PEPFAR Activities Have a Beneficial Effect on Overall Health Outcomes

The President's Emergency Plan for AIDS Relief (PEPFAR) initiative has been criticized for being too focused on one disease and not working to strengthen health systems in partner countries. In a recent analysis, researchers evaluated whether PEPFAR activities have been directly associated with system-wide improvements.

The researchers compared 12 non-HIV World Bank database indicators of health-system strengthening between 12 sub-Saharan African countries that had generalized HIV epidemics and had received PEPFAR funding (focus countries) and 29 such countries not included in the program (control countries) over two time periods: 1995 to 2002 (pre-PEPFAR) and 2004 to 2010 (during PEPFAR).

Proximal indicators of health-system strengthening such as tuberculosis (TB) prevalence, TB case detection, and TB treatment–completion rates were significantly improved in focus countries after PEPFAR implementation. Life expectancy, a distal indicator of health-system strengthening, increased significantly faster in focus countries than in control countries after PEPFAR implementation. Although other distal indicators such as infant and under-5 mortality rates decreased faster in focus countries than in control countries after PEPFAR implementation, the difference was not significant. The implementation of PEPFAR did not appear to have an effect on vaccination rates but did not divert resources from other public health activities.