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NewsNotes, May-June 2010
Vol. 35 No. 3

Global Health Initiative: Promises, questions

See related article in March-April 2010 NewsNotes

President Obama’s ambitious Global Health Initiative (GHI) was first proposed in May 2009 as a way of combining the U.S. government’s multiple international public health programs under one umbrella. The purpose of this framework is to provide greater integration and coordination of health services, with a particular focus on strengthening health systems and improving the wellbeing of women and children. With the release of the implementation’s consultation document and the president’s proposed FY2011 budget, the shape and scope of the program has become clearer. A final version of the GHI is expected in early summer. The following article was written by Maryknoll Office for Global Concerns intern, Stephen DeWitt, OFM.

The consultation document identifies seven key principles on which the GHI will be based: Implement a women and girl-centered approach; increase impact through strategic coordination and integration; strengthen and leverage key multilateral organizations, global health partnerships, and private sector engagement; encourage country ownership and invest in country-led plans; build and sustain ability through health systems strengthening; improve metrics, monitoring and evaluation; and promote research and innovation. These are all excellent principles that have the potential to improve significantly the nature of U.S. sponsored health services around the world. From an HIV/AIDS perspective the focus on a women and girl-centered approach, increased country ownership, and health systems strengthening are particularly welcome.

Serious questions exist, however, as to whether the implementation of these principles is truly possible as the program is currently designed. One of the biggest issues revolves around the funding of the GHI: Will enough money be allocated to fully implement the above proposals, especially for the President’s Emergency Plan for AIDS Relief (PEPFAR)? The administration’s FY2011 budget proposal reduces the U.S. contribution to the Global Fund for AIDS, Tuberculosis, and Malaria and essentially flat-funds PEPFAR for the coming year. On April 12 the Boston Globe reported that PEPFAR has already instructed some clinics in Uganda to stop enrolling new patients on anti-retroviral medications. Eric Goosby, U.S. Global AIDS Coordinator, contends that the instruction was merely a reminder to clinics to stay within already agreed upon budgets, but the net effect remains the same: new patients are being turned away and not receiving critical medication.

If this trend continues, important gains in the fight against HIV/AIDS will be imperiled. This action also comes at a time when HIV/AIDS activists are already questioning the administration’s commitment to HIV/AIDS and fuels speculation that the GHI is part of a plan to shift focus from HIV/AIDS to less costly diseases. To be clear, there is nothing wrong with the U.S. developing programs to address other important international health problems, but this should not be done at the expense of AIDS victims in the developing world.
Other questions focus on the GHI’s structure and implementation, including the leadership and governance structures; tools for evalution; meaning of “country-ownership” and accountability to donors; and the role of civil society.

Another important factor is that many of the GHI proposals lack either adequate targets or do not integrate those targets with existing ones. For example, the HIV/AIDS-related targets in the consultation document appear to reflect PEPFAR’s current five-year plan and have not been adjusted to the six-year time-frame of the GHI. This is especially noticeable in the area of tuberculosis, where the GHI consultation document’s targets are significantly lower than those proposed in the Lantos-Hyde Act reauthorizing PEPFAR. In the area of health-systems strengthening, the documents proposed support and training of 140,000 new health care workers over six years is well shy of the estimated 4.25 million needed to fill critical shortages in GHI target countries.

For more information check the Kaiser Family Foundation Policy Brief on the U.S Global Health Initiative (pdf), available on the MOGC website.

Faith in action:

Encourage your member of Congress to support full funding for PEPFAR and other programs that implement U.S. commitments in response to HIV and AIDS, malaria and tuberculosis.

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