in many respects) unparalleled.  As Amanda Glassman recently noted, the number of people receiving HIV/AIDS treatment in low and middle income countries has gone from 300,000 in 2003 to almost 14 million in 2015 – and about half of this is supported by the US Government.  PEPFAR’s major challenge today is making these gains permanent and the on-going epidemic control efforts sustainable everywhere, even while acknowledging that the same funding levels are not likely to be sustained.

PEPFAR’s Sustainability Action Agenda, launched in 2015 as part of PEPFAR 3.0, recognizes that many countries are in a position to “advance domestic HIV/AIDS investments and assume greater partner country responsibilities for increased financing, management and implementation – but the seeds for this evolution must be sown early.” In this context, PEPFAR’s Sustainability Index is an important tool for advancing towards sustainability objectives. As PEPFAR 3.0 says, the Index should inform annual investments to steadily advance sustainability across critical areas. These metrics, sign-posts and feedback loops will be critical for meeting PEPFAR’s related goal to “hardwire sustainability within PEPFAR’s business practices.”

This is an ambitious agenda that Plan supports on our own and through the Modernizing Foreign Assistance Network (MFAN).  The path to sustainability – to aligning your programs and initiatives to local priorities which are jointly implemented and co-financed — will provide the best opportunities for lasting impact. Plan International, a $1 billion/year organization, operating in 70+ countries, has a bit of experience (some good and some not so good) pushing for a transition from service delivery to sustainable locally-owned programming. So allow me to make a couple of observations about this challenge.

First, I will note that this will not be achieved (certainly not be achieved everywhere) in 3 to 5-years.  So being realistic about what is achievable by when is important.  Also, signposts of progress towards that ultimate goal are essential. Otherwise, it is too easy to focus only on rapid service delivery at the cost of enduring progress.

Second, we should be clear about how we are defining as a path to sustainability.   For Plan, the ultimate measure of sustainability is when local governments, civil society, the private sector or some combination fund an initiative that had been previously funded by Plan. When this happens, Plan can step aside as a donor and service provider and exit the area. Independent ex-post evaluations have shown that these results outlast Plan’s investments with both local funding and local activism clearly evident 5 to 9 years later.  We are mindful that money is fungible and of what is being displaced, so we evaluate not just what is being funded but how local civil society is engaged and exercising social accountability at the community level.

By the way, Plan research has also found that even where Plan has developed very strong local capacity, local partners all too often continue to view Plan as the owner. And as Plan, we have too often treated local NGOs as service delivery mechanisms.  Further progress towards sustainability requires consistent actions from Plan’s leadership and staff that demonstrate our commitment to yield power to local actors, to trust local processes.

As a multi-billion dollar, high-profile program of the US government, PEPFAR will likely face a number of these same challenges as it seeks to shift the perceptions of partner governments, implementing partners and staff.  If Plan’s experience is any guide, the shifting of internal business practices to build sustainability into “all planning and implementation processes at the outset,” is a goal that only the attention of the most senior executive leadership can advance effectively. We applaud Ambassador Birx’s attention to these central topics at PEPFAR. We look forward to hearing more from the Ambassador and our development community colleagues about the lessons PEPFAR and its partners have learned when it comes to embedding sustainability at today’s MFAN-Plan Policy Event at the National Press Club.

MFAN and Plan Host U.S. Global AIDS Coordinator Ambassador Birx to Discuss PEPFAR’s Sustainability Agenda

Wednesday, January 20th, 2016
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WASHINGTON, January 20, 2016 – On Thursday, January 21st, MFAN and Plan International USA will host U.S. Global AIDS Coordinator & Special Representative for Global Health Diplomacy Ambassador Deborah Birx for a keynote address, followed by a panel of development experts for a discussion of The U.S. President’s Emergency Plan for AIDS Relief’s (PEPFAR) Sustainability Agenda.

The event will be held from 2:00 – 3:30 in The Holeman Lounge at the National Press Club (529 14th St. NW, 13th Floor). Carolyn Miles, President and CEO of Save the Children and MFAN Co-Chair, will introduce Ambassador Birx, and Dr. Jeffrey Sturchio, President and CEO of Rabin Martin, will moderate the panel.

