Audit of the Department of State’s Coordination and Oversight of the U.S. President’s Emergency Plan for AIDS Relief

AUD-SI-20-17
    Report Contents
    Unclassified
    Unclassified


    What OIG Audited
    The United States Leadership Against Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), Tuberculosis, and Malaria Act of 2003 launched the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to combat HIV/AIDS. Since PEPFAR’s inception, the U.S. Government has committed more than $80 billion to combat HIV/AIDS in more than 50 countries. The Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (OGAC) is responsible for leading the U.S. Government’s international HIV/AIDS efforts. At overseas missions, the PEPFAR Country Coordinator is the top OGAC employee in the country. This individual’s responsibilities include coordinating and facilitating the interagency approach to PEPFAR.

    The Office of Inspector General (OIG) conducted this audit to determine whether PEPFAR Country Coordinators at selected overseas missions effectively coordinated with interagency partners and whether OGAC has overseen selected missions’ performance toward achieving PEPFAR goals. OIG performed fieldwork for this audit in Washington, DC, and overseas at Missions Kenya, Malawi, Tanzania, and Uganda.

    What OIG Recommends
    OIG made four recommendations to address the deficiencies noted with the development of Country Operational Plans (COP). On the basis of OGAC’s response to a draft of this report, OIG considers two recommendations closed and two recommendations resolved, pending further action. A synopsis of OGAC’s response to the recommendations offered and OIG’s reply follow each recommendation in the Audit Results section of this report. OGAC’s response to a draft of this report is reprinted in its entirety in Appendix C.

    What OIG Found
    OIG found that PEPFAR Country Coordinators at the four missions audited effectively coordinated with interagency partners to reach consensus on their respective COPs. However, OIG found that a majority of those whom OIG interviewed on PEPFAR country teams had concerns regarding the COP development process. Furthermore, OIG identified a lack of effective communication regarding the COP development process. Overall, across the four missions, PEPFAR country teams expressed concerns regarding performance targets, OGAC-developed COP preparation tools, and the timeline to develop the COP. Furthermore, across the four missions, PEPFAR country teams consistently expressed the belief that their input was not considered during the COP development process, especially regarding the attainability of performance targets and changes to the COP preparation tools. OGAC leadership, however, stated that performance targets were developed on the basis of country needs and that it has, in fact, sought and considered feedback regarding the tools. These conditions occurred, in part, because OGAC leadership has not effectively applied the Department of State’s leadership and management principles, especially regarding the expectation to encourage open dialogue to express differences of opinion. The lack of effective communication may affect PEPFAR program implementation efforts.

    Lastly, OIG found that OGAC established a process to oversee PEPFAR program implementation via its PEPFAR Oversight and Accountability Response Team, which conducts quarterly consultation calls with overseas missions. By implementing these consultation calls, which include an analysis of results by key performance indicators, OGAC has established monitoring and evaluation activities that foster accountability and promote the effective use of resources toward epidemic control and the attainment of PEPFAR goals.

    Recommendation Number
    1
    Closed Implemented Significant

    OIG recommends that the Office of the U.S. Global AIDS Coordinator and Health Diplomacy, in accordance with Department of State Leadership and Management Principles for Department Employees, develop and implement an action plan to promote open dialogue and trust between Office of the U.S. Global AIDS Coordinator and Health Diplomacy officials and PEPFAR country team members when establishing performance targets for the U.S. President’s Emergency Plan for AIDS Relief.

    Recommendation Number
    2
    Closed Implemented Significant

    OIG recommends that the Office of the U.S. Global AIDS Coordinator and Health Diplomacy develop and implement a communication plan on the suggested changes to Country Operational Plan preparation tools offered by U.S. President’s Emergency Plan for AIDS Relief country team members, including a mechanism to address and convey decisions on suggested changes.

    Recommendation Number
    3
    Closed Implemented Significant

    OIG recommends that the Office of the U.S. Global AIDS Coordinator and Health Diplomacy seek the assistance of an independent party to conduct an evaluation of the Country Operational Plan development process and provide options for adjustment to the timeline.

    Recommendation Number
    4
    Closed Implemented

    OIG recommends that the Office of the U.S. Global AIDS Coordinator and Health Diplomacy, in coordination with the Bureau of Human Resources, develop and implement a plan to hire full-time Civil Service U.S. President’s Emergency Plan for AIDS Relief Country Coordinators.