From the PEPFAR report, the same thing Justin Sandefur mentioned above:
When PEPFAR was announced, many economists thought it would not be cost-effective to treat AIDS. They were wrong. Their initial concern was understandable: when PEPFAR began in 2004, first-line antiretroviral therapy cost about $1,000 per year, so treating everyone with HIV would cost tens of billions of dollars. Many experts worried that PEPFAR would lead to funding cuts for other highly cost-effective aid efforts. But the pessimistic forecasts didn’t come true. First, the Bush Administration decided to fund PEPFAR on top of existing aid efforts. Second, the massive increase in funding for antiretroviral drugs created demand that helped drive competition and innovation, and supercharged an existing race to develop cheaper, more effective generic drugs.3 Today, a year of first-line antiretroviral medication costs about $60.
As a result, PEPFAR has saved between 7.5 and 30 million lives, at a cost between $1,500 and $10,000 per life saved, and has also prevented at least 5.5 million babies from being born with HIV. It has also gotten more cost-effective each year as medication costs decline, doing more and more on a budget that has been declining in real dollars since 2009.
Some other quotes that stood out to me:
PEPFAR was conceived of and launched during a time of widespread skepticism about foreign aid. It had become clear that lots of foreign aid was corrupt, wasteful, or unhelpful. But the thesis behind PEPFAR was that health interventions might succeed where larger development interventions often had not. Accountability for health interventions is easier—we can tell whether or not a drug has reached a patient. Results are more measurable. And while development interventions are often premised on ideological claims that may come and go, or on theories of investment that may not hold up, health interventions have only the simple thesis that health is better than sickness and life is better than death.
In the present day, PEPFAR has been successfully handing off responsibilities in partner nations, targeting 70% of funding through local organizations including partner country governments. Some countries, including Botswana and South Africa, have successfully transitioned to funding a majority of their own HIV efforts, with PEPFAR now playing a smaller supporting role.
PEPFAR requires very good accounting controls, with every expenditure documented and demonstrated to be in line with program requirements. For this report, we read three recent Office of the Inspector General audits of PEPFAR program recipients. The three audits we reviewed found undocumented expense rates ranging from 0% to 2% of program expenses, and they demanded repayment of every dollar unaccounted for.
Quoting Goldsmith, Horiuchi, and Wood 2014, “PEPFAR has, indeed, positively affected how publics in recipient countries regard the US … what types of aid, under what conditions, might be effective in influencing foreign public opinion about the donor. Specifically, our theory is that foreign aid that is targeted, sustained, effective, and visible is more likely to affect mass opinion. … as Goldsmith and Horiuchi(2012) show, changes in public opinion within Country B about Country A can influence Country B’s foreign policy behavior toward Country A.” (emphasis ours).
From the PEPFAR report, the same thing Justin Sandefur mentioned above:
As a result, PEPFAR has saved between 7.5 and 30 million lives, at a cost between $1,500 and $10,000 per life saved, and has also prevented at least 5.5 million babies from being born with HIV. It has also gotten more cost-effective each year as medication costs decline, doing more and more on a budget that has been declining in real dollars since 2009.
Some other quotes that stood out to me: