PEPFAR has saved lives but, as the IOM report notes, it has the potential to save many more. While not minimizing its achievements, the IOM report notes that PEPFAR imposes limitations upon its own potential through faulty budget and resource allocation framework, on the one hand, and its failure to allow local agencies and partners, comparative and constructive autonomy, on the other.
At present, PREPFAR allocates a mere 20% to prevention and, in further constraint upon the ability and capacity of local agencies to combat the spread of AIDS, precisely articulates the prevention strategies which have to be implemented. Accordingly, it allocates a third of the prevention budget to abstinence programs, even though the latter may not be relevant within the cultural and societal environments of some of the PEPFAR target countries. As may be inferred from the IOM’s report, PEPFAR ultimately conspires against its own ability to fulfill the promise and hope which is embodied within it, insofar as its budget allocation framework is, in essence, a mandate for the misallocation and wastage of scarce and precious resources – resources upon which the lives of the 8,000 people who die of AIDS every day are dependant upon. It is from within the parameters of the aforementioned concern that the IOM’s recommends both the expansion of the budgetary resources allocated to prevention and the allowance for greater autonomy in the determination of the prevention strategies which will be deployed