The purpose of this document is to provide guidance to national AIDS programmes and partners on the use of indicators to measure and report on the country response. The 2016 United Nations Political Declaration on Ending AIDS, adopted at the United Nations General Assembly High-Level Meeting on AIDS in June 2016, mandated UNAIDS to support countries in reporting on the commitments in the Political Declaration. The Political Declaration on Ending AIDS built on three previous political declarations: the 2001 Declaration of Commitment on HIV/AIDS, the 2006 Political Declaration on HIV/AIDS and the 2011 Political Declaration on HIV and AIDS.

The report titled The Urgency of Now: AIDS at a Crossroads, demonstrates the HIV response is at a crossroads: success or failure will be determined by which path leaders take. The report shows that the decisions leaders make this year will determine whether AIDS is ended as a public health threat by 2030. Taking the wrong path, by limiting resourcing or clamping down on human rights, would lead the pandemic to continue to grow, costing millions more lives and undermining global health security.

The focus of this issue is on global advances in conducting monitoring and evaluation (M&E) of the global response to the HIV/AIDS epidemic. Only by implementing comprehensive and sustainable M&E systems will we know how much progress we are making, as nations and as a global community, in combating this pandemic. The chapters primarily focus on developing nations and are presented largely from the perspective of evaluators working for donors, international agencies, and national governments. Although it is clear that a comprehensive M&E system must eventually include both monitoring and evaluation, the initial aim has been to establish a foundation derived largely from surveys and monitoring information. To date, much of the focus in M&E has come from the global level because new global funding initiatives been launched and required rapid scale-up and the development of technical guidance, international standards, and indicators for monitoring progress and determining success. At the regional and country levels, the challenge has been to implement national M&E plans and systems within a context of overall low M&E capacity and a range of M&E needs.

On cover and title page: United Nations General Assembly Special Session on HIV/AIDS

Since 2004, the U.S. government has supported the global response to HIV/AIDS through the President's Emergency Plan for AIDS Relief (PEPFAR). The Republic of Rwanda, a PEPFAR partner country since the initiative began, has made gains in its HIV response, including increased access to and coverage of antiretroviral therapy and decreased HIV prevalence. However, a persistent shortage in human resources for health (HRH) affects the health of people living with HIV and the entire Rwandan population. Recognizing HRH capabilities as a foundational challenge for the health system and the response to HIV, the Government of Rwanda worked with PEPFAR and other partners to develop a program to strengthen institutional capacity in health professional education and thereby increase the production of high-quality health workers. The Program was fully managed by the Government of Rwanda and was designed to run from 2011 through 2019. PEPFAR initiated funding in 2012. In 2015, PEPFAR adopted a new strategy focused on high-burden geographic areas and key populations, resulting in a reconfiguration of its HIV portfolio in Rwanda and a decision to cease funding the Program, which was determined no longer core to its programming strategy. The last disbursement for the Program from PEPFAR was in 2017. Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program describes PEPFAR-supported HRH activities in Rwanda in relation to programmatic priorities, outputs, and outcomes and examines, to the extent feasible, the impact on HRH and HIV-related outcomes. The HRH Program more than tripled the country's physician specialist workforce and produced major increases in the numbers and qualifications of nurses and midwives. Partnerships between U.S. institutions and the University of Rwanda introduced new programs, upgraded curricula, and improved the quality of teaching and training for health professionals. Growing the number, skills, and competencies of health workers contributed to direct and indirect improvements in the quality of HIV care. Based on the successes and challenges of the HRH program, the report recommends that future investments in health professional education be designed within a more comprehensive approach to human resources for health and institutional capacity building, which would strengthen the health system to meet both HIV-specific and more general health needs. The recommendations offer an aspirational framework to reimagine how partnerships are formed, how investments are made, and how the effects of those investments are documented.