Cambodia has been at the forefront of the fight against HIV/AIDS and is often cited as one of the few countries to reverse its generalized HIV epidemicU.S. Government funding has contributed substantially to the country’s success. However, the Cambodian Government faces multiple development priorities and decreasing international donor funding, resulting in a need to enhance impact while reducing the cost of the HIV response, focusing on HIV high-risk groups. To support efforts to prevent new infections through case detection and ensuring that patients start and continue treatment, and to reduce Cambodia’s dependence on donors, in November 2012 USAID/Cambodia awarded the HIV/AIDS Flagship Project to a Cambodian nongovernmental organization. We conducted an audit of the 5-year, $30 million cooperative agreement to determine whether it was achieving its planned results and whether the results were sustainable.
While the Flagship project developed and piloted innovations for HIV/AIDS treatment and prevention, it did not fully achieve its planned results. USAID did not ensure that cost-effectiveness was considered when innovations were evaluated. Further, the evaluations were not always used for decision making, with some innovations being scaled up despite evidence of minimal impact or with no evaluations at all. In addition, USAID did not ensure that the project had adequate performance indicators to quantify progress in implementing innovations or to measure the impact of the project’s capacity-building efforts.
Further, an abrupt drop in funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria may affect the sustainability of innovations developed during the project. While the project was designed to strengthen local nongovernmental organizations to minimize the need for future external funding, continued support from other donors after the project was a key assumption for project success. However, an early and unanticipated decrease in funding required the project to revise its plans. The project’s alternate plan lacked clarity, including how it would be financed.
We made, and USAID/Cambodia agreed with, one recommendation to inform any future USAID efforts in Cambodia to combat HIV/AIDS.