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Making the Soldier Decisive on Future Battlefields

May 14, 2013 Comments off

Making the Soldier Decisive on Future Battlefields

Source: National Research Council

The U.S. military does not believe its soldiers, sailors, airmen, and marines should be engaged in combat with adversaries on a "level playing field." Our combat individuals enter engagements to win. To that end, the United States has used its technical prowess and industrial capability to develop decisive weapons that overmatch those of potential enemies. In its current engagement—what has been identified as an "era of persistent conflict"— the nation’s most important weapon is the dismounted soldier operating in small units. Today’s soldier must be prepared to contend with both regular and irregular adversaries. Results in Iraq and Afghanistan show that, while the U.S. soldier is a formidable fighter, the contemporary suite of equipment and support does not afford the same high degree of overmatch capability exhibited by large weapons platforms—yet it is the soldier who ultimately will play the decisive role in restoring stability.

Making the Soldier Decisive on Future Battlefields establishes the technical requirements for overmatch capability for dismounted soldiers operating individually or in small units. It prescribes technological and organizational capabilities needed to make the dismounted soldier a decisive weapon in a changing, uncertain, and complex future environment and provides the Army with 15 recommendations on how to focus its efforts to enable the soldier and tactical small unit (TSU) to achieve overmatch.

Sodium Intake in Populations: Assessment of Evidence

May 14, 2013 Comments off

Sodium Intake in Populations: Assessment of Evidence

Source: Institute of Medicine

From press release:

Recent studies that examine links between sodium consumption and health outcomes support recommendations to lower sodium intake from the very high levels some Americans consume now, but evidence from these studies does not support reduction in sodium intake to below 2,300 mg per day, says a new report from the Institute of Medicine.

Despite efforts over the past several decades to reduce dietary intake of sodium, a main component of table salt, the average American adult still consumes 3,400 mg or more of sodium a day – equivalent to about 1 ½ teaspoons of salt. The current Dietary Guidelines for Americans urge most people ages 14 to 50 to limit their sodium intake to 2,300 mg daily. People ages 51 or older, African Americans, and people with hypertension, diabetes, or chronic kidney disease – groups that together make up more than 50 percent of the U.S. population – are advised to follow an even stricter limit of 1,500 mg per day. These recommendations are based largely on a body of research that links higher sodium intakes to certain “surrogate markers” such as high blood pressure, an established risk factor for heart disease.

The expert committee that wrote the new report reviewed recent studies that in contrast examined how sodium consumption affects direct health outcomes like heart disease and death. “These new studies support previous findings that reducing sodium from very high intake levels to moderate levels improves health,” said committee chair Brian Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania Perelman School of Medicine. “But they also suggest that lowering sodium intake too much may actually increase a person’s risk of some health problems.”

Assessing Risks to Endangered and Threatened Species from Pesticides

May 7, 2013 Comments off

Assessing Risks to Endangered and Threatened Species from Pesticides

Source: National Research Council

The US Fish and Wildlife Service (FWS) and the National Marine Fisheries Service (NMFS) are responsible for protecting species that are listed as endangered or threatened under the Endangered Species Act (ESA) and for protecting habitats that are critical for their survival. The US Environmental Protection Agency (EPA) is responsible for registering or reregistering pesticides under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and must ensure that pesticide use does not cause any unreasonable adverse effects on the environment, which is interpreted to include listed species and their critical habitats. The agencies have developed their own approaches to evaluating environmental risk, and their approaches differ because their legal mandates, responsibilities, institutional cultures, and expertise differ. Over the years, the agencies have tried to resolve their differences but have been unsuccessful in reaching a consensus regarding their assessment approaches.

As a result, FWS, NMFS, EPA, and the US Department of Agriculture asked the National Research Council (NRC) to examine scientific and technical issues related to determining risks posed to listed species by pesticides. Specifically, the NRC was asked to evaluate methods for identifying the best scientific data available; to evaluate approaches for developing modeling assumptions; to identify authoritative geospatial information that might be used in risk assessments; to review approaches for characterizing sublethal, indirect, and cumulative effects; to assess the scientific information available for estimating effects of mixtures and inert ingredients; and to consider the use of uncertainty factors to account for gaps in data. Assessing Risks to Endangered and Threatened Species from Pesticides, which was prepared by the NRC Committee on Ecological Risk Assessment under FIFRA and ESA, is the response to that request.

