Publication Date:

07 Jul 2013


Pfeiffer J (2013) The Struggle for a Public Sector: PEPFAR in Mozambique. In Biehl J, Petryna A (Eds.), When People Come First: Critical Studies in Global Health. Princeton, NJ: Princeton University Press.



The President’s Emergency Program for AIDS Relief (PEPFAR) has significantly transformed the global health landscape by injecting $15 billion into HIV/AIDS care and treatment programs in twenty countries between 2004–2010. In Mozambique, PEPFAR funds constituted nearly 60 percent of all health sector planned spending by 2008. While debates about PEPFAR’s restrictions on condom promotion, sex worker education programs, and abortion/reproductive health have dominated critiques of the program, perhaps the single most important aspect of PEPFAR’s rollout has largely escaped scrutiny in the wider global discussion: PEPFAR funding, by design, does not directly flow through the public sector. This chapter draws on the author’s firsthand experience in Mozambique to describe the tension, conflict, and potentials created by new major aid flows to Africa.


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