America Living With AIDS

Government Responsibilities

when a choice had to be made
between putting the money into the
actual delivery of services or into
administration.
State and local governments have a
substantial need for technical assistance, evaluation, and program dollars. These activities should not be
forced to compete with each other.
For example, full funding of the Ryan
White CARE Act is required to meet
both the operational and administrative needs of CARE Act programs.
There is a critical need for more
broad-based technical assistance and
capacity building in all HIV-related
programs. In addition, ways must be
found to ensure that new programs
are responsive to local needs.
There is also a notable lack of agencywide guidance for program evaluation within CDC, the Health Resources
and Services Administration (HRSA),
the National Institute on Drug Abuse,
and other PHS agencies. Such leadership should emphasize the short-term
development of information that will
be useful in further policy planning
and in program design and implementation. Evaluation plans are most
objective and useful when they are
developed before programs are implemented; but unfortunately at present
they are almost exclusively designed
and instituted after programs have
been implemented. This results in
unnecessary complexity, undue delay,
and greater costs than the information
produced would warrant. Finally, to
warrant investment in them, evaluations must be synthesized and disseminated in a manner useful to state and
local agencies.

Coordination
As noted above, federal HIV-related
programs are housed in a number of
federal agencies, without a coordinating body or lead agency to track and
resolve contradictory and overlapping
program elements. States and localities are left to cope with funding and
administrative requirements that expand their
own bureaucracies and
limit their flexibility.
With the implementa- ke
tion of the CARE Act
have come some improvements in interagency
coordination within PHS, con
particularly between of
HRSA and CDC. Neither
Congress nor federal eve
agencies are preparing
adequately, however, for wh
the growing discrepancy the
between available resources and caseloads of tt
HIV-infected persons. offic
Plans should be undertak- lo
en with a sense of urgency
to make changes in policies, structures, functions, WILI
and uses of public monies
to cope with dramatic
expansion of needs. Plans
must also be made to cope
with shifts and evolutions in relationships between government and private
partners.
The necessity of planning cannot be
overemphasized. It is all the more
pressing in light of the critical budget

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