Is Funding Our Only Global Health Priority?


Dear Fellow Advocates, 

Surely all of us are scouring
over the President’s budget released this week to answer the questions
on all of our minds: did he listen when we spoke?  Did he really
mean what he said when he committed himself to increased funding for
global health and foreign assistance programs-or were those just empty
campaign promises?  While our current President is a master of
words, we recognize that the budget proposal speaks louder than words – it
is the blueprint of his true priorities.  And we want to know where
we stand.   

In a briefing to our advocacy
community on Tuesday, May 5, and in an official statement from the President,
the Obama Administration introduced budget numbers for global health
as part of a "six year strategy."  Many members and organizations
in our community were quick to respond that the proposed $63 billion
over six years amounts to a failure on behalf of this administration
to both fulfill campaign promises and that millions of lives may be
lost as a result.  As a global health advocate, I share a deep
sense of disappointment that these numbers are not higher.  Global
health is but a small slice of our governmental spending, yet its impact
is proven to be so crucial in the protection of a right to a healthy
life for so many people around the world.   

Yet a part of this story is
untold when just looking at numbers. Even amidst our disappointment
with the President’s numbers, there was an increase.  And we
must recognize that while we lead the world in funding and support for
global health programs, we lag – to the detriment of those people we
are trying to support – in our commitment to sound policy governing
that funding.   

Well, fellow advocates, there
was another, crucial part of the President’s statement on global
health that somehow was overlooked by some members of our community
who could utter nothing but words of contempt for the perceived stinginess
of the six-year strategy.  President Obama said in a written statement,
"We cannot simply confront individual preventable illnesses in isolation. 
The world is interconnected, and that demands an integrated approach
to global health."   

Wow.  Imagine that. 
An "integrated approach to global health."  What does that
mean?  They’re certainly words for which I’ve advocated. 
But in practice – what would this look like and why do I think this
is much more monumental than some of our colleagues are recognizing? 

Well, for so long, global health
advocates have worked tirelessly to build up funding streams and programming
for specific issue areas, be they family planning, maternal
and child morbidity and mortality, HIV and AIDS, tuberculosis, malaria,
other neglected tropical diseases, safe water and sanitation, food security,
or others.  With a limited amount of discretionary funding to appropriate,
this has resulted in competition within our community for the same pots
of funding and on-the-ground implementation that is manifest in segmented
and disjointed health care services – reflective of the manner in which
the funds were authorized and appropriated.   

Don’t get me wrong – U.S.
global health programs are some of the best in the world.  However,
for a young woman in a low or middle income country in need of contraceptive
commodities, she must visit the family planning clinic; if she also
wants testing for HIV, she must go to another clinic miles away, and
in the case she tests positive, she must access food to take her HIV
medication at another source miles away from there.  For that young
woman, the current U.S. global health portfolio is simply not realistic. 
The lack of coordination does a disservice to both the people our global
health programs try to serve and the ultimate public health and development
results we seek to achieve.   

A Stanford University Medical
School study recently found that the President’s Emergency Plan for
AIDS Relief had reduced the death toll from HIV and AIDS by 10 percent. 
Ten percent.  That’s a million lives.  We were able to do
that even though our clinics are miles apart and funding for one illness
or condition cannot go to the other, etc., etc.  And I understand
that funding is what made that happen – money flowed and supported the
rapid scale up of interventions that transformed HIV from a death sentence
to a disease that when treated effectively can be managed indefinitely. 
All this in very low resource settings where many public health experts
said it could not be done.   

I write this open letter to
our community to ask us to take a step back amidst the budget analysis
to imagine what we could do if those clinics were better coordinated
and those services were better integrated.  Imagine how many illnesses
and conditions would be averted, how much more effective treatment would
be, how many more lives would be saved-and most importantly – how
much more empowered all the people accessing health care would be.   

The same Stanford study referenced
above also found that PEPFAR "has had no appreciable effect on prevalence
of the disease in those nations."  No appreciable effect on prevalence. 
If we do not integrate our global health programs, especially reproductive
health (including comprehensive sex education, family planning, maternal
health, among other emphases) with HIV, a disease that is primarily
transmitted through unprotected sexual intercourse, will any amount
of funding ever be enough?  I don’t think so.  And even
if we were to fund treatment for every person living with HIV throughout
the world, where are our priorities as a country if we are not equally
as committed to empowering those persons to prevent the transmission
in the first place?   

President Obama’s global
health strategy, while it may not deliver on the numbers, indicates
that the administration is ready to do the difficult task of adjusting
and reconfiguring the way we do global health work. 
Moreover, Secretary Clinton’s recent testimony to the House Committee
on Foreign Affairs unapologetically declared this administration’s
support for healthcare and foreign aid investments that focus on the
empowerment
of individuals to make choices about their reproductive
health despite the widespread politicization of those interventions. 
The Obama Administration is by no means perfect, and a "strategy"
is nothing without implementation.  But this is undeniably a step
in the right direction.    

As advocates, I think we can
all agree on one thing: we have a responsibility to our constituents,
not our political representatives.  Our government leaders are
to be held accountable-decried when they make bad decisions and praised
when they show bold leadership.  In this instance, I must voice
my strong disagreement with those who are choosing not to recognize
the critical paradigm shift that has been introduced in the administration’s
strategy: a focus on integration.  I will be the first to challenge
the administration if I believe it is falling short on following through
with this strategy – but at this moment, integration is the bold and
transformative change to global health policy on which the lives of
millions depend for their health and wellbeing, and on which the future
of the U.S. global health portfolio depends for its success.  Money
is an important part, but not the only part of the equation and we as
advocates have a responsibility to our constituents to support this
agenda.   

Sincerely,

Brian Ackerman

This post first appeared on Amplify.

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  • http://www.wilsoncenter.org/ecsp invalid-0

    Thanks for flagging the integration theme. Certainly change I could believe in for I think we constantly undercut gains that could be captured through integration or at least recognition on interconnections. Much easier to count, measure, and track single sector, but what’s easiest is not always most effective. Let’s at least give integrated efforts a chance to compete at scale and with resources to see if they can achieve results greater than the sum of the parts.

  • invalid-0

    Hi Brian… Really glad that you are hopeful here and certainly integration is what many of us have been demanding across various aspects of the work–HIV programs integrated with family planning, maternal and child health, TB and malaria programs, etc. It’s absolutely what makes sense. But here’s my two worries:
    1) The 2010 budget includes no serious new money for any of this integration–with family planning programs basically flat-lined at miserably low levels. The US government is not implementing any of these programs, only funding them, right?
    2) I have not heard anything about how USAID will be fundamentally revamped to focus on delivering actual services to real people with concrete targets and outcomes. Part of why we pushed so hard to pull AIDS programs out of USAID and create PEPFAR was that the USAID bureaucracy fails to measure it’s success based on lives saved or people accessing real measurable services, but instead on money out the door.

    So let’s figure out how to demand programs that are really based on RESULTS from USAID and programs that are based on sound science out of PEPFAR (where at least we know they’re failing because they are delivering real programs we can see failing to address comprehensive prevention).

    Of course programs should be integrated–and holding PEPFAR funded program accountable for that is essential. But before we go forward in integrating FUNDING streams, I want to know that we’re not going back to the bad old way of doing development funding… Obama’s statement says nothing about that, nothing about multilateralism, nothing about results-driven financing, nothing about participation of affected communities… so I’m still waiting.

  • invalid-0

    Dear People,
    I learned that a prominent advisor has a JAMA article (2008?) arguing that more US effort should be placed on the two major killers of children. I´d be most appreciative to get his name and/or reference to the article.

    Much thanks, David

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