We have an enormous obligation to address the needs of other countries because we can, Executive Director of the U.S. Global Health Initiative (GHI) Lois Quam said at a Kaiser Family Foundation briefing Wednesday. “But we’re going to have to create new money by being more effective and efficient.”
It’s a familiar tune in the current economy.
But global health advocates are eager to see what changes the president’s ambitious six-year, $63 billion initiative is inciting on the ground – especially when many questions remain about what the GHI is and how it’s different from the programs previously in place.
The Kaiser event addressed some of these questions by exploring the rollout of the GHI, and the progress and challenges that arise when translating the GHI in the field. “GHI is about creating momentum – making gains and keeping gains as we move forward” with a whole-of-government approach, said Quam, recently back from about two months of traveling to several of the 80 countries where GHI is active.
Accompanying Quam on the panel of experts were three U.S. field representatives from “GHI-plus” countries, which are selected to serve as learning laboratories for global health interventions and strategies. These 8 GHI plus countries – Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal and Rwanda – received about a quarter of all GHI funding in fiscal year 2010. (Seven of the 8 plus countries have their strategies available online).
Former GHI Planning Lead for Malawi, Mamadi Yilla, said her “aha moment” was learning how “siloed” the internal operations of the U.S. government were – that the GHI prompted them to engage the work of various government agencies and departments, expand upon their expertise, to influence what happens in the health sector.
In the health sector in particular, for example, Malawi was rolling out a new nursing education partnership initiative that was funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) program. “We used this opportunity in-house to ask, ‘What have we been doing in the nursing sector?’,” Yilla said. They found a lot of duplication, she said, and quite a few of their programs were supporting curriculum development at a local college of nursing, “So there was an opportunity to find some savings and do more with what we had,” Yilla said. They also forged relationships with the Clinton Health Access Initiative and Norway, two organizations active in improving nursing in-country as well.
In the same vein, Bethanne Moskov, health team leader for the U.S. Agency for International Development in Mali, said, “We now look to each other to bring technical assistance to the table.” She gave the example that Peace Corps volunteers are now able to, “Access any training offered by other U.S. agencies to spread the work that we’re doing.”
During the question and answer session, David Bryden of Results asked Quam how the president plans to show his support for GHI when he has yet to commit to attending the United Nations (UN) High-Level Meeting on AIDS in New York in early June – likely to be the last UN meeting on AIDS – and optimistic funding forecasts for the GHI still put it on path to be about $11 billion short of its $63 billion goal.
“Rest assured that your colleagues in the U.S. government are thinking hard about how to make the biggest impact at the high-level meeting,” Quam said, after partially addressing the funding question, stating that Obama’s fiscal year (FY) 2012 budget request includes significant increases for global health funding and the administration should get credit for that.
According to Jen Kates, vice president and director of Global Health and HIV Policy at the Kaiser Family Foundation, if the fiscal year FY 2012 budget request for the GHI was met at $9.8 billion (the president’s request) and then flat-funded at $9.8 billion for FY ‘13 and FY ‘14, the gap to reach the $63 billion would still be $7.4 billion.
When asked about the likelihood that Obama’s global health funding request would even make it into the final funding bill, Kates sad, “We are in one of the toughest budget environment in a long time, and it is not yet known how this will play out.”
Panelist Mark Green, senior director at the U.S. Global Leadership Coalition and former ambassador to Tanzania, made the point that one of the big challenges in going forward with the GHI is messaging and managing expectations.
“As we talk about GHI we need to be very clear about the resources that are involved, especially in the field,” Green said.
“If we’re not careful, there will be disappointment.”