Panelists include:

  • Janis Timberlake, Director of Sustainability and Development, Office of the U.S. Global AIDS Coordinator
  • Tessie San Martin, President & CEO, Plan International USA
  • Amanda Glassman, Vice President for Programs and Director of Global Health Policy, Center for Global Development
  • Jennifer Kates, Director of Global Health & HIV Policy, Kaiser Family Foundation

PEPFAR, the U.S. government initiative to help save the lives of those suffering from HIV/AIDS around the world, is the largest commitment by any nation to combat a single disease internationally. PEPFAR is driven by a shared responsibility among donor and partner nations to make smart investments to save lives.

The program is now in Phase 3 (2013-present) and is focused on transparency and accountability for impact, as well as accelerating core interventions for sustainable epidemic control. PEPFAR is investing resources strategically and geographically to reach populations at greatest risk with evidence-based programs. PEPFAR’s Sustainability Action Agenda, launched in 2015 as part of Phase 3, recognizes that many countries are in a position to take on greater responsibilities for increased financing, management, and implementation of key lifesaving programs.

MFAN and Plan believe that accountability and local ownership are vital prerequisites to enable leaders and citizens in developing countries to take responsibility for their own development. We have been pleased to see PEPFAR prioritize the Sustainability Action Agenda as part of Phase 3, recognizing that many countries are now in a position to assume greater responsibility of financing, managing, and implementing programs to combat HIV/AIDS.

At Thursday’s discussion, we will welcome experts from leading international development organizations and PEPFAR representatives to discuss PEPFAR’s shift toward sustainability, how this connects to country transitions, and what lessons have been learned.

NOTE TO EDITORS: Please RSVP to Jill MacArthur,


Ambassador-at-Large, Deborah L. Birx, M.D., is the Coordinator of the United States Government Activities to Combat HIV/AIDS and U.S. Special Representative for Global Health Diplomacy. Ambassador Birx is a world-renowned medical expert and leader in the field of HIV/AIDS. Her three-decade-long career has focused on HIV/AIDS immunology, vaccine research, and global health. As the U.S. Global AIDS Coordinator, Ambassador Birx oversees the implementation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest commitment by any nation to combat a single disease in history, as well as all U.S. Government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria. Serving as the U.S. Special Representative for Global Health Diplomacy, she aligns the U.S. Government’s diplomacy with foreign assistance programs that address global health challenges and accelerate progress toward: achieving an AIDS-free generation; ending preventable child and maternal deaths; and preventing, detecting, and responding to infectious disease threats.

About MFAN

The Modernizing Foreign Assistance Network (MFAN) is a reform coalition composed of international development and foreign policy practitioners, policy advocates and experts. MFAN was created to build upon the bipartisan consensus that has emerged over the last decade that the U.S. should play a leadership role in achieving economic growth and reducing poverty and suffering around the world, and that we can play this role more effectively, efficiently, and transparently.

MFAN is dedicated to working with the Administration, Congress, and the development community to advance a reform agenda that will make U.S. development assistance and policy work harder for the American people and for people in developing countries. We believe that successful reforms will maximize the impact of our assistance, and will help to ensure support in the future among policymakers and the American people for the resources necessary to maintain development as a pillar of U.S. engagement.

For more information, please visit:

About Plan International USA
Plan International USA, part of the Plan International Federation, is a child-centered development organization that believes in the promise and potential of children. For more than 75 years in over 50 developing countries, Plan has been breaking the cycle of child poverty.  Everything Plan does  – from strengthening health care systems to improving the quality of education, to advocating for increased protection and beyond – is built with, and owned by, the community. The result is a development approach designed to improve the lives of the youngest members of the community for the longest period of time.

For more information, please visit

Glazing Eyes But Warming Hearts

Tuesday, December 22nd, 2015
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See below for a guest post from Diana Ohlbaum, Co-Chair of MFAN’s Accountability Working Group


No, it’s not a hot toddy – it’s the State Department’s Foreign Assistance Data Review, quietly released last week.  Unless you’re a data geek, this is not a report you’ll want to curl up in front of the fire with.  It’s the kind of thing that makes one’s eyes glaze over, but a sober assessment leads to the conclusion that this is a big win for MFAN in 2015.  Here’s why:

First, a wide range of participants from nearly every regional and functional bureau in the State Department recognized that existing systems are not being fully utilized to track or report on foreign assistance programs.  The group met monthly to map out the current processes and identify quick fixes and long-term solutions.  Just getting people to see the lack of transparency as a problem and come up with a plan for addressing it is a victory in itself.

Second, the report came up with key recommendations for advancing State’s ability to monitor and manage its own programs as well as to report on them more comprehensively and transparently.  The first recommendation (designated as Phase II, since the first phase was the review itself) is to develop a standardized process for managing and tracking all foreign assistance projects across their full lifecycle, and allow for accurate reporting.  This work has already begun, and is expected to take three to four months.

The next recommendation is to do exactly what MFAN and Publish What You Fund have been advocating: developing “a costed management plan and timeline for the necessary system changes to supplement the business process improvement in managing foreign assistance.”  English translation: they will figure out what kinds of computer upgrades are needed, how long this will take, and what it will cost.  This step, Phase III, is expected to take six to seven months.

The final stage will be to implement whatever new computer systems and processes are needed to enable State to fulfill all its reporting commitments, including the International Aid Transparency Initiative, and make more data-driven decisions.  The Office of Foreign Assistance Resources hopes to put this in motion before the end of the administration.

Ultimately, the breakthrough here isn’t that State now feels obligated to be more transparent.  It’s not that they are doing MFAN a favor or have buckled under to MFAN’s pressure.  The significance of this review is that the State Department has begun to understand that they need accurate, comprehensive, reliable, comparable and timely data in order to fulfill their own, internal responsibilities to oversee, manage and implement aid effectively.  And once they are truly invested in producing good quality data for their own uses, it will be a lot easier to get them to share it with other stakeholders, who can verify it and provide feedback.

I’m not certain that the Foreign Assistance Data Review would have occurred without MFAN’s urging and encouragement.  But it does appear that State’s heart is in this now, and that brings great comfort and cheer to all of us in the holiday season.

Making U.S. Foreign Aid Not-So-Foreign: Taking Stock of Our Aid Transparency Progress

Monday, December 21st, 2015
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See below for a guest post by Dennis Vega, Managing Director for Planning, Performance, & Systems at the Office of U.S. Foreign Assistance Resources, U.S. Department of State. This is the second post on the topic of transparency for our ACCOUNTdown Dialogue Series.


The end of 2015 marks an important milestone for the U.S. government’s efforts to increase foreign aid transparency: in 2011 on the eve of the fourth High Level Forum on Aid Effectiveness in Busan, South Korea, the U.S. pledged to publish foreign aid data in the internationally agreed upon standard with a goal for providing comprehensive data for the available elements by the end of 2015. This pledge was not a matter of ceremony – we believe that open government leads to better government and, by extension, aid transparency has the potential to change lives. The U.S. is committed to increasing transparency and the quality of data to help recipient governments manage aid, empower citizens, and support data-driven development. By making our own government more transparent, we are applying fundamental principles of our foreign policy – openness and accountability – at home, as well as abroad.

Since the fourth High Level Forum in 2011, the U.S. government has made more data open to the public than ever before.  The State Department coordinates across more than 20 U.S. government agencies to make foreign assistance data publicly available on and the International Aid Transparency Initiative (IATI) registry. Originally built with one data set in 2011, the data on now represents 98 percent of the U.S. foreign assistance portfolio – over $30 billion of annual programming. And, vast improvements have been made in the quality and comprehensiveness of the data. In 2016, anyone with an Internet connection will be able to link U.S. foreign assistance dollars to results at the country level by running analyses on a single data set!

In the early days of our efforts, there was a great need to educate some federal agencies on the value of aid transparency; among many other demands on staff time and resources, working towards aid transparency was often seen as something that would be nice to do – but not a priority. Over the past five years, agencies have evolved in their stance of the value of transparency. Now, rather than being seen as a mandate, agencies are now coming to the team to discuss ways to improve data quality. We are encouraged by these conversations and will continue to foster them.

While there is much to celebrate, this journey has not been without its challenges, and we acknowledge the U.S. will fall short of its goal to fully publish foreign aid data to IATI at the end of this year.  While the agencies on represent 98 percent of all foreign assistance, we do not have complete data sets for any of the 10 agencies. These gaps are due to IT system limitations, a variety of business models, and resource constraints. Aid transparency is a significant priority for the U.S. government, but efforts to increase our data must compete against other pressing and immediate issues each agency manages. Difficult trade-offs have to occur between deploying resources to address urgent global challenges and allocating resources for aid transparency improvements.

Furthermore, business models and budget processes within the U.S. government will continue to fall short of the full IATI standard.  IATI requests budget forecasts for three years, but the U.S. government only produces single year budgets. In other cases the IATI standard requests detailed information falling into the category of personally identifiable information the U.S. government doesn’t release.

Finally, as timely reporting is desirable, we need to automate data collection. This requires the use of systems which were never designed to collect and report the level of detail required by our transparency commitments. This disconnect between the data we want and the data we have is our biggest challenge. Changing systems or building new systems is costly and lengthy. It is important for us to acknowledge these challenges and have an open dialogue with the community.

Nevertheless, we are committed to increasing transparency, and the recent public release of the State Department’s first-ever Foreign Assistance Data Review findings and recommendations document illustrates this commitment. The recommendations in this review will improve the Department’s ability to use data for informed decision-making and help meet transparency commitments.

We know there is more to be done, and we have set the wheels in motion on several initiatives to accelerate progress in 2016. We launched our toolkit to assist agencies who are not yet reporting, and we are working with the Office of Management and Budget to develop a comprehensive, standard data inventory for all agencies.

For the first time, the 2015 U.S. National Action Plan for Open Government included a commitment to engage in selective capacity building efforts to promote foreign assistance data use.  Recommendations on how to implement this commitment will be drawn from USAID’s Aid Transparency Country Pilot Assessments released in May 2015.  At the State Department, we are engaged in several efforts to promote data usage. Through the Department of State’s Public Private Partnership with universities, the Diplomacy Lab, we recently completed a three month project with students at the University of California-San Diego and the University of Notre Dame on improving usability of the data on The findings and recommendations will directly guide our improvement efforts in 2016. We are also working through the Department’s Office of eDiplomacy to better use technology to engage with stakeholders globally.

These accomplishments and subsequent dialogue would not have been possible without the support and encouragement from the aid transparency community. Their advocacy is instrumental in advancing the policy agenda and raising awareness to senior leaders across agencies.  The community pushes us to rapidly improve and constructively works with us to make advances. The Modernizing Foreign Assistance Network’s (MFAN) advocacy and Publish What You Fund’s technical support is critical. The community’s expertise, experience, and perspective are key inputs into our decision-making process. Through our consultative partnership, we have improved our approach to transparency.

We are proud of the many advances in our aid transparency journey and are learning from the obstacles that emerge along the way. As global actors come together to achieve the Sustainable Development Goals over the next 15 years, our collective commitment to data-driven decision-making will be essential to solving globally pressing issues and measuring progress. Whether you are member of the advocacy community, an implementer of foreign assistance, an academic, or a government employee, we all believe that open government leads to better government. So we’ll continue to push together to do more, faster, to make our government better.

Letter to USAID Administrator Gayle Smith: Priorities for 2016

Monday, December 21st, 2015
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December 18, 2015

The Honorable Gayle Smith
U.S. Agency for International Development
Ronald Reagan Building
Washington, D.C. 20523
Attn: Ms. Michele Sumilas

Dear Gayle:

On behalf of the Modernizing Foreign Assistance Network (MFAN), we wish to congratulate you once again on your confirmation as Administrator of USAID. We stand ready to work with you to confront the numerous development challenges and humanitarian crises around the world, and to ensure the reforms initiated by this Administration are achieved and institutionalized for future leaders.

To solidify the Obama Administration’s global development legacy and to achieve its ambitious goal of ending extreme poverty by 2030, we hope you will urgently prioritize the following:

1.Establish Public Metrics of Sustainability and Institutionalize Local Solutions: High-level commitment is needed to deepen the agency’s work on sustainability and country ownership. USAID’s Local Solutions initiative is an important step to advance inclusive country strategies and programs that work with local partners to build country ownership. Embedding this approach across the agency will require both your political leadership and the establishment of agency-wide metrics of sustainability and country ownership. MFAN’s Metrics for Implementing Country Ownership paper and a recent GAO report on Local Solutions (GAO-15-377) both called for metrics to assess partner-country capacity, ownership, and sustainability. USAID reported that it would complete such indicators by December 31, 2015.

  • We urge you to champion Local Solutions and ensure that USAID publicly releases and implements agency-wide indicators of sustainability and country ownership, so that progress in these areas can be evaluated.

2.Catalyze Local Resources and Support Local Priorities

Where countries are willing, United States assistance can be transformational: encouraging them to generate more of their own revenue and spend it on development priorities, paving a path toward long-term poverty reduction and self-reliance. Recognizing the catalytic impact of such investment, at the 2015 Financing for Development Conference the United States committed to doubling support for public sector domestic resource mobilization over the next three years.

  • To ensure the success of this effort, President Obama’s FY17 budget request should put the U.S. on a transparent path to fulfill its Addis Tax Initiative commitment to double total support for public sector domestic resource mobilization in three years. This should be: a cross-agency effort, with a funding baseline for doubling that includes USAID, Treasury, and PEPFAR; consistent with MFAN’s principles of public sector domestic resource mobilization; and accomplished without establishing additional earmarks or directives.
  • In keeping with the President’s development vision outlined in the Presidential Policy Directive (PPD) #6, USAID should work with the aid community and Congress to reduce earmarks and directives and better align investments with country priorities.

3.Fulfill Major Commitments to Foreign Aid Transparency and Accountability

USAID has made significant gains in the amount and quality of data published under the International Aid Transparency Initiative (IATI), including developing and approving initial phases of a management plan to achieve full compliance with the international standard. Yet the ultimate value of the data is in its use.  USAID should build on its early steps – a three-country pilot study and an expanded foreign aid transparency commitment in the new U.S. National Action Plan for the Open Government Partnership – and deepen efforts to understand how foreign aid data is being used and how to increase its utility.

  • We encourage you to continue to prioritize improvements in transparency by supporting the bipartisan, bicameral “Foreign Aid Transparency and Accountability Act” (H.R. 3766/S. 2184) that was recently approved unanimously by both the House of Representatives and the Senate Committee on Foreign Relations.
  • We urge you to invest in the capacity of local actors to utilize data and by raising awareness of the importance of local data use among country counterparts and within USAID missions themselves.  Making data available in the official language of the partner country is one important step that will enhance the usability of the data.

4.Institutionalize Policy and Budget Functions

Much of USAID’s recent policy dynamism can be attributed to the restoration of its policy and budget functions under this Administration. Institutionalizing these core structures is vital to the President’s goal of reestablishing “the United States as the global leader on international development” and his “long-term commitment to rebuilding USAID as the U.S. Government’s lead development agency and as the world’s premier development agency,” as outlined in PPD-6.

  • We encourage you to more deeply embed the policy and budget functions of USAID.

5.Continue to Prioritize Food Aid Reform

Reform of U.S. food assistance that enables greater reach and impact would be a profound addition to the legacy of this Administration.

  • We urge you to make U.S. food aid reform one of your top budget and legislative priorities, and strengthen engagement with Capitol Hill. Congressional support is critical to making food assistance more effective at reaching millions of additional vulnerable people worldwide.

You, better than anyone, understand how important these initiatives are to USAID being an effective development agency, an objective we hold in common. Please let us know if and how we can be of assistance.

With warm regards,

George Ingram
MFAN Co-Chair
Brookings Institution

Carolyn Miles
MFAN Co-Chair
Save the Children

Connie Veillette
MFAN Co-Chair
The Lugar Center