Copyright in the Digital Era: Building Evidence for Policy

May 7, 2013 Comments off

Copyright in the Digital Era: Building Evidence for Policy

Source: National Research Council

Over the course of several decades, copyright protection has been expanded and extended through legislative changes occasioned by national and international developments. The content and technology industries affected by copyright and its exceptions, and in some cases balancing the two, have become increasingly important as sources of economic growth, relatively high-paying jobs, and exports. Since the expansion of digital technology in the mid-1990s, they have undergone a technological revolution that has disrupted long-established modes of creating, distributing, and using works ranging from literature and news to film and music to scientific publications and computer software.

In the United States and internationally, these disruptive changes have given rise to a strident debate over copyright’s proper scope and terms and means of its enforcement–a debate between those who believe the digital revolution is progressively undermining the copyright protection essential to encourage the funding, creation, and distribution of new works and those who believe that enhancements to copyright are inhibiting technological innovation and free expression.

Copyright in the Digital Era: Building Evidence for Policy examines a range of questions regarding copyright policy by using a variety of methods, such as case studies, international and sectoral comparisons, and experiments and surveys. This report is especially critical in light of digital age developments that may, for example, change the incentive calculus for various actors in the copyright system, impact the costs of voluntary copyright transactions, pose new enforcement challenges, and change the optimal balance between copyright protection and exceptions.

Practices and Performance Measures for Local Public Agency Federally Funded Highway Projects

May 2, 2013 Comments off

Practices and Performance Measures for Local Public Agency Federally Funded Highway Projects

Source: Transportation Research Board

TRB’s National Cooperative Highway Research Program (NCHRP) Synthesis 442: Practices and Performance Measures for Local Public Agency Federally Funded Highway Projects explores what performance measures, delivery practices, strategies, and tools are currently used in relation to federally-funded local public agency (LPA) highway project development and delivery, and how they are used to measure success in project administration.

Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy

May 1, 2013 Comments off

Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy

Source: Institute of Medicine

For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families.

In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA’s Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically: the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments.

Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy reviews the current evidence, including the peer-reviewed published literature and peer-reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were considered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task.

Observed Customer Seating and Standing Behaviors and 2 Seat Preferences Onboard Subway Cars in New York City

April 17, 2013 Comments off

Observed Customer Seating and Standing Behaviors and 2 Seat Preferences Onboard Subway Cars in New York City (PDF)

Source: Transportation Research Board

Using an observational sampling methodology, this study explores seat occupancy patterns found in New York City subway cars under non-crowded conditions based on special attributes of otherwise highly homogenous plastic bench seats. Onboard seating patterns, measured as relative seat occupancy probabilities, are explained in terms of interactions between railcar design, layout, customer preferences, and resulting behaviours. Prior research has generally focused on passengers distribution between cars within long trains, or desirability of attributes common to all seats, rather than passengers seating patterns within a single car. Results, based on seating- and standing-room occupancy statistics, show customers have a clear preference for seats adjacent to doors, no real preference for seats adjacent to support stanchions, and disdain for bench spots between two other seats. On cars featuring transverse seating, customers prefer window seats, but have almost equal preference for backward- or forward-facing seats. No gender bias was detected amongst all seated passengers, but as load factor increased, men have higher probabilities of being standees compared to women. 90% seat utilization is only achieved at 120% load factor; furthermore, standing customers strongly prefer to crowd vestibule areas between doors (particularly in cars with symmetric door arrangements), and hold These findings are consistent with published anecdotes. Future cars should be designed with asymmetric doors, 2+2+2 partitioned longitudinal seats, and no stanchions or partitions near doorways. Further research should be conducted in commuter rail vehicles with suburban layouts, booth seating, and also other cities’ subways, to further understand customer seating preferences.

