In many Western nations, a woman who is about to give birth has to go to the hospital, call her doctor, and be admitted for observation. The mother and child have some of the best professional attention, even if both are healthy. However, for many African mothers the process is much more arduous. The essentials for proper obstetric care, prenatal and antenatal, and maternal health cannot be done in one hospital due to the lack of equipment, trained medical personnel, and knowledge. The mother either decides to travel the long journey to a better facility or take the chance of birthing alone.
The differing of resources is the basis for President Barack Obama’s Global Health Initiative (GHI) which aims to achieve significant health improvements and form a country-led platform. With the achievement of the dual objectives above, it provides the foundation for sustainability in essential health care and public health programs. The Obama administration has stressed global health as a major concern in terms of equity and affordability; funding the health sector will allow for advancements in economic development, education, gender equality, and political stability. The GHI appears to be a well-developed, complex, and ambitious undertaking by the Obama administration.
The GHI proposed by President Obama addresses the need to help partner countries improve health outcomes by strengthening their health systems. The main focus is to “improve the health of women, newborns and children through programs including infectious disease, nutrition, maternal and child health, and safe water.” With the designated focus, the:
HIV/AIDS—President’s Emergency Plan for AIDS Relief (PEPFAR) plans to support the prevention of 12 million new HIV infections, provide support for 4 million on treatment, and support the care for 12 million others.
- Malaria—reduce burden of malaria 50% for the 70% or 450 million at risk in Nigeria and the Democratic Republic of the Congo (DRC).
- Tuberculosis (TB)—reduce the prevalence by 50% and save approximately 1.3 million individuals.
- Maternal Health—across assisted countries, reduce mortality by 30% to save approximately 360,000 mothers.
- Child Health—save 3 million children by reducing the under-5 mortality rates by 35%.
- Nutrition—reduce children under-nutrition in food insecure regions by 30% (in partnership with President’s Feed the Future Initiative).
- Family Planning and Reproductive Health—be able to prevent 54 million unplanned pregnancies by using a modern contraceptive prevention measure.
- Neglected Tropical Diseases (NTDs)—reduce prevalence of 7 NTDs by 50% among the 70% of affected population; eliminate onchocerasis in Latin America by 2016, eliminate lymphatic filariasis globally by 2017, and eliminate leprosy.
These overall goals have country-specific targets, but the GHI wants to achieve the aggregate set of goals by 2015. The GHI mission has set reachable targets, but nothing is possible without funding.
To achieve these ambitious but attainable goals, GHI has dedicated a vast array of resources and funding totaling $63 billion over the next six years. President Bush’s five year GHI plan, from 2003-2008 allotted $22 billion for AIDS, Malaria, and TB while $5 billion was spent on Other Global Health Priorities, bringing the total spending on global public health to $27 billion. Conversely, President Obama’s five year GHI plan, 2009-2014, has allotted $51 billion on AIDS, Malaria, and TB, while $12 billion will be spent on Other Global Health Priorities, totaling about $63 billion. This amounts to a 133% increase in the level of total funding.
The Obama administration advocated at the 2009 G8 summit in L’Aquila, Italy for the creation of an effective development partnership in global health. The GHI plans to maximize every dollar invested by the US government to allow for sustainable health impacts. The key principles, which are the core of the GHI, include: promoting a woman- and girl-centered approach to global health, strengthening relationships with important multilateral organizations, global health partnerships, and private sector management, focusing on country ownership and country-led initiatives, and allowing more research and innovation to strengthen health systems to receive and reach sustainability. The foundation has been laid for a successful global health initiative: attainable targets, proper funding, and core principles; however, the key component will be the implementation stage of President Obama’s GHI.
The US government currently provides medical/global health assistance to approximately 80 countries and is the world’s leader in that regard. Even though specific diseases and diverse health systems vary between countries, the four step implementation process works the same across borders. These steps include:
- do more of what works,
- build on and expand existing platforms to foster stronger systems and sustainable results,
- innovate for results, and
- collaborate for impact
For each country receiving global health assistance, experts from the US government will work with partner governments to evolve and master country-led national health programs. The GHI program will apply to all areas where US government dollars are used, but GHI will select 20 GHI Plus countries that demonstrate “significant opportunities for impact, evaluation, and partnership with governments.” These countries will give examples on how to build and expand existing platforms, how to best use inputs to receive the best outputs/results, and how to work in collaboration with partner governments, US government agencies, and global partners. However, not every country can become a GHI Plus country. The outlined criteria makes a country a prime candidate for increased assistance: having the potential to support the other U.S. development investments and bilateral, multilateral, and foundation investments; existence of health information and programming with a certain basic level of functionality; the magnitude and severity of the health problems; and the partner country’s interest in participating and supporting monitoring, evaluation, and transparent reporting on progress.
The US government, Congress in particular, will select 10 countries, to become Phase I of the GHI Plus country proposal, which will receive an additional $200 million, in fiscal years 2011 and 2012, from the GHI fund. The eight countries selected include: Ethiopia, Kenya, Malawi, