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Q&A: Head of the Global Health Initiative Talks Next Moves

First announced in 2009, the initiative was envisioned as a comprehensive approach to health in the developing world that would integrate HIV/AIDS and other health services, and strengthen health systems.

Critics of the program say that it hasn’t moved quickly enough and that the funding — a proposed $63 billion over six years — isn’t enough to expand the global health mission.

The eight “plus” countries — Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda — were chosen to serve as models for integrating health services, and better serving women and children, among other goals.

GHI Executive Director Lois Quam was at the International Conference on Global Health this week to provide an update and talked with the PBS NewsHour about what’s been accomplished and what’s ahead.

NewsHour: How would you assess the progress in the GHI focus countries one year in?

GHI Executive Director Lois Quam: GHI has taken hold in our plus countries. I see that in many ways, I see that in the energy of our teams, they own these GHI country strategies. We’ve seen a very significant level of collaboration and cooperation between all the government agencies…we see an increase in real results on the ground. We see that we are able to treat more people, save more lives and that we are able to put the building blocks in place so that countries can do a better job of caring for their own citizens.

This has enabled us to take the learnings from round one and go out to another group of roughly 20 countries in round two and we’ll be getting those plans in over the next couple weeks. Then we’ll go out to a further 30 countries in round three.

NewsHour: When you talk about being able to treat more people, and the lessons that you’ve learned this year, what are some examples of that?

Quam: In a place like Mali, for example, we discovered as we sat down and did our overall global health plan …that there were areas of duplication and certain areas of overlap that weren’t quite well-defined, so what we were able to do there is really kind of streamline our work and that frees up important new resources in other areas. So that specifically allowed us to improve the services we are providing for neglected tropical diseases, a huge problem in that region, and then expand the work that we are doing there.

In Ethiopia, we’re doing tremendous work working with PEPFAR and the existing programs on skilled health attendants that can provide services in rural areas, which is so important. Only 6 percent of women in Ethiopia give birth in a facility, and that leads to enormous loss of life and complications and such terrible hardship for their families. So those are just two of our many many examples. We are looking at interesting ways of changing how medical education works in Rwanda that would allow Rwanda to be more self-sufficient.

Our goal in GHI is to work with our partner countries so that they can take care of their own heath needs effectively over time by our providing leadership and support and helping them get a handle on the crises they have in place. But our objective is really to help them meet their own needs.

NewsHour: There has been some criticism of the pace of the GHI, that it’s not being implemented quickly enough, that there’s not enough money attached to it to really broaden this U.S. global health mandate. How do you respond to that?

Quam: First let me respond to the question around speed. We have been doing very significant work in these countries, which I don’t think is as visible in Washington as we’d like it to be and that’s why we are looking at doing more forums with leaders from the countries themselves. All the action in this field takes place in country…and that’s what you’re going to see, you’re going to see less of headquarters and more of the field and that will give people a more accurate sense of what is going on.

I think in addition with regard to money, this administration has supported global health very strongly. There was an intention to very significantly increase funding, the obvious challenges around the federal budget have made that more difficult to do than we thought it was when GHI was announced in 2009.

Despite that, the administration has been very, very strong in these areas, and so we’re very proud of that support and just last week the administration announced important new initiatives around making sure that women who are HIV positive bearing babies who are HIV negative, which is a huge accomplishment in Africa, one we know can be done because we’ve done it in this country.

We also announced an increase in funding as a part of the international coalition for vaccines for poor children around the world. But what we know we need to do is we need to create the new money that we need to solve these challenges by improving the efficiency and effectiveness always of what we do, because we know that despite the very strong support for global health in the public and in the Congress, that the country faces real budget challenges and we are going to respond to those.

NewsHour: Earlier this year we saw some very promising research showing that ARVs could work as prevention for HIV transmission. On the ground, implementing this would mean greatly expanding the pool of patients that would need these medications, have GHI and PEPFAR been talking about implementing this?

Quam: Oh of course and that is an example of the U.S. government’s leadership, the work that NIH did under Tony Fauci. It’s a breakthrough finding because what we’ve been struggling to find in HIV is better ways of preventing the spread of the epidemic, that’s the most essential thing. This research gives us a new window into that, I take that very very seriously and that is really important.

Now we, with the international community as a whole, need to really discuss what the implications of that research is on our global strategy for HIV and AIDS. That process began in earnest last week at the United Nations.

NewsHour: At this point has there been any specific discussion about allocation of resources for funding for this type of expansion?

Quam: We are in the process of looking at that research and understanding what the implications are on our existing efforts. The U.S. global health programs play a very major role in prevention already and as we with the international community determine what we are going to do there we will be ready to say more about that.

NewsHour: When can we expect to learn which countries are in round two of the GHI?

Quam: We’ll be announcing that later this summer. They get the benefit of everything the plus countries learned and one of the things that we’ve found is most important is the sharing between the plus countries and the next round of countries, that’s where a lot of the deep learning comes.

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