Assessment of Advanced Solid State Lighting

April 3, 2013 Comments off

Assessment of Advanced Solid State Lighting

Source: National Research Council

The standard incandescent light bulb, which still works mainly as Thomas Edison invented it, converts more than 90% of the consumed electricity into heat. Given the availability of newer lighting technologies that convert a greater percentage of electricity into useful light, there is potential to decrease the amount of energy used for lighting in both commercial and residential applications. Although technologies such as compact fluorescent lamps (CFLs) have emerged in the past few decades and will help achieve the goal of increased energy efficiency, solid-state lighting (SSL) stands to play a large role in dramatically decreasing U.S. energy consumption for lighting. This report summarizes the current status of SSL technologies and products—light-emitting diodes (LEDs) and organic LEDs (OLEDs)—and evaluates barriers to their improved cost and performance.

Assessment of Advanced Solid State Lighting also discusses factors involved in achieving widespread deployment and consumer acceptance of SSL products. These factors include the perceived quality of light emitted by SSL devices, ease of use and the useful lifetime of these devices, issues of initial high cost, and possible benefits of reduced energy consumption.

Guidebook for Construction Management Practices for Rural Projects

March 27, 2013 Comments off

Guidebook for Construction Management Practices for Rural Projects

Source: Transportation Research Board

TRB’s National Cooperative Highway Research Program (NCHRP) Research Results Digest 381: Guidebook for Construction Management Practices for Rural Projects focuses on tools and techniques that may be used to help improve aspects of construction management in the rural environment. Tools and techniques covered in the report address issues such as construction administration, engineering, operation, and safety; cost estimation; scheduling; quality control and assurance; and claims and disputes.

NCHRP RRD 381 defines rural projects as those that cost less than about $2 million and occur in an area with a population less than 50,000 people.

Adapting to a Changing World–Challenges and Opportunities in Undergraduate Physics Education

March 26, 2013 Comments off

Adapting to a Changing World–Challenges and Opportunities in Undergraduate Physics Education

Source: National Research Council (National Academies Press)

Adapting to a Changing World was commissioned by the National Science Foundation to examine the present status of undergraduate physics education, including the state of physics education research, and, most importantly, to develop a series of recommendations for improving physics education that draws from the knowledge we have about learning and effective teaching. Our committee has endeavored to do so, with great interest and more than a little passion.

The Committee on Undergraduate Physics Education Research and Implementation was established in 2010 by the Board on Physics and Astronomy of the National Research Council. This report summarizes the committee’s response to its statement of task, which requires the committee to produce a report that identifies the goals and challenges facing undergraduate physics education and identifies how best practices for undergraduate physics education can be implemented on a widespread and sustained basis, assess the status of physics education research (PER) and discuss how PER can assist in accomplishing the goal of improving undergraduate physics education best practices and education policy.

Optics and Photonics: Essential Technologies for Our Nation

March 26, 2013 Comments off

Optics and Photonics: Essential Technologies for Our Nation
Source: National Research Council

Optics and photonics technologies are ubiquitous: they are responsible for the displays on smart phones and computing devices, optical fiber that carries the information in the internet, advanced precision manufacturing, enhanced defense capabilities, and a plethora of medical diagnostics tools. The opportunities arising from optics and photonics offer the potential for even greater societal impact in the next few decades, including solar power generation and new efficient lighting that could transform the nation’s energy landscape and new optical capabilities that will be essential to support the continued exponential growth of the Internet.

As described in the National Research Council report Optics and Photonics: Essential Technologies for our Nation, it is critical for the United States to take advantage of these emerging optical technologies for creating new industries and generating job growth. The report assesses the current state of optical science and engineering in the United States and abroad–including market trends, workforce needs, and the impact of photonics on the national economy. It identifies the technological opportunities that have arisen from recent advances in, and applications of, optical science and engineering. The report also calls for improved management of U.S. public and private research and development resources, emphasizing the need for public policy that encourages adoption of a portfolio approach to investing in the wide and diverse opportunities now available within photonics.

Optics and Photonics: Essential Technologies for our Nation is a useful overview not only for policymakers, such as decision-makers at relevant Federal agencies on the current state of optics and photonics research and applications but also for individuals seeking a broad understanding of the fields of optics and photonics in many arenas.

