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Global health advocates deal with losing clout

Somali mothers and their babies wait for vaccines at a health center in Mogadishu, Somalia. One million children still die at birth every year due to lack of care.
Somali mothers and their babies wait for vaccines at a health center in Mogadishu, Somalia. One million children still die at birth every year due to lack of care.

For the first time in nearly 15 years, the US government is poised to reduce its investment in global health.

The Obama Administration, which has long had a fairly spotty, confused and yet self-congratulory approach to fighting diseases of poverty, has submitted a budget request that has disturbed many in the global health community who, for more than a decade, saw themselves as at the top of the aid and development hierarchy.

Here’s a good breakdown of Obama’s $50 billion foreign assistance request from the Center for Global Development’s Casey Dunning. Global health would still get a big chunk, $8.1 billion, but that represents a nearly 5 percent cut from last year. And, as Humanosphere reported yesterday, some say we’re still not spending nearly enough if the goal here is to drive health improvements as a means to reducing global poverty.

Christine Sow
Christine Sow

“The request is much lower than anyone expected,” said Christine Sow, the new director of the new-and-improved Global Health Council (GHC), a Washington, D.C.-based organization that itself caused some confusion and consternation when it suddenly announced it was shutting down in mid-2012.

Sow was in Seattle this week to meet with others, like those at the Washington Global Health Alliance, to revive and re-orient the case for keeping global health at the top of the development agenda.

The GHC explained its 2012 closure in a somewhat cryptic letter that said: “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.”

Huh? It turned out that the real reason was loss of funding from the Bill & Melinda Gates Foundation, as Humanosphere reported in 2013. It also turned out that the global health community thought the ‘shifting landscape’ made the organization and its advocacy of their causes even more relevant than it had been. So the GHC was reborn and reconfigured with Sow eventually appointed to take the helm.

It could be rough seas. At least when compared to the previous 15 years of dramatic growth in funding for projects aimed at reducing the burden of HIV, malaria, TB and other diseases that disproportionately afflict and impoverish the poorest people on the planet. This golden age of global health led to the creation of massive initiatives like the Global Fund to Fight AIDS, TB and malaria, the President’s Emergency Plan for AIDS Relief (Pepfar), the Global Alliance for Vaccines and Immunization (GAVI) and other projects that resulted in tens of millions of lives saved – and improved.

Global health funding by source. BMGF is the Gates Foundation, GFATM is the Global Fund, GAVI is the Global Alliance for Vaccines and Immunization.
Global health funding by source. BMGF is the Gates Foundation, GFATM is the Global Fund, GAVI is the Global Alliance for Vaccines and Immunization.

As the graph above shows, from the Institute for Health Metrics and Evaluation’s report on global health financing, funding for global health (aka DAH, development assistance for health) shot up for many years but leveled off in the last few, in part due to the global economic crisis.

But the global economic downturn is not the only reason for this ‘shift in the landscape.’ Sow said after a decade or more of many great successes in these efforts targeting single diseases, the aid and development field is in need of a new, more comprehensive approach.

“I was working in Mali when we launched Pepfar and I saw it from the recipient country’s side,” she said.

Sow worked in Mali for nearly a decade on a number of issues including family planning and child health. Pepfar, she said, was a great and critically needed response to the HIV/AIDS pandemic in Africa. But because of its unilateral focus on HIV/AIDS and some of the US government restrictions placed on how the money was used, it also caused harm. Health needs are seldom limited to one disease.

“If we wanted to help a woman with reproductive health needs, for example, we couldn’t use the Pepfar money,” Sow said. So while the international community was celebrating its efforts against AIDS, she said, these highly focused efforts sometimes had the unintended effect of undermining the need to improve the overall function of health systems in poor countries.

“We now recognize the need for a more holistic, systems approach in global health,” Sow said. The new GHC will be a leader in advocating for health systems strengthening and more sustainable health projects done within a broader strategy of development, she said. Sow said she is not among those freaking out about the loss of funding to this or that specific program.

“I think moving toward a systems approach, and away from the disease-specific approach, is a change for the better,” she said.

But the Obama Administration proposal to reduce funding overall for global health while beefing up funding for other development assistance projects (like Power Africa, which some critics say is mostly subsidizing corporate investments in Africa as opposed to ’empowering’ poor communities) means the global health community does have to make the case that improving health, fighting disease, is still one of the best ways to fight poverty.

“We need to make it clear it’s not just health for health’s sake,” Sow said.


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.