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Tough Times, Tough Choices: Charting PEPFAR’s Next Chapter While Safeguarding Its Legacy
The US administration is shaping a new approach to the future of PEPFAR which emphasises greater country ownership and government-to-government support, paired with a reduction in financial assistance.
In a new brief, we propose a differentiated three-track framework to guide a responsible PEPFAR transition in 55 recipient countries.
- Track 1 – Graduation: For wealthier and stable partner countries able to feasibly absorb PEPFAR funding on a relatively rapid timeline, following a phased shift of service delivery to government systems.
- Track 2 – Toward self-reliance: For poorer, higher-burden countries, allowing extended timelines to gradually increase domestic financing while sustaining PEPFAR funding for key treatment and prevention outcomes.
- Track 3 – Compassionate: For the poorest and most fragile countries where sustained PEPFAR investment is required, with potential scope for partial service delivery via national systems in some settings.