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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.



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.