By Bunmi Yekini
The amfAR on Tuesday warned that new agreements underpinning the United States’ global HIV response risk weakening oversight and accountability, as countries take on greater responsibility for programmes funded by Washington.
In a report titled “Unmeasurable and Unaccountable,” the organization examined seven Memoranda of Understanding (MOUs) signed under the America First Global Health Strategy with countries including Nigeria, Kenya and Uganda, focusing on how they track progress in combating HIV.
The agreements are tied to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), one of the world’s largest HIV/AIDS initiatives, which is gradually shifting from U.S. funding toward greater country-level ownership.
While the MOUs aim to encourage domestic investment and long-term sustainability, amfAR said the current framework lacks the metrics needed to ensure effective oversight of billions of dollars in U.S. health spending.
“The metrics are incapable of providing any basis for reasonable and necessary oversight,” the report said, adding that the agreements also fail to establish a clear pathway toward more meaningful performance indicators in future phases of the HIV response.
Transparency concerns
The report also highlighted confidentiality provisions that could limit access to key data, warning that information on programme performance may be restricted to U.S. officials and host governments.
Brian Honermann, a policy official at amfAR and lead author of the report, said the arrangements could leave U.S. taxpayers dependent on foreign governments for access to information about how funds are used.
“That’s unacceptable,” he said, arguing that oversight mechanisms should remain robust as financial responsibility shifts.
Risks to a flagship programme
PEPFAR has long been praised for its transparency and measurable targets, helping to save millions of lives since its launch in 2003. But amfAR cautioned that weakening those features could undermine its effectiveness.
“Gutting what made the programme impactful will squander millions of U.S. taxpayer dollars and may place just as many lives at risk,” said Greg Millett, a senior policy official at the organization.
The report comes as global health agencies and governments seek to balance donor support with greater national ownership of HIV programmes, amid ongoing efforts to sustain progress against the epidemic.