Underground Engineering for Sustainable Urban Development

March 20, 2013 Comments off

Underground Engineering for Sustainable Urban Development

Source: National Research Council

For thousands of years, the underground has provided humans refuge, useful resources, physical support for surface structures, and a place for spiritual or artistic expression. More recently, many urban services have been placed underground. Over this time, humans have rarely considered how underground space can contribute to or be engineered to maximize its contribution to the sustainability of society. As human activities begin to change the planet and population struggle to maintain satisfactory standards of living, placing new infrastructure and related facilities underground may be the most successful way to encourage or support the redirection of urban development into sustainable patterns. Well maintained, resilient, and adequately performing underground infrastructure, therefore, becomes an essential part of sustainability, but much remains to be learned about improving the sustainability of underground infrastructure itself.

At the request of the National Science Foundation (NSF), the National Research Council (NRC) conducted a study to consider sustainable underground development in the urban environment, to identify research needed to maximize opportunities for using underground space, and to enhance understanding among the public and technical communities of the role of underground engineering in urban sustainability.

Underground Engineering for Sustainable Urban Development explains the findings of researchers and practitioners with expertise in geotechnical engineering, underground design and construction, trenchless technologies, risk assessment, visualization techniques for geotechnical applications, sustainable infrastructure development, life cycle assessment, infrastructure policy and planning, and fire prevention, safety and ventilation in the underground. This report is intended to inform a future research track and will be of interest to a broad audience including those in the private and public sectors engaged in urban and facility planning and design, underground construction, and safety and security.

Improving Self-Escape from Underground Coal Mines

March 20, 2013 Comments off

Improving Self-Escape from Underground Coal Mines

Source: National Research Council

Coal mine disasters in the United States are relatively rare events; many of the roughly 50,000 miners underground will never have to evacuate a mine in an emergency during their careers. However, for those that do, the consequences have the potential to be devastating. U.S. mine safety practices have received increased attention in recent years because of the highly publicized coal mine disasters in 2006 and 2010. Investigations have centered on understanding both how to prevent or mitigate emergencies and what capabilities are needed by miners to self-escape to a place of safety successfully. This report focuses on the latter – the preparations for self-escape.

In the wake of 2006 disasters, the U.S. Congress passed the Mine Improvement

and New Emergency Response Act of 2006 (MINER Act), which was designed to strengthen existing mine safety regulations and set forth new measures aimed at improving accident preparedness and emergency response in underground coal mines. Since that time, the efforts of the National Institute of Occupational Safety and Health (NIOSH) and the Mine Safety and Health Administration (MSHA) have contributed to safety improvements in the mining industry. However, the Upper Big Branch mine explosion in 2010 served as a reminder to remain ever vigilant on improving the prevention of mine disasters and preparations to help miners survive in the event of emergencies.

This study was set in the context of human-systems integration (HSI), a systems approach that examines the interaction of people, tasks, and equipment and technology in the pursuit of a goal. It recognizes this interaction occurs within, and is influenced by, the broader environmental context. A key premise of human-systems integration is that much important information is lost when the various tasks within a system are considered individually or in isolation rather than in interaction with the whole system. Improving Self-Escape from Underground Coal Mines, the task of self-escape is part of the mine safety system.

Transitions to Alternative Vehicles and Fuels

March 18, 2013 Comments off

Transitions to Alternative Vehicles and Fuels

Source: National Research Council

For a century, almost all light-duty vehicles (LDVs) have been powered by internal combustion engines (ICEs) operating on petroleum fuels. Energy security concerns over petroleum imports and the effect of greenhouse-gas (GHG) emissions on global climate are driving interest in alternatives. This report assesses the potential for reducing petroleum consumption and GHG emissions by 80% across the U.S. LDV fleet by 2050, relative to 2005. It examines the current capability and estimated future performance and costs for each vehicle type and non-petroleum-based fuel technology as options that could significantly contribute to these goals. By analyzing scenarios that combine various fuel and vehicle pathways, the report also identifies barriers to implementation of these technologies and suggests policies to achieve the desired reductions. Several scenarios are promising, but strong, effective, and sustained but adaptive policies such as research and development (R&D), subsidies, energy taxes, or regulations will be necessary to overcome barriers such as cost and consumer choice.

