Global Health Initiative

The Obama Administration's $63-billion initiative aimed at advancing global health.

RECENT POSTS

New US Ambassador says ‘global health diplomacy’ is not just re-branding a stalled strategy | 

Nearly four years ago, the Obama Administration announced with great enthusiasm the launch of the Global Health Initiative, which it described as a “critical investment in a new, comprehensive global health strategy.”

Then, nothing much happened. Years went by with occasional bits of celebratory fireworks from Sec. of State Hillary Clinton about how important global health is and what leaders we Americans are — or rhetoric about new efforts to coordinate programs and improve efficiencies.

But the GHI never seemed to come together. The economic crisis and other issues appeared to dominate the Administration’s focus and global health mostly remained off the radar. Funding was maintained for the most part, but few saw much of any vision or coherent strategy.

Last summer, the Obama Administration announced it was closing the Global Health Initiative – by elevating it to a diplomatic tier. The response from the global health, aid and development community was (like this and this) largely: “Yeah, right.”

Eric Goosby, a well-known figure in HIV/AIDS circles as U.S. Global AIDS Coordinator, was given the additional job of serving as the chief of the State Department’s new Office of Global Health Diplomacy. Today, the Kaiser Foundation held a fascinating discussion and Q&A with Goosby, who has the arguably difficult job of convincing many that the Obama Administration is actually going to do something this time.

I’m watching it now (catching up) and will provide some highlights later.

I should note that Goosby was asked if his new role as the US global health diplomat will include dealing with the deadly fall-out from the CIA pretending to be health workers, doing vaccinations, in Pakistan. Most agree that the Taliban’s latest practice of murdering of polio vaccinators is a direct result of this ill-advised scheme.

Goosby said the “White House is all over that issue already.” Really? How so?

Here is a brief take on Goosby’s talk by Science Speaks, which poses a number of other questions as to what Goosby actually meant. Some will be concerned about the vague rhetoric, so far a hallmark of the Obama Administration’s approach to global health. My question: Is ‘concretize’ a word?

The Sudden Death and Rebirth of the Global Health Council | 

 

GHClogoThe global health community was left bewildered when the Global Health Council suddenly announced last April that it was closing.

Members of the prestigious, decades-old organization were not warned in advance, participants in the upcoming annual meeting had to abruptly cancel their plans and the GHC’s cryptic explanation (scroll down to April) just left everyone scratching their heads:

“Times have changed… Funding that once existed to promote a broad-based health agenda is now focused on specific health issues. The fundamental shifts in the health landscape have led the Board to revisit the relevance of the organization and determine that the Council’s current operating model is no longer sustainable.”

But times have changed again, apparently.

The organization is being resurrected with a new board, a slightly new name (Global Health Coalition) and with purportedly a new and more relevant strategy. Continue reading

Rhetoric versus reality on Obama Administration’s AIDS policies overseas | 

Jessica Mack

This is a guest post by Jessica Mack

Jessica Mack is a global gender specialist and freelance writer. She is currently based in Bangkok, Thailand where she works on issues of violence against women and girls in the Asia Pacific region. More at www.jessmack.com. You can also follow her on Twitter @fleetwoodjmack

The Obama Administration talks a lot about integrating and coordinating our various global health projects, and also about how important it is to empower women. That’s the rhetoric. Here’s one womens health advocate’s view of the reality.

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Preventing the spread of HIV and AIDS has a lot to do with promoting safe sex.

That may sound obvious, but it seems to remain a mystery to those in the U.S. Government who set our AIDS prevention policies overseas. Stemming the spread of HIV has as much to do with family planning and enabling safe sex as it does with ensuring access to affordable drugs, accurate education, or changing norms and mindsets at the community level.

So it would make a hell of a lot of sense if all money for HIV/AIDS prevention efforts also included money for family planning. But alas.

Though the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been touted as one of our nation’s most successful initiatives in global health (and certainly one of President George W. Bush’s most positive legacies) it continues to miss the mark on this important point.

Oddly, PEPFAR will allow funds to be used for condoms — but only if they are promoted for protection against HIV as opposed to pregnancy.

PEPFAR recently released its 2013 country operational plan (COP), the framework for how its funding should be used by developing countries. This included what activities should and should not be supported – with one big bolded addition.

Under the section titled “Family Planning” – which extolls the importance of family planning as an effective means for reducing HIV/AIDS – is added this sentence: “PEPFAR funds may not be used to purchase family planning commodities.”

Um, come again?

This bizarre prohibition has had and will continue to have the effect of systematically cleaving contraceptive services from HIV/AIDS treatment and prevention services, oftentimes quite literally into different clinic sites and distinct service providers.

It doesn’t make sense, and it’s dangerous.

Continue reading

Op-Ed: The (significance of) Global Health Initiative’s death is greatly exaggerated | 

On the Healthy Lives blog, a leading global health advocate contends that all the complaints surrounding the Obama Administration’s recent announcement of its plan to shutter the Global Health Initiative (GHI) are missing the real point.

Karl Hofmann, CEO of PSI (which used to stand for Population Services International but now wants to be just PSI because the organization today does much more than reproductive health) argues that closing down the GHI doesn’t matter. Hofmann contends the goal of the GHI is to better coordinate global health projects, to foster ‘country ownership’ and that it is funding, which has remained stable, that matters more than bureaucratic structure.

I’m not sure I agree, but it’s an interesting perspective and a quick read. Here it is re-posted.

By PSI CEO Karl Hofmann

Karl Hofmann

The announcement Friday before the July 4 weekend that the Administration’s signature Global Health Initiative (GHI) was being replaced by a new Office of Global Health Diplomacy at State was greeted with withering criticism from many in the global health community.

Here’s why this change matters less than one might first think.

GHI was meant to bring coordination and integration to the USG’s vast global health bureaucracy, and particularly to drive more integrated health programming in the GHI focus countries.  The aim to achieve greater integration of Washington agencies and their individual health appropriations was never as likely nor frankly important as the aim to achieve more integrated health programming at country level.  The former is Washington’s favorite contact sport, with endless periods on the field and no permanent winners — it’s sensible for the Administration to stop beating its head against this goal post.  The latter probably has much more significance to the intended beneficiaries of US global health assistance, and here there has indeed been some country-level progress.
What matters more than org charts is of course appropriations.  In truth, the Administration and Congress have done rather well by global health, given our fiscal realities.

As a former US ambassador, I know the challenges of trying to get interagency coordination in Washington.  In fact, it’s often easier to get on-the-ground coordination in a particular embassy country team than it ever is to get agencies’ Washington headquarters to even talk to each other. Putting more emphasis on making global health integration a programmatic reality at the country level is probably the right way for the Administration to bring GHI principles to life.

 

Report: Obama’s Global Health Initiative lacks initiative, clear strategy | 

A new report by the Center for Global Development‘s Nandini Oomman and Rachel Silverman says that the Obama Administration’s once much-celebrated (though always vague) Global Health Initiative appears to suffer from a severe case of bureaucratic anemia:

At its launch, the GHI was met with great excitement and showed much promise as a coordinating mechanism to streamline U.S. global health funding and improve aid effectiveness. Thus far, however, the initiative has been plagued by problems with transparency, leadership, coordination, funding, and implementation, leading to deep skepticism both within and outside the U.S. government.

You can read their short, incisive report here as a PDF.

Oomman and Silverman don’t just whine about it. They present options to help GHI ‘regain the promise it held’ beginning with getting past vague generalities to clarify what it is and how it is supposed to work .

CGD colleague Connie Veillette also weighs in with Where Oh Where has the GHI Gone? The Whole of Government Approach Hangs in the Balance.

Veillette partly blames the lack of initiative and confusion at GHI on the political jockeying now plaguing our approach to foreign aid due to infighting between Sec. Hillary Clinton’s folks at the U.S. State Department and Raj Shah’s gang at the U.S. Agency for International Aid over ‘reforming’ foreign aid. Here’s my own, semi-serious, look at the tussle back when it started in early 2010.

Also see Global Post’s series on the Global Health Initiative over the past year.

News flash: Global health continues to stagnate under Obama | 

The Kaiser Family Foundation yesterday held a briefing on the Obama Administration’s ‘new’ approach to global health featuring, as keynote speaker, U.S. Health and Human Services Secretary Kathleen Sibelius.

Nothing much of substance seems to have happened, which some will say is in keeping with the Obama Administration’s strategy for global health. Sibelius claimed that the U.S. has always been and is today a leader in the fight against diseases of poverty, quoting Secretary of State Hillary Clinton:

“At a time when people are raising questions about America’s role in the world, our leadership in global health reminds them who we are and what we do.”

True enough. America has been a leader in many aspects of global health, such as the fight against AIDS and malaria. But none of that lead was established by the Obama Administration. It was mostly President George W. Bush’s leadership (especially on AIDS in Africa) — and to a great extent a small, private operation based in Seattle run by a software tycoon — which gave us the lead.

The Obama Administration, as documented in this excellent series of articles (also funded by Kaiser) in GlobalPost called Healing the World, hasn’t really accomplished much of anything … besides a lot of talk, new reports and announced ‘new’ shifts in strategy.

You can see for yourself, if you want to watch Kaiser’s video of the two-hour Beltway confab:

Two news organizations tried to cover the Kaiser event but I don’t know what they said since both, Congressional Quarterly and Politico Pro, are hidden behind a subscriber paywall. Kaiser quoted from one of the reports, by CQ’s Rebecca Adams:

“The strategy identifies 10 major objectives but does not include metrics for gauging success,” the news service writes, adding Sebelius “said the plan ‘does not represent a radical new direction but seeks to provide a focus to ongoing efforts.”

That doesn’t really sound new, or maybe even like much of a strategy. Most folks seem to have stopped paying much attention to the Obama Administration’s global health strategy — because it seems like mostly just rhetoric with no new funding and little in the way of substantive action.

 

GlobalPost: Obama’s Global Health Initiative shuns abortion services | 

The online international news organization GlobalPost has been taking an in-depth look at the Obama Administration’s Global Health Initiative (GHI) as part of its new endeavor, Global Pulse.

Managed and sometimes written by John Donnelly, one of the best global health journalists out there, I dare say the Global Pulse series is probably the most comprehensive, on-the-ground look at what the Administration is doing to fight disease in the developing world.

Here’s one of the their latest posts, by Hanna Ingber Win entitled GHI’s Missing Piece in Nepal, about the problems caused by the ongoing prohibition of U.S. foreign aid funding of abortion services.

Hanna Ingber Win, Global Post

Win opens her post:

LAMAHI, Nepal – United States President Barack Obama set up the Global Health Initiative to take a more comprehensive approach to improving health care in developing nations. In particular, his administration has given great weight to saving the lives of women and to supporting countries’ priorities in health care.

But there’s one exception: abortion.

In Nepal, that exclusion is in plain view, and many say the lack of support disregards evidence that safe abortions can save women’s lives. Nearly all experts here — with the notable exception of those employed by the U.S. government — publicly state that the best way to improve maternal health is by offering a wide range of services that includes more awareness about and access to safe abortion.

 

“On the ground” reality vs rhetoric regarding Obama’s Global Health Initiative | 

I wonder if anyone, other than those who want money from it, is paying that much attention to the Obama Administration’s once-ballyhooed grand vision known as the Global Health Initiative.

So far as I can tell the vision seems to be still a bit blurry and shrinking, from the original pledge of $63 billion over six years to maybe more like $55 billion, give or take a billion. Continue reading