PEPFAR is one of the most popular, bipartisan US foreign aid programs. The State Department says it has saved 25million lives, but there isn't much public, independent verification. Last week I invited some friends to a weekend hackatjon to see if PEPFAR's numbers held up.
What we found was that, yeah, there's a pretty strong case for PEPFAR. Even using conservative assumptions and ignoring many of its positive impacts, our best guess is that the program indeed saved 19million lives by 2018.
We also got an appreciation for why PEPFAR is considered such a star program. Real funding for PEPFAR has been decreasing since 2009, but the program has been doing more over time, because costs have been in freefall. When it started each patient cost $1000/month. Now? $5/mo.
My main contribution to this group report was looking at whether there were significant rates of fraud and misreporting. I read PEPFAR-related audits from the office of the inspector's general. They consistently demanded very high standards of documentation and found <2% fraud.
You can read our report here: pepfarreport.org.
Overall, I came away with an appreciation for why, when you ask people in Congress which foreign aid program they're genuinely proud of, so many of them name PEPFAR. It has done an astonishing amount with 0.08% of the federal budget. I read the procedures for how they make sure clinics aren't overreporting patients with quarterly checkins to see if documented clinic attendance matches reported attendance. I read the accounting procedures. PEPFAR is very serious about oversight.
But while some programs get so caught up in documenting what they do that overhead swallows the results, PEPFAR also has really, really good results. Because HIV is such a killer in the regions where PEPFAR operates, you can see PEPFAR's effects directly from national-level mortality records. Calculating the program's lives saved with a differences-in-differences approach from national-level mortality records gets results prettyy similar to the results you get from looking at the benefits of ART. So using several different methodologies, we ended up highly confident that PEPFAR has indeed saved many millions of lives in a highly cost effective way, and our median estimate is about the State Department's. But don't trust us - read our work! The report lays out our assumptions, our questions, our skepticisms, and which papers we drew on. It was a joint project by people coming from a wide range of backgrounds and across the political spectrum. It is a real, sincere effort to take an independent look at this question.
It is also a work in progress. It's fact checked and we engaged with external reviewers, but that doesn't mean we're done. We'll be engaging with questions, adding to the FAQ, and making any corrections if they are necessary. The decision of whether to reauthorize PEPFAR and how to improve it is a big one and we want to make sure that everyone, Republican or Democrat or distrustful of both parties, has the tools to make up your mind on this one yourself.
Overall, I came away with an appreciation for why, when you ask people in Congress which foreign aid program they're genuinely proud of, so many of them name PEPFAR. It has done an astonishing amount with 0.08% of the federal budget. I read the procedures for how they make sure clinics aren't overreporting patients with quarterly checkins to see if documented clinic attendance matches reported attendance. I read the accounting procedures. PEPFAR is very serious about oversight.
But while some programs get so caught up in documenting what they do that overhead swallows the results, PEPFAR also has really, really good results. Because HIV is such a killer in the regions where PEPFAR operates, you can see PEPFAR's effects directly from national-level mortality records. Calculating the program's lives saved with a differences-in-differences approach from national-level mortality records gets results prettyy similar to the results you get from looking at the benefits of ART. So using several different methodologies, we ended up highly confident that PEPFAR has indeed saved many millions of lives in a highly cost effective way, and our median estimate is about the State Department's. But don't trust us - read our work! The report lays out our assumptions, our questions, our skepticisms, and which papers we drew on. It was a joint project by people coming from a wide range of backgrounds and across the political spectrum. It is a real, sincere effort to take an independent look at this question.
It is also a work in progress. It's fact checked and we engaged with external reviewers, but that doesn't mean we're done. We'll be engaging with questions, adding to the FAQ, and making any corrections if they are necessary. The decision of whether to reauthorize PEPFAR and how to improve it is a big one and we want to make sure that everyone, Republican or Democrat or distrustful of both parties, has the tools to make up your mind on this one yourself.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
