Inside the Global Health Initiative

Posted on

By: Tim Thomas, Advisor, MHTF

Our friends at the Global Health program at the Council on Foreign Relations recently distributed a report of what they’ve learned about the new-ish US Global Health Initiative with a bias toward girls and women, which both President Obama and Secretary-of-State Clinton have touted as a keystone of their administration’s foreign policy.

The governance and structure of the GHI has been a topic of conversation and concern for those of us working in global health, and this excerpt from the June 18th CFR Global Health Update provides some welcome clarity:

“Don Shriber of the U.S. Department of Health and Human Services (HHS) said the governance of the Global Health Initiative has (finally) been hammered out in a form that ultimately lets the buck stop with Jack Lew, Deputy Secretary of State for Management and Resources. Beneath Lew will be an Overarching Strategic Council, composed of USAID, the State Department, the President’s Emergency Plan for AIDS Relief (PEPFAR), HHS, the Millennium Challenge Corporation (MCC) and the Treasury Department. It will meet monthly to assess the global health efforts. Answering to that Council will be the trifecta of leadership over the GHI: Rajiv Shah (head of USAID), Thomas Frieden (Director of Centers for Disease Control and Prevention), and Ambassador Eric Goosby (head of PEPFAR/U.S. Global AIDS Coordinator).

“Eight countries will serve as learning laboratories for innovation and new policy initiatives by the Obama administration’s Global Health Initiative. The countries…are:  Bangladesh, Malawi, Rwanda, Nepal, Guatemala, Ethiopia, Kenya and Mali.

They constitute the ‘GHI-Plus’ countries, which will get the closest, and presumably best-funded, attention from the new trifecta of the Executive Branch’s $63 billion, six-year Global Health Initiative. Overall, the GHI is unfolding on various scales in a total of 81 countries. Amie Batson, of USAID, said the GHI-Plus countries were selected based on in-country enthusiasm, democracy-building, potential for cross-sector integration of innovative programs and the presence of other donor partners – chiefly, the International Health Partnership (Norway and the United Kingdom, primarily), the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines and Immunisation (GAVI) program.”

The  distribution of funding in the GHI among health sectors remains a bit of a mystery.  According to the Kaiser Family Foundation’s analysis of the President’s FY 2011 Budget Request to Congress, PEPFAR and Malaria account for 81% or $51billion, and “Other Global Health Priorities” account for 19% or $12 billion.  MNCH and nutrition are slated for 9% and family planning/reproductive health are down for 6%.  But there are down-stream funding mechanisms that may confuse this allocation. As the Global Fund, GAVI and other multilateral donors that will receive much of the GHI funding increasingly exhort about the value of multi-sectoral, integrated approaches within their vertical funding structures, the question lingers of whether or not the GHI will restrict any of its contributions to maternal, sexual, and reproductive health and how/if those restrictions will be accounted for in the GHI budget.

Stay tuned as more on the GHI unfolds….we’ll keep you posted.