Both PMI and PEPFAR are structured so that a central office coordinates all relevant USG programs. In PEPFAR, the Office of the Global AIDS Coordinator (OGAC) was established in the Department of State, answering directly to the Secretary, and mandated to coordinate and oversee the work of all USG agencies implementing HIV/AIDS programs in the focus countries. It thus oversees programs of USAID, the Departments of Health and Human Services, Commerce, Defense, and Labor, as well as the Peace Corps. The U.S. Malaria Coordinators office, located in USAID, oversees cross-agency collaboration between USAID and the CDC and includes other federal partners in its interagency steering group.
The distinctive feature shared by OGAC and the U.S. Malaria Coordinator is that they have ultimate decision-making and budgetary authority. While both coordinators are linked to a specific agency, they have the authority to make decisions and determine funding for other agencies programs. They have stature as well; both coordinators are appointed by the President, which offers both practical and symbolic assets; in addition the OGAC appointment is an ambassador-level position.
OGAC and the U.S. Malaria Coordinator represent innovative ways to structure and support executive leadership with the goal of enhancing the coherence of and reducing fragmentation and redundancy in USG efforts around a specific public health problem. This executive leadership model used by PEPFAR and PMI could be adapted for other settings, such as other USG efforts, linking various agencies and possibly private sector stakeholders, although it is perhaps most appropriate for clearly defined problems. Where there is great variation in the understanding of a problem and/or the programmatic approaches applied to it, it likely would be more difficult to justify or win acceptance of a central decision-making authority. Such a model also might be used by very large foundations that need to coordinate different operational units.