President Obama announced his Global Health Initiative (GHI), a $63 billion program to be spread over six years, in 2009. But the ambitious program aiming to promote health worldwide is likely to fall shy of its funding target.
“We don’t know what’s going to happen in the next three years, but I think even an optimistic budget scenario would not bring funding to $63 billion,” said Vice President and Director of Global Health and HIV Policy at the Kaiser Family Foundation, Jennifer Kates. In fact, even if funding levels were to remain constant going forward, which some think is an optimistic future budget scenario, Kates said, the total allocation will still fall short by about $11 billion.
Moreover, in the global AIDS community there remain significant questions about the level of activity and progress in implementing the vision of the GHI to date.
In a speech in February, U.S. Agency for International Development (USAID) Director Rajiv Shah said, “If we can target the freed resources provided by GHI toward the expansion of new scientific breakthroughs, I believe by 2016, we can: save the lives of over 3 million children, prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies and cure 2.4 million people infected with TB.”
But where do those predictions stand given the current economic situation and what some call the most challenging budget environment on Capitol Hill in decades?
In the fiscal year (FY) 2011 budget battle recently waged on the Hill, global health funding in general fared better than might have been expected, with the President’s Emergency Plan for AIDS Relief (PEPFAR) program taking only a slight cut from FY 2010 levels; flat funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria; and family planning and reproductive health programs getting a five percent cut. But with the FY 2012 budget proposal from the House including significant cuts to global assistance, global health programs might not fare so well in the future.
Science Speaks interviewed Kates following the publishing of a series of articles in the Global Post* by John Donnelly outlining the “Waiting for Godot”-type experience of President Obama’s GHI. As the second article in the series points out, there are still a lot of questions even among those who advocate for global health program funding: What is the GHI? What does it include? Is it in effect yet on the ground and how is it different from what was previously in place?
According to the initiative’s website, “GHI ensures that agencies conducting global health initiatives combine their efforts to maximize results.” Functioning as an aggregate of existing funding streams, GHI is an umbrella that covers current programs, including the PEPFAR program, funding for tuberculosis, malaria, a lot of other funding at USAID for neglected tropical diseases, family planning, and so on.
Regardless, Kates says the funding situation will present a challenge for combating global health moving forward. Even if the next three years were flat-funded at FY 2011 levels – what she calls an optimistic scenario – there will be a big gap, with total GHI funding reaching only about $52 billion.
“GHI is a new approach to the existing global health programs of the government and a strategy for being more coordinated, efficient, thinking about the ultimate beneficiary at the end of the day and what they need… But ultimately, if there are gaps in the funding there will be challenges for the programs in the field to scale up to meet demand,” Kates said.
And what about AIDS programs specifically?
“PEPFAR is part of the GHI – that means the entire $48 billion that was authorized for Lantos-Hyde – that’s part of the $63 billion. And there is also a big gap here between what has been appropriated and what’s left to reach that $48 billion,” Kates said, adding that since both programs are inextricably linked, given that PEPFAR itself is a little more than 70 percent of GHI budget, what happens with PEPFAR will undoubtedly have important implications for the GHI’s goals and strategy.
The PEPFAR program has been touted in recent years as successfully doing more with less, creating incredible efficiencies, most notably enormous cost savings through procuring the cheapest generic medications and reducing shipping costs by using ground services whenever possible. “How far can these efficiencies go toward what appears to be a big gap in funding? We just don’t know how big that gap is going to be,” Kates said.
“It doesn’t appear that we’re going to be in a scenario where we’re going to be able to do more with the same amount, but rather to do more with less, and that’s a challenge.”
Kaiser will be hosting a briefing on May 25 exploring how the GHI is changing what happens in the field, featuring GHI Executive Director Lois Quam.
* Kaiser sponsors the work of three Kaiser/Global Post Global Health Reporting Fellows, but does not have any editorial influence over the publication or its fellows.