Ep 18: USAID, Global Health, and PEPFAR

Today, panelists, Ashley Frost and James Maloney, Deputy Directors, Office of HIV/AIDS USAID, discussed USAID's localization initiative, locally-led development, and the importance of diversified local partners. They discuss USAID's Global Health work, how USAID supported PEPFAR and the successes it has enjoyed, including statistics of lives saved and changed.

James Maloney and Ashley Frost share the new PEPFAR five-year strategy, the USAID Approach to HIV and Optimized Programming (AHOP). AHOP is a framework for USAID to employ assets through efficient, measured, and simplified programmatic approaches to ensure resilient and country-led approaches to the HIV response. The AHOP defines five critical pathways through which USAID will assist countries in sustaining epidemic control and accelerating progress in those that have not yet achieved the 95-95-95 goals. Each pathway outlines planned results and time-bound milestones. If this resonates with you, share successes with Congress to fund the five-year reauthorization of PEPFAR.

IN THIS EPISODE:

• [00:32] Mike Shanley outlines key talking points regarding the accomplishments that PEPFAR has achieved over the last 20 years, delivering unprecedented impact in the global fight against HIV AIDS.

• [02:57] Ashley Frost and James Maloney describe their roles at USAID as Deputy Directors.

• [04:40] Discussion where funding originates, the investments they make at the primary healthcare level, and successes they have accomplished through PEPFAR, stating that USAID is the largest donor and they are advancing work in the HIV vaccine space.

• [11:00] James shares statistics of the impact made in the world attributed to PEPFAR and reflects on the history of growth and prevention.

• [14:50] Discussion of localization, local entities and partners and relationships within country-led staff and senior diplomats in their countries.
  [20:06] Looking forward to goals and objectives, James discusses the AHOP framework in response to HIV.

• [25:24] Ashley comments on the importance of keeping an open dialogue between all partners within the HIV AIDS space, and James outlines the importance of seeing the 5-year reauthorization of PEPFAR.

KEY TAKEAWAYS:

• Oftentimes, hospitals and building new infrastructure is what gets a "ribbon cutting", but in terms of buying the best health outcome with USAID's investments from U.S. taxpayers, the first area of importance is investments made at a primary care level, which will most impact healthcare outcomes, saving lives and supporting healthy lives. The second thing that drives a lot of USAID's investments across individual disease or health areas is health security.

• Much of PEPFAR's success lies in engaging with local partners. With regard to localization, the Office of HIV AIDS and the Global Health Bureau have been the front runners in the agency and have been able to guide our agency in these spaces. Right now, about 58 percent of our resources are implemented through local entities, and those sets of partners have been diversified. Small business engagement in the U.S. is essential and has much to offer to the work we can accomplish together. More significant international partners have specific skill sets that are necessary for USAID. As we think about localization, everyone needs to think outside the box and remember that one size does not fit all.

• By the end of 2025, the vision is to help countries reach what the USAID calls the global commitment of 95-95-95 goals. That means that 95 percent of those who have HIV know their status. 95 percent of those individuals are on treatment, and 95 percent of those individuals would be virally suppressed. The AHOP defines five critical pathways through which USAID will assist countries in attaining these goals.

RESOURCES:

Aid Market Podcast

Aid Market Podcast YouTube

Mike Shanley - LinkedIn

James Maloney - LinkedIn

USAID Approach to HIV and Optimized Programming

BIOGRAPHIES:

James Maloney has served as the Deputy Director for the Office of HIV/AIDS (OHA) within the Global Health Bureau at the United States Agency for International Development (USAID) since March 2020. OHA provides overall programmatic guidance for USAID's implementation of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and oversight of $4 billion in 53 countries. In March 2022, following Russia's invasion of Ukraine, James was asked to support the National Security Council Global Health Development Directorate and serve as the Coordinator for the Ukraine and Regional Health working group. In October 2022, James was designated as the Senior Operations Official for the Global Mpox Response Team and has led coordination of the United States' global response to mpox. Previously, James led the Supply Chain for Health Division at USAID overseeing over $700 million per year in HIV commodity procurement and supply chain management to advance HIV epidemic control and strengthen the capacity of countries to manage health supply chains. Prior to joining USAID Washington, James served as Senior Technical Advisor from 2015 to 2018 with USAID Haiti managing primary health care and supply chain programs to improve the availability, quality and utilization of health services in the areas of maternal and child health, HIV and TB, reproductive health, nutrition, and WASH. Prior to Haiti, James worked in South Africa from January 2010 with the Department of State and served as the Country Coordinator for PEPFAR and lead the U.S. Government's interagency response to HIV/AIDS in South Africa.

Ashley Frost joined the Office of HIV/AIDS (OHA) as Deputy Director in August 2023. As a Foreign Service Officer, she most recently served as Health Office Director for USAID/Southern Africa. Over the last decade, she has served as Deputy Director for Operations, Care and Treatment Lead, and Strategic Information (SI) Lead, supporting USAID's PEPFAR programming in South Africa, Zambia, and Guatemala/Central America. Ashley holds a Ph.D. in Sociology and Demography from Penn State University, and her academic work includes quantitative and qualitative research in HIV, reproductive health, and gender. Before joining USAID in 2011, she worked with Congressional staff members, international researchers, policymakers, and program managers to improve evidence-based decisions for public health outcomes. She served as an education Peace Corps Volunteer in Benin, West Africa.

Fun Facts: Ashley has three sons (ages 12, 9, and 9), and they do many sports as a family! They spend their free time jogging, biking, hiking, and attending many soccer games. Ashley and her husband, Jason, are section hiking the Appalachian trail each year and have walked through Georgia, North Carolina, and Tennessee together. Degrees: MA, PhD in Sociology and Demography, Languages: English, Spanish, French (comprehension)