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GlobalPost looks at Obama Admin’s “stumbling” Global Health Initiative

“A slow, stumbling start.”

That’s how John Donnelly, writing in GlobalPost, characterizes the Obama Administration’s Global Health Initiative. The online international news organization has published a short series called  “Healing the World” (yeah, kind of corny) that critically examines the initiative.

The U.S. government is, in fact, doing a lot when it comes to global health needs on a number of fronts — most of which were launched under President George Bush.

The Bush Administration’s global health “strategery” led to PEPFAR, a massive effort aimed at helping those with HIV/AIDS in Africa, the President’s Malaria Initiative and we remain the largest donor to multilateral initiatives like the Global Fund for AIDS, TB and Malaria.

These are amazingly grand and good things we are doing. But part of the problem with the U.S. approach to global health has been a lack of coordination among these initiatives and the various agencies carrying them out.

When the Obama Administration came in, they immediately announced their intention to remain committed to the overall global health cause while also bringing more order and a coherent strategy. Yet at the same time, they seemed to immediately back away from supporting specific projects. It was all broad rhetoric.

Here’s a post I wrote last year about Sec. of State Hillary Clinton’s celebration of our commitment while simultaneously planning to reduce funding to it, and another later one noting the slippery way we reduced support to the Global Fund (while claiming to boost it).

“The Global Health Initiative is off to a very poor start,” Stephen Morrison, a health policy expert at the Center for Strategic and International Studies, tells GlobalPost. “It has no new money.”

More importantly, it appears to have very little clear definition of a strategy or even a coherent identity. What the heck is the Global Health Initiative (GHI) anyway? Hardly anybody seems to know.

Donnelly, formerly with the Boston Globe and one of the top journalists out there on matters of global health, is the right person to dig into the fuzzy and confusing picture surrounding the GHI. Donnelly writes:

This new strategy put Obama’s signature on a main pillar of his administration’s foreign assistance. His pledge was to expand U.S. government focus much more aggressively into other critical global health challenges, such as saving mothers when they give birth or protecting communities from river blindness, instead of the United States continuing to attack one disease at a time, such as AIDS, tuberculosis and malaria, without any coordination.

But the reality so far falls dramatically short of the vision.

Donnelly went to Ethiopia to look at how the GHI is working and being received by those it is intended to help.

He quotes the chief of one AIDS treatment program, Dr. Solomon Zewdu, who is overwhelmed with patients and awaiting some kind of word on future U.S. assistance for AIDS care: “Have they defined GHI yet?”

The GlobalPost series also features an interview with Lois Quam, Obama’s new director of the Global Health Initiative.

I wrote about Quam in March after she was appointed — and about how little people knew about Quam or what she intended to do. Kind of like the GHI itself.

Why, many asked, appoint an American health care executive from Minnesota (I was born in Minnesota; I like Minnesota) to run a program that should actually operate in almost polar opposition to the way American health care operates?

Success in global health is almost the antithesis of American health care. It is, or should be, about emphasizing prevention over treatment, low-cost solutions versus high-tech solutions, public health systems versus market-based health care … and so on. Perhaps the last thing people in poor countries need are $100 pills and MRI machines.

Donnelly’s Q&A with Quam is unlikely to allay such concerns (or, sorry, qualms). Most of what she says is broad statements and generalizations that don’t address the fundamental problem — nobody seems to know what this thing is or what it’s trying to do.

For further detailed analysis of the GHI policy and strategy (or lack of it), I also recommend you read the Center for Global Development’s Nandini Oomman most recent take.


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.