Challenges and Opportunities for Change in Food Marketing to Children and Youth: Workshop Summary

March 13, 2013 Comments off

Challenges and Opportunities for Change in Food Marketing to Children and Youth: Workshop Summary

Source: Institute of Medicine

The childhood obesity epidemic is an urgent public health problem. The most recent data available show that nearly 19 percent of boys and about 15 percent of girls aged 2-19 are obese, and almost a third of U.S. children and adolescents are overweight or obese (Ogden et al., 2012). The obesity epidemic will continue to take a substantial toll on the health of Americans. In the midst of this epidemic, children are exposed to an enormous amount of commercial advertising and marketing for food. In 2009, children aged 2-11 saw an average of more than 10 television food ads per day (Powell et al., 2011). Children see and hear advertising and marketing messages for food through many other channels as well, including radio, movies, billboards, and print media. Most notably, many new digital media venues and vehicles for food marketing have emerged in recent years, including Internet-based advergames, couponing on cell phones, and marketing on social networks, and much of this advertising is invisible to parents.

The marketing of high-calorie, low-nutrient foods and beverages is linked to overweight and obesity. A major 2006 report from the Institute of Medicine (IOM) documents evidence that television advertising influences the food and beverage preferences, requests, and short-term consumption of children aged 2-11 (IOM, 2006). Challenges and Opportunities for Change in Food Marketing to Children and Youth also documents a body of evidence showing an association of television advertising with the adiposity of children and adolescents aged 2-18. The report notes the prevailing pattern that food and beverage products marketed to children and youth are often high in calories, fat, sugar, and sodium; are of low nutritional value; and tend to be from food groups Americans are already overconsuming. Furthermore, marketing messages that promote nutrition, healthful foods, or physical activity are scarce (IOM, 2006). To review progress and explore opportunities for action on food and beverage marketing that targets children and youth, the IOM’s Standing Committee on Childhood Obesity Prevention held a workshop in Washington, DC, on November 5, 2012, titled "New Challenges and Opportunities in Food Marketing to Children and Youth."

Measuring What We Spend: Toward a New Consumer Expenditure Survey

March 11, 2013 Comments off

Measuring What We Spend: Toward a New Consumer Expenditure Survey

Source: National Research Council

The Consumer Expenditure (CE) surveys are the only source of information on the complete range of consumers’ expenditures and incomes in the United States, as well as the characteristics of those consumers. The CE consists of two separate surveys: (1) a national sample of households interviewed five times at three-month intervals; and (2) a separate national sample of households that complete two consecutive one-week expenditure diaries. For more than 40 years, these surveys, the responsibility of the Bureau of Labor Statistics (BLS), have been the principal source of knowledge about changing patterns of consumer spending in the U.S. population.

In February 2009, BLS initiated the Gemini Project, the aim of which is to redesign the CE surveys to improve data quality through a verifiable reduction in measurement error with a particular focus on underreporting. The Gemini Project initiated a series of information-gathering meetings, conference sessions, forums, and workshops to identify appropriate strategies for improving CE data quality. As part of this effort, BLS requested the National Research Council’s Committee on National Statistics (CNSTAT) to convene an expert panel to build on the Gemini Project by conducting further investigations and proposing redesign options for the CE surveys.

The charge to the Panel on Redesigning the BLS Consumer Expenditure Surveys includes reviewing the output of a Gemini-convened data user needs forum and methods workshop and convening its own household survey producers workshop to obtain further input. In addition, the panel was tasked to commission options from contractors for consideration in recommending possible redesigns. The panel was further asked by BLS to create potential redesigns that would put a greater emphasis on proactive data collection to improve the measurement of consumer expenditures. Measuring What We Spend summarizes the deliberations and activities of the panel, discusses the conclusions about the uses of the CE surveys and why a redesign is needed, as well as recommendations for the future.

Environmental Decisions in the Face of Uncertainty

March 9, 2013 Comments off

Environmental Decisions in the Face of Uncertainty

Source: Institute of Medicine

The U.S. Environmental Protection Agency (EPA) is one of several federal agencies responsible for protecting Americans against significant risks to human health and the environment. EPA estimates the nature, magnitude, and likelihood of risks to human health and the environment; identifies the potential regulatory actions that will mitigate those risks and protect public health and the environment; and uses that information to decide on appropriate regulatory action. Uncertainties in the data and analyses on which these decisions are based enter into the process at each step. As a result, the informed identification and understanding of the uncertainties inherent in the process is an essential feature of environmental decision making.

The EPA asked the IOM to provide guidance to its decision makers and their partners in states and localities on approaches to managing risk in different contexts when uncertainty is present. It also sought guidance on how information on uncertainty should be presented to help risk managers make sound decisions and to increase transparency in its communications with the public about those decisions.

Countering the Problem of Falsified and Substandard Drugs

March 8, 2013 Comments off

Countering the Problem of Falsified and Substandard Drugs

Source: Institute of Medicine

Falsified and substandard medicines provide little protection from disease and, worse, can expose consumers to major harm. Bad drugs pose potential threats around the world, but the nature of the risk varies by country, with higher risk in countries with minimal or non-existent regulatory oversight. While developed countries are not immune, – negligent production at a Massachusetts compounding pharmacy killed 44 people from September 2012 to January 2013 – the vast majority of problems occur in developing countries where underpowered and unsafe medicines affect millions.

It is difficult to measure the public health burden of falsified and substandard drugs, the number of deaths they cause, or the amount of time and money wasted using them. The FDA asked the IOM to assess the global public health implications of falsified, substandard, and counterfeit pharmaceuticals to help jumpstart international discourse about this problem. At the international level, productive discussion relies on cooperation and mutual trust. This report lays out a plan to invest in quality to improve public health.

Oral Health Literacy – Workshop Summary

March 7, 2013 Comments off

Oral Health Literacy – Workshop Summary

Source: Institute of Medicine

Oral health and oral health literacy are of national interest as demonstrated in the recommendations of two recent IOM reports – Advancing Oral Health in America and Improving Access to Oral Health Care for Vulnerable and Underserved Populations – as well as in the objectives of the HHS Healthy People 2020. Limited oral health literacy is associated with inaccurate knowledge about preventive measures such as water fluoridation, dental care visits, and oral health-related quality of life. The public and health care providers are largely unaware of the basic risk factors and preventive regimens for many oral diseases. Oral disease is expensive in terms of teeth, time, and money and results in pain, disfigurement, loss of school and work days, and even death when left untreated.

The IOM Roundtable on Health Literacy was interested in exploring findings from oral health literacy research and how such findings are being translated into oral health practice as well as the intersection between oral health literacy and health literacy. The roundtable held a workshop on March 29, 2012, to examine the field of oral health literacy. This document summarizes the workshop.

IOM — Evaluation of PEPFAR

February 26, 2013 Comments off

Evaluation of PEPFAR

Source: Institute of Medicine

Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States has provided an unprecedented level of health and development assistance and health diplomacy around the world. PEPFAR has saved and improved the lives of millions of people; supported HIV prevention, care, and treatment; strengthened systems; and engaged with partner countries to facilitate HIV policy and planning for sustainable responses to their epidemic.

The IOM evaluation drew upon a variety of data sources, including quantitative data, extensive document review, and primary qualitative data collection through more than 400 interviews, including some site visits, with diverse stakeholders in 13 PEPFAR partner countries, at PEPFAR’s headquarters, and at other institutions and agencies involved in the global HIV response.

PEPFAR has been globally transformative. Across partner countries, PEPFAR was described as a lifeline, and people credit PEPFAR for restoring hope. The initiative’s future contributions will be informed by its past achievements and lessons learned from challenges it has faced. PEPFAR will continue a new direction as it supports partner countries in taking on more central roles in accountability and setting strategic priorities for investment in their HIV response.

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