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https://www.devex.com/news/pepfar-teams-complain-of-dictatorial-directive-and-autocratic-leadership-96576af

14 February 2020

WASHINGTON — In an audit published Thursday, the U.S. State Department’s Office of Inspector General described wide-ranging concerns about the management approach taken by the Office of the U.S. Global AIDS Coordinator and Health Diplomacy, which provides leadership for the U.S. President’s Emergency Plan for AIDS Relief.

Since its creation by President George W. Bush in 2003, PEPFAR has channeled more than $80 billion to the fight against HIV in more than 50 countries. The initiative is currently led by Deborah Birx, who was appointed U.S. Global AIDS Coordinator by President Barack Obama in 2014 and retained in her position by President Donald Trump.

The OIG audit examined programs and planning processes in Kenya, Malawi, Tanzania, and Uganda.

Many of the harshest criticisms relate to the process for creating PEPFAR’s annual country operational plans. Of 229 responses received from country team members about the COP development process, 183 — or 80% — were negative.

Several of the responses described unreasonable targets set by PEPFAR’s leaders and an unwillingness to hear feedback from country teams about why they might not be achievable.

Since Trump took office in 2017, the White House has proposed repeated cuts to PEPFAR’s budget, which the U.S. Congress has rejected every year. Birx has responded to budgetary pressure by emphasizing the importance of prioritizing resources for the places and interventions in which they can be most effective in helping countries achieve epidemic control.

In addition to concerns about performance targets, country team members cited broader issues related to OGAC’s management approach. Of 68 statements the inspector general’s office received about OGAC’s leadership, 49 — or 72% — were negative. The auditors cited responses that described OGAC’s leadership as “dictatorial,” “directive,” and “autocratic.”

In a written response to the audit that is dated Jan. 27, 2020, Birx wrote that her office was “pleased” with the findings related to “effective coordination and oversight of the PEPFAR interagency partners, program and performance.”