The State Department and USAID announced eight focus countries that will get extra help from Obama’s proposed six-year, $63 billion Global Health Initiative Friday.
The new plan aims to better integrate health services and in particular improve mother and child health in countries around the world. Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda will serve as labs to help determine how the GHI is implemented throughout the 80 countries where the U.S. is involved in global health work.
“These countries are about that learning opportunity,” said Amie Batson, USAID’s deputy of the Global Health Initiative, and were chosen for geographic diversity, local government interest and because of promising existing initiatives on the ground.
The countries will receive extra management guidance and technical support in working to strengthen their health systems, said Batson, but details about how much funding will be allocated are not yet known.
The new health initiative is intended to build on the existing President’s Emergency Plan for AIDS Relief, PEPFAR. Ambassador Eric Goosby, United States Global AIDS Coordinator, told the NewsHour in an interview earlier this year that the GHI will help make better use of country resources.
“Think of your own health care. Does it make sense for you to address your health care one disease at a time, or does it make sense for you to go to one spot that looks at the whole picture of your health care needs?” Goosby said.
“That’s really what the GHI is doing. It’s taking the next step and allowing services to meet the needs of the patient in front of them.”
Goosby cited a hypothetical where PEPFAR workers treating an HIV positive woman could not help with immunizations or other health concerns, because of the “vertical,” disease specific funding line.
Despite Goosby’s arguments, AIDS advocates are concerned the plan is detrimental to providing and expanding access to life-saving antiretroviral medications around the world. While the proposed GHI budget expands global health funding, the PEPFAR budget request for this year is only a 2.2 percent increase, short of the annual growth the program has seen since its inception.
The result of this slow down, said Paul Zeitz, executive director of the Global AIDS Alliance, is that people are beginning to be turned away from some programs in Africa.
“The President has requested basically a flat lining of funding for the emergency AIDS program,” said Zeitz. “New patients are not being enrolled, people are being told ‘we’re full’ and we’re seeing a real backlog of people–women, and pregnant women, and other kinds of vulnerable people–that are medically eligible for life-saving AIDS medicines being turned away.”
David Apuuli, director of the Uganda AIDS Commission told a panel discussion at a global health conference earlier this week Uganda “is headed for a crisis” as global AIDS funding flattens from all sources. The New York Times reported in May, “Uganda is the first and most obvious example of how the war on global AIDS is falling apart..it is the first country where major clinics routinely turn people away.”
Goosby acknowledged there is a huge unmet need for ARVs around the globe and said the many international players in the fight against AIDS and the individual countries will have to work together.
“We need to change the way we think about response to this unmet need, and acknowledge that one program is not going to successfully meet that unmet need,” Goosby said.
As for the GHI as a whole, Goosby said the U.S. is doing everything it can to “increase the number of lives that we are able to impact and save.”