Blueprint for Global Health Initiative Raises Fresh Questions About Funding

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The Obama Administration has finally lifted the curtain, if only for a preview, on its proposed $63 billion six-year Global Health Initiative (GHI), which the President first unveiled almost a year ago with a broad-brush call for a more integrated comprehensive approach to funding global health. 

Amid much anticipation, the White House yesterday released a 21-page “consultation document” on the GHI. You can read the full GHI document here. The Administration is seeking comments and input on the plan by Feb. 22nd. To offer your perspective, send an email to ghi_comments@state.gov.

Perhaps the biggest news in the document—and the element that raises the most questions—relates to funding. Although there aren’t many new details about how the $63 billion would be spent over the six year timeline, the consultation does outline plans to set up a “GHI Strategic Fund Reserve.”

For FY 2011, this new GHI Fund will have $200 million to support a review of country health plans, to scale up “proven cost-effective interventions” for maternal and child health and infectious diseases, and to begin integration interventions, according to GHI document. In addition, in FY 2011 and 2012, the GHI fund will be tapped to help 10 “GHI Plus” countries with additional technical, management, and financial resources to implement integrated programs and make investments across health conditions. The list of GHI Plus countries will be expanded to 20 in later years.

But there’s concern about where that $200 million will come from. White House officials have made it clear that some of that money will come from PEPFAR and other global health programs. What’s not clear is how much of PEPFAR’s budget, for example, will flow into the GHI Fund. Nor is it clear how those PEPFAR/GHI funds will be spent, i.e. will global AIDS money be used to finance nutrition or child health programs or will it be used for AIDS-related services?

If it’s the former, that could be devastating for efforts to combat HIV and TB, which need every penny available in this era of tiny budget increases. PEPFAR is slated to get a $141 million increase under the Obama budget blueprint, a welcome boost but too small to match the scope of the epidemic. If $100 million of that flows to the GHI Fund, that does not leave much to scale up treatment and prevention as the Administration has promised. As for TB, it would only see a $5 million increase over FY 2010 levels under the White House plan, a bump up that leaves little to spare for other causes. Click here to read more about the Obama budget for global health.

On another front, the GHI document outlines treatment targets for eight identified focus areas, including HIV/AIDS, TB, maternal health, and nutrition, among others. For example, the document says the GHI will strive to save 3 million children’s lives by reducing under-5 child mortality rates by 35 percent in targeted countries. On tuberculosis, the GHI will seek to treat 2.6 million new TB cases and 57,200 MDR TB cases and save approximately 1.3 million lives by reducing TB prevalence by 50 percent. But there aren’t too many details about how those targets would be reached.  

One thing is certain: The Administration needs to hear from HIV and TB experts about the GHI document. Whether it’s a comment about funding, the criteria to choose the GHI Plus countries or something else, please weigh in with your insights to ghi_comments@state.gov.

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  1. Pingback: Final GHI To Be Unveiled Soon, Many Details Still Uncertain « Science Speaks: HIV & TB News

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