GHI watchers wonder as “next steps” include closing office

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The announcement that the office of the three-year-old Global Health Initiative would close came in a blog posting headlined "Global Health Initiative Next Steps" on the eve of the Fourth of July holiday last week.

When the White House announced the Global Health Initiative in 2009, it was to be a six-year, $63 billion effort to combat neglected and preventable diseases, improve family planning, nutrition, address causes of maternal and child mortality, and, in the process, improve health care and health outcomes.

It has been more than a year since anyone has heard any mention of the money, those watching the initiative say. Instead, the status of the GHI only became murkier in the last year with a projected budget for fiscal year 2013 that cut funding to the President’s Emergency Plan For AIDS Relief by 562.9 million — a more than 12 percent cut, and included a $28 million drop in funding for maternal and child health programs.

The second-to-last paragraph included the information that the GHI office would close.

Then, last week a link to an item called “Global Health Initiative’s Next Steps” appeared on GHI’s web page. A blog post signed by all four of its principals: USAID Administrator Rajiv Shah, Global AIDS Coordinator  Eric Goosby, Centers for Disease Control and Prevention Director Thomas Frieden and GHI Executive Director Lois Quam, the item reiterated the three-year-old initiative’s goals and progress before mentioning, in the second-to- last paragraph, that its “next steps,” and “move forward,” would include closing the GHI office at the State Department. At the same time, the new “Office of Global Health Diplomacy” would be “stood up.” According to the post, “The Global Health Initiative will continue as the priority global health initiative of the U.S. Government.”

What did it mean, this drop from upper-case to lower-case initiative? What will end when the GHI office closes? What will begin when the new one is “stood up?” And as for results, while the GHI, had promised to move “from process to outcomes,” the July 3 announcement said: “Success in the next phase will be measured by our ability to leverage our collective interagency leadership to influence global stakeholders, align donor investments with country resources and oversight and maintain and build country-focused technical support that expands capacity for global health priorities.”

“If I’m going to be optimistic, I would say this could be beneficial for the issue of health in poor countries. If it really does mean that the U.S. government is going to elevate global health to be a core issue in its diplomatic relations with developing countries, it would have an important impact in terms of political commitment to this issue,” Ann Starrs, president of Family Care International, told Science Speaks. Starr’s organization is one of two dozen in a coalition that issued a set of recommendations in October 2009: The Future of Global Health: Ingredients for a Bold & Effective Global Health Initiative. The group has been watching GHI’s progress during the last three years, and had discussed recent rumors that the office would close. Still, the announcement, when it came, seemed to leave the future to the imagination.

While outgoing GHI Executive Director Lois Quam stressed in a subsequent conversation with Starrs — and, later, with Science Speaks — that United States ambassadors will play a central role in the initiative, that is not spelled out in the announcement.

In addition, how much ambassadors in some countries will be able to do remains a question.

“My experience with ambassadors in country — they have a lot of stuff on their plates,” Donna Barry, advocacy and policy director of Partners In Health, another member of the coalition. While some would relish the opportunity the new role might offer, Barry added, she is concerned others won’t be able to take on an additional challenge.

That shouldn’t be a problem, Quam told Science Speaks.

“Our ambassadors representing the United States have regular ongoing contact with heads of state and other key leaders,” she said. “The roles we’re asking our ambassadors to play is consistent with their responsibilities.”

The response she has received to last week’s announcement, she said, has been positive.

“People see diplomacy as a strong channel to further global health goals,” she said. “The thought that that’s what we’re going to be doing more of was very encouraging to people.”

While “elevating the role of diplomacy in global health,” the work would be “focusing less on headquarters, teams, big meetings in DC,” Quam said.

If the July 3rd blog post seemed a quiet way to post good news, “it wasn’t inconspicuous from our point of view,” Quam said.

The operating committee of the post’s three other signers, Goosby, Frieden and Shah will continue to direct the initiative’s strategies, Quam said. She will be part of the transition team, and will help set up the Office for Global Health Diplomacy.

In the meantime, the organizations that formed the GHI monitoring coalition have benefited from their experience, Starr said.

“It’s helped to build organizational as well as individual connections between organizations that were working in different aspects of health — HIV/AIDS, family planning, maternal and child health, water and sanitation. Groups that don’t normally work together were brought together in response to GHI to articulate a coherent, integrated vision of what we thought health services and health programs should look like,” Starrs said.

She believes that effort will continue. Watching the next steps of the initiative is “more important than ever, because we’re back in a situation to keep tabs on what three different agencies are doing,” she added.

“What they’re saying is that while the GHI office will close, GHI is not ending, it’s going forward in different channels,” Starrs said. “In an optimistic perspective, that is what will happen. In a pessimistic perspective, we go back to three organizations pursuing different targets with different approaches, and there’s limited coordination, no synergy.”

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