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“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.

The Kaiser Foundation is one of the organizations out there trying to bring more attention to global health policy. The philanthropy has been hosting a number of forums featuring Obama’s new global health czar Lois Quam and others trying to shine more light on the Global Health Initiative (GHI).

The latest Kaiser forum was dubbed by the Science Speaks blog as “Exploring the Global Health Initiative on the ground.” I assume — since this was a wonky DC-based forum — that by “on the ground” they were referring to Quam’s recent two-month excursion traveling around 80 poor countries assessing global health. Quam came into the job as a health care executive with little (no?) experience in global health matters.

Maybe the headline for the Kaiser forum was a riff on an earlier report by a different DC-based think tank entitled “On the ground with the Global Health Initiative.”

That report was based on an assessment of the GHI made by a team of experts, including Seattle’s own PATH President Chris Elias, evaluating what impact the Obama Administration’s new strategy has made on efforts to improve health in Kenya.

In short, not much.

Existing U.S. or U.S.-funded programs aimed at increasing access to children’s vaccines, AIDS drugs, malaria drugs or bednets and other disease-fighting interventions have made a big impact in Kenya (and elsewhere). But the GHI remains merely an abstraction to most, with little impact — other than maybe to instill fear of coming funding cuts disguised by language such as “improved efficiencies” or “country ownership.”

The dollar figures in all these discussions, about the GHI or the Global Fund, probably don’t foster much public understanding since most of us fog over when governments talk of billions.

Simply put, it’s actually not that much money when taken in context — such as the amount we spend (about $20 billion annually) just to air-condition tents and other military structures in Iraq and Afghanistan.

What reducing funding for the GHI means “on the ground” is that more poor children are at risk of dying from stupid, easily preventable diseases like diarrhea or pneumonia, more people with HIV will die from AIDS or malaria and so on. Sorry to be blunt but that’s really what all this means on the ground.

For a look at the GHI on the ground in Ethiopia, I re-recommend John Donnelly’s series in GlobalPost.


About Author

Tom Paulson

Tom Paulson is founder and lead journalist at Humanosphere. Prior to operating this online news site, he reported on science,  medicine, health policy, aid and development for the Seattle Post-Intelligencer. Contact him at tom[at] or follow him on Twitter @tompaulson.