Noting “PEPFAR has been criticized for its vertical or ‘stove-piping’ structure, with resources targeting a specific disease rather than working to strengthen the underlying health system,” a study published in the Journal of Acquired Immune Deficiency Syndromes “aimed to evaluate whether PEPFAR activities were associated with system-wide improvements in both proximal and distal indicators of health systems strengthening.” According to the abstract, “[t]he progressive scale-up of PEPFAR-supported activities was associated with consistent improvements in proximal indicators of health systems strengthening” and “was also associated with improvements in broader measures of health system strength, most clearly life expectancy” (Cohen et al., 12/18).