Health Policy Project

The Health Policy Project has ended, but work continues under a new USAID five-year project, Health Policy Plus (HP+).

Sustainable VMMC programs: They Didn’t Mean To!



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Sustainable VMMC programs: They Didn’t Mean To!
Experts from the International AIDS Economists Network pre-conference
Dr. Dino Rech is shown at left with other male circumcision experts at the July 19, 2014 IAEN pre-conference session in Melbourne, Australia. Dr. Emmanuel Njeuhmeli, USAID, center, was a senior advisor to the South Africa office on male circumcision.
Health Policy Project

MELBOURNE, Australia--Dr. Dino Rech of the Centre for HIV and AIDS Prevention Studies (CHAPS), a regional NGO based in South Africa, told participants at the International AIDS Economists Network (IAEN) pre-conference about how USAID’s shift from a cooperative agreement to a fixed-fee contract helped push his organization closer to sustainability – “but, they didn’t mean to!”

When USAID decided to support efforts in South Africa to expand voluntary medical male circumcision (VMMC) though a fixed-price contract with local groups rather than the more traditional cooperative agreement, some traditional partners reacted negatively. Eventually the South African groups came together to establish a standard price for such services. In principle, the well-known advantages of fixed fee contracts include introducing market efficiencies and a lower unit cost for services. But another result from setting up a fixed-price contract was unexpected.

In implementing the project as part of the team awarded the contract, CHAPS was efficient enough to complete the work with carry-over funds. This surplus allowed CHAPS to bid on other tenders in the region. Although still disadvantaged, relative to better-funded international NGOs, this move to a contract had the unexpected side effect of moving CHAPS closer to long-term sustainability.

In short, CHAPS supported the USAID Forward strategy of more local involvement—but it didn’t mean to!

For more information on the Health Policy Project’s work on country ownership, see

For information on HPP’s work on male circumcision, see

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The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA). The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

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