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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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Country Ownership/Partnership Frameworks

Moving forward, PEPFAR is increasingly focused on ensuring sustainability of HIV/AIDS programs established during the first years of its emergency phase.  PEPFAR’s primary goal is country ownership and meaningful involvement of countries as partners as efforts proceed to build their capacity.

HRSA has built partnerships—between experts in the U.S. and people and institutions overseas—to build skills and prepare host countries so that they may better manage their own programs over the long term.  Partnerships have been established with multiple indigenous agencies and thousands of individual staff members. Capacity needs are jointly identified and training is delivered so that capacity—now and in the future—can be guaranteed. 

Country Operational Plans (COPs) and other PEPFAR tools help guide activities over time as they increasingly transition to locally-managed agencies and government ministries. Sustainability is also being put into action under five-year plans for each country.  Called Partnership Frameworks, they are intended to guide the delivery of services along with development of the long-term capacity of governments to direct, manage, and ultimately finance health programs.  Sustainability also applies to how PEPFAR funds are being streamlined under a broader Global Health Initiative, where priorities are determined by recipient countries with U.S. government approval.  HRSA’s work mirrors this approach.  Efforts include:

  • Training health care workers to deliver care and supporting them through mentoring, partnerships, and other methods
  • Partnering with programs to improve the delivery of care
  • Monitoring and evaluating how services are provided
  • Building infrastructure like information systems and supply systems to manage resources wisely, and
  • Building leadership to manage programs.

photo of clinic

HRSA’s Plan for Sustainability


The HRSA/Global Program will lead the development of sustainable health systems abroad by working to integrate best practices—appropriately adapting them with in-country leadership to strengthen clinical and administrative capabilities. Areas of focus will include education and training of health professionals, care and treatment of vulnerable populations, capacity building in support of effective continuous improvement in clinical care and program administration, and quality management.