An analysis of project expenditures and results under different PEPFAR partnership models: Nigeria SIDHAS

The project is managed by an international prime partner, FHI 360, and involves two types of subpartners: local subrecipients and primary subpartners. The analysis of project expenditures and results under different partnership models was conducted by Data.FI using standardized PEPFAR expenditure reporting (ER) data and PEPFAR monitoring, evaluation, and reporting (MER) data. The analysis included two projects, but the focus was on SIDHAS, which operates in 13 states in Nigeria. The project works to integrate HIV/AIDS and TB care by building the country's capacity to deliver high-quality, comprehensive prevention, treatment, and services. The prime partner accounted for 16 percent of SIDHAS project expenditures, mostly categorized as project management expenditures. Primary subpartners accounted for 52 percent of expenditures, with the largest share of expenditures being for care and treatment. Local subrecipients accounted for about one-third of expenditures, with the majority of expenditures being for care and treatment as well. The analysis compared the breakdown of results with reported expenditures for local subrecipients by mapping both to states. The results showed that among the states, Akwa Ibom accounted for the largest portion of expenditures and results for both HIV testing services and care and treatment. This finding aligns with the "treatment surge" plan that was implemented there to address the high burden of HIV, low risk perception, and limited access to antiretroviral therapy in remote areas. The analysis demonstrated that standardized ER and MER datasets can be used to help understand the contribution of different types of project partners to results. However, the analysis is limited by the lack of data within the ER and MER datasets to directly link the two types of data by partner and/or site. Additional information provided by the SIDHAS project did allow for some linkages and further analysis. The SIDHAS project reported accomplishments in many areas that support efficiency improvements in service delivery, including various types of technical assistance and support for development of electronic medical records, logistics support for allocating drugs and test kits, support for high-frequency reporting and data use, and technical assistance provided to state and national government agencies. Other types of analysis, such as case studies, could be conducted to demonstrate how these types of support and their associated expenditures contribute to improving results. Comparing the shares of results for the two indicators with shares of expenditures of local subrecipients across states, it was observed that for some states the shares of results and expenditures are well aligned. For others, there is a pronounced difference between the share of results and expenditures. This may be due to a number of factors influencing results, such as the characteristics of the epidemic and the population in each state, or factors influencing costs, such as location accessibility, or rural versus urban locations. Additional analysis could investigate the sources of these differences. The SIDHAS project is a five-year cooperative agreement funded by the U.S. President's Emergency Plan for AIDS Relief through the U.S. Agency for International Development under Agreement No. 7200AA19CA0004, beginning April 15, 2019. It is implemented by Palladium, in partnership with JSI Research & Training Institute (JSI), Johns Hopkins University (JHU) Department of Epidemiology, Right to Care (RTC), Cooper/Smith, IMC Worldwide, Jembi Health Systems, and Macro-Eyes, and supported by expert local resource partners.