Fiscal Year 2023 Inspectors General Coordinated PEPFAR Oversight Plan

The U.S. government provides foreign assistance to fight HIV/AIDS, tuberculosis, and malaria— three of the world’s deadliest infectious diseases—to help stem human suffering, economic loss, and political instability in developing countries. In 2003, the Bush administration established the President’s Emergency Plan for AIDS Relief (PEPFAR), and Congress passed the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act. The act established the Office of the U.S. Global AIDS Coordinator and Health Diplomacy (OGAC) at the U.S. Department of State (State) and gave OGAC primary responsibility for coordinating all resources and international activities of the U.S. government to combat the HIV/AIDS epidemic.

OGAC allocates funds to PEPFAR-implementing agencies, particularly the Department of Health and Human Services’ (HHS) Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID).¹ The CDC and USAID, in turn, provide funds for HIV treatment, care, and prevention activities through grants, cooperative agreements, and contracts with selected implementing partners, such as U.S.-based and international nongovernmental organizations (NGOs) and partner-country governmental entities. The Peace Corps also allocates PEPFAR funds for health-related programming; its Volunteers manage some grants and serve as health Volunteers.

The offices of inspectors general (OIGs) of the implementing agencies are required to coordinate their activities and jointly develop coordinated annual plans for oversight to avoid duplication and maximize efficiency.² In addition to joint annual planning, the implementing agencies began meeting periodically in 2017 to share information and discuss planning. This closer cooperation led the respective OIGs to begin holding quarterly meetings in 2018; include the Peace Corps OIG and the Government Accountability Office; and increase cooperation on overseas audits and investigations of efforts to combat HIV/AIDS, tuberculosis, and malaria. In 2020, quarterly meetings began addressing the impacts from the COVID-19 pandemic on PEPFAR oversight efforts and identifying areas where PEPFAR and COVID-19 oversight intersect.

In 2021, the OIGs initiated a new effort to enhance and deepen coordinated oversight and established a PEPFAR Coordinated Oversight Working Group to plan contemporaneous audits addressing common themes across their respective agencies. The FY 2022 plan included a coordinated proposal for USAID and HHS OIG to examine controls over reprogramming of PEPFAR funds for COVID-19. This plan includes a second coordinated proposal for USAID and HHS OIG to examine PEPFAR’s engagement with civil society organizations in annual planning, community-led monitoring, and COVID-19 response. While each OIG will conduct its work independently, their collective oversight of crosscutting issues is intended to provide greater insight and utility for Congress and key stakeholders. We look forward to continued engagement by the agencies, Congress, and other key stakeholders around the world as we implement this plan during FY 2023.

_{¹ Other implementing agencies are the Peace Corps and the Departments of State, Defense, Labor, and Commerce. Other HHS offices and agencies receiving PEPFAR resources are the Office for Global Affairs, the Food and Drug Administration, the Health Resources and Services Administration, the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration.}

_{² The coordinated plan is required by the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, Public Law 108-25, as amended by the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, Public Law 110-293; the PEPFAR Stewardship and Oversight Act, Public Law 113-56; and the PEPFAR Extension Act of 2018, Public Law 115-305.}