U.S. Global Health Initiative: An Opportunity to Provide Short (and Useful) Comments on a Tall Order

February 3, 2010

Yesterday’s release from the White House of the FY2011 budget  and a simultaneous release of a consultation draft of the Global Health Initiative (GHI) by the State Department signal a strong commitment and evolving action plan from the Obama administration for global health engagement in 2011 and beyond.

Funding commitment: Putting $9.6 billion in to perspective
With the $9.6 B requested for global health for 2011 the Obama administration is increasing its financial commitment for global health, despite the many competing domestic and global priorities in the 2011 budget.  That says something about this administration’s willingness to continue the very good trend that President Bush put in to place with PEPFAR in 2003.  A quick look at the graph (with a shout out to Jen Kates and her team at the Kaiser Family Foundation for providing this as it comes hot of their press!) below shows a greater than 5 fold increase in U.S. funding for global health from 2001 to 2011.

The bulk (almost $7B of which is PEPFAR, including $1B for the Global Fund) of the funding is for HIV (details of the budget for global health can be found here) but the GHI is setting for itself a broader set of global health goals, making it more ambitious than PEPFAR, and potentially more responsive to a range of global health priorities in countries of greatest need. 

Ambitious Targets
The draft strategy is ambitious, to use the administration’s own adjective for its targets:
“We have set out ambitious targets to inspire an intensive effort. While specific targets will be established at the country level, the GHI is expected to achieve the following aggregate goals by the time performance can be measured in 2015.”  Full details of these targets and their specific timelines may be found in Annex A of the draft strategy (Page 12 and 13) but a few highlights of the targets and goals from this strategy are listed below as a snapshot of the challenge ahead:

HIV/AIDS: PEPFAR will: (1) support the prevention of more than 12 million new HIV infections; (2) provide direct support for more than 4 million people on treatment; and (3) support care for more than 12 million people, including 5 million orphans and vulnerable children.
Malaria: Reduce the burden of malaria by 50 percent for 450 million people, representing 70 percent of the at-risk population in Africa. This effort will include the expansion of malaria efforts into Nigeria and the Democratic Republic of Congo.
Tuberculosis (TB): Save approximately 1.3 million lives by reducing TB prevalence by 50 percent. This will involve treating 2.6 million new TB cases and 57,200 multi-drug resistant (MDR) cases of TB.
Maternal Health: Save approximately 360,000 women’s lives by reducing maternal mortality by 30 percent across assisted countries.
Child Health: Save approximately 3 million children’s lives, including 1.5 million newborns, by reducing under-5 mortality rates by 35 percent across assisted countries.
Nutrition: Reduce child undernutrition by 30 percent across assisted food insecure countries in conjunction with the President’s Feed the Future Initiative.
Family Planning and Reproductive Health: Prevent 54 million unintended pregnancies. This will be accomplished by reaching a modern contraceptive prevalence rate of 35 percent across assisted countries, reflecting an average 2 percentage point increase annually, and reducing to 20 percent the number of first births by women under 18.
Neglected Tropical Diseases (NTDs): Reduce the prevalence of 7 NTDs by 50 percent among 70 percent of the affected population, contributing to: (1) the elimination of onchocerciasis in Latin America by 2016; (2) the elimination of lymphatic filariasis globally by 2017; and (3) the elimination of leprosy.

Your chance to influence a major U.S. foreign assistance initiative
This is a tall order and the administration needs your help to think through issues of implementation and measurement of results for success.  For example, are these targets the right metrics of success? Many of us criticized PEPFAR for focusing on counting numbers treated and numbers cared for rather than on a decrease in deaths due to HIV and a decrease in new infections in a given population. So, what’s different about these targets?  In a refreshingly participatory process,  this administration has called for your comments on the Global Health Initiative’s draft strategy.  My colleagues at CGD and I will comment on specifics about the GHI strategy as we digest its different components. Send your useful and practical comments (read as–best to stay away from pushing for more money in this economic climate!) to ghi_comments@state.gov by February 22^nd. Let’s see what and how well we can do with the billions we have for global health. It’s an opportunity to contribute to the making of a major US foreign assistance program, so let’s try to get it right—that is achieving the targets laid out (relative to need by country and available budget) and being able to measure these to demonstrate success.  And if you are inspired and want our readers from around the world to know what you have shared with the U.S. government,  feel free to post your comments here as well.

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1. Ninive Pelaez Says:
   February 5th, 2010 at 3:26 pm

   I hope this will help the people that really needed. Funding Institution that are using the money in an non- honesty way worry me. Poor people continue to be more poor in the Dominican Republic and the one with power more rich.Is important to make new recomendation to Global HIV/AIDS policy.

2. Giorgio Cometto Says:
   February 8th, 2010 at 1:02 pm

   A continued and renewed emphasis by the USG on global health is welcome news. In order that the resources invested translate into the achievement of the desired outcomes, however, the resources should be provided and channelled in a manner that comprehensively strengthens health systems, building the health workforce, helping to remove financial barriers to access, revamping logistics and information systems, strengthening the management and stewardship capacity of governments, etc.

   The disease-specific focus that characterizes certain health programmes needs to be combined with a comprehensive system strengthening approach that goes beyond individual service delivery areas and recognizes (and addresses) the common underlying health system bottlenecks.

3. Eleásara Says:
   February 17th, 2010 at 8:15 am

   I think that the added value of this initiative is the inclusion of strenghtening health systems which have been weackened for the past years. In one hand, i think that it is important to give space for recipinte countries to fully participate in the design and implementation of the programs, and for the GHI to be has aligned as possible with national systems bearing in mind that most of the countries face challenges that starts with the lack of adequate human resources both medical and managerial. In addition, Monitoring and evaluation systems need to be strenghtened in order to guarantee that results are measured in a timely and effective manner. I would like to highlite the fact that the GHI initiative is one of the few that has clearly and systematically included gender issues, as a means to achive the results.

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