An impressive coalition of 25 US based global health organizations has promulgated their policy recommendations for Obama this week.
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The United States, through a Global Health Initiative, should:
• Double U.S. aid for global health to approximately $16 billion per year in 2011 and challenge other donors to similarly scale up their investments;
• Establish bold U.S. targets for improved health outcomes in each of the six GHI areas and contribute our fair share to reach the healthrelated Millenium Development Goals; and
• Ensure that as we invest in programs to scale up health for all, we build on successful programs and fulfill existing commitments.
The Global Health Initiative
President Obama’s Global Health Initiative (GHI) represents an historic opportunity to achieve bold and ambitious targets in the fight against the most daunting global health challenges of our generation. Alongside related efforts to reform U.S. foreign assistance and to coordinate various initiatives that populate the global health landscape, the GHI is an important signal of the intention of the U.S. government to expand its leadership on global health. At a moment of global economic downturn, we recall the Institute of Medicine’s statement from earlier this year that global health programs “play a crucial role in the broader mission of U.S. foreign policy to reduce poverty, build stronger economies, promote peace, and enhance the U.S. image in the world today.”
Currently the GHI consists only of a limited number of known elements; fundamental aspects such as scope, targets, timelines, and specific costing data have yet to be finalized. The language of a broad and realistic vision of what the U.S. can accomplish, however, is encouraging. This report strongly supports the President’s focus on the six areas identified: HIV; tuberculosis; malaria; reproductive, maternal, newborn and child health; health systems and health workforce; and neglected tropical diseases.
TOWARD A BOLD & EFFECTIVE GLOBAL HEALTH INITIATIVE
“We cannot fix every problem. But we have a responsibility to protect the health of our people, while saving lives, reducing suffering, and supporting the health and dignity of people everywhere. America can make a significant difference in meeting these challenges, and that is why my Administration is committed to act.” –-President Barack Obama, May 5, 2009
To substantively tackle these areas, success will depend upon key decisions:
• First, funding targets must be sufficient to meet current estimates of the U.S. share of funding required to reach internationally agreed upon goals in the six priority areas of the GHI. The nation’s highest scientific body— the National Academies of Sciences, Institute of Medicine—eloquently articulated the U.S. interest in investing significantly more in global health. Initial figures for GHI—$63 billion over six years – will not be sufficient.
• Second, investing in each of these key areas could yield major synergies for people’s health—with an exponential benefit in lives saved. Yet an expanded response to certain health priorities at the expense of planned scale up in other areas would miss this opportunity. To help achieve these key elements of what the GHI can be, a coalition of civil society organizations with expertise in the six GHI priority areas has developed an analysis of the appropriate U.S. program and funding targets that should define the GHI. Our analysis also includes recommendations for policy changes necessary to facilitate the success of the GHI.
Ingredients for A Bold & Effective Initiative
The U.S. government can and should be a leader in global health on a larger scale—moving the world toward realization of the human right to health through smart, aggressive scale up of key health services that improve not only the health of people but also the economies of nations.
This requires continued expansion of what is working and scale up of other priority efforts to levels sufficient to reap the synergies possible—ensuring systems of health that can care for people long term. We cannot address maternal and child health in Southern Africa, for example, without aggressively scaling up AIDS treatment to address the largest cause of deaths of mothers and, often, their nurses and midwives as well. Simultaneously, with smart, integrated and additional programming we can ensure that their communities are stronger because these same women do not die in child birth, their children do not die of pneumonia, and everyone receives core preventative care. As the GHI announcement highlights, a cross-cutting commitment to strengthening country health systems is essential for this to happen—and this will require increased investment in the health workforce to address bottlenecks that have impeded effective health programs for decades. In order to reflect a bold, innovative new approach to global health a GHI is needed which:
1• Supports bold, people-centered, outcome-oriented services reaching toward universal access to health. A focus on a selective set of the cheapest interventions has been the hallmark of weak and ineffective responses that have undermined progress in reaching global health commitments. The GHI should not support rationing of services based on a narrow and restrictive concept of cost effectiveness.
2• Supports direct health service delivery as the core of U.S. global health programs. Major scale up in the purchase of commodities and provision of services to people should be central where it is not currently.
3• Continues promised growth of HIV/AIDS, TB, and malaria programs and uses these as a platform for expanded services. As the greatest killers of people living in impoverished nations, infectious diseases must continue to be a major priority. U.S.-supported HIV programs have been used to expand community health care coverage; these innovative models for delivering integrated community care should be expanded as best practices. This will require full funding of the Lantos-Hyde Act.
4• Sets bold U.S. targets based on global need to urgently scale-up sexual, reproductive, maternal, and child health and neglected disease response. Despite decades of promises to address these priorities, far too little progress has been made, and scandalous rates of preventable sickness, death and disability must spur the U.S. to bold action.
5• Strengthens health systems by focusing on recruiting, training, and retaining health workers. None of the U.S. priorities described here will be reached without sufficient midwives, doctors, nurses, and community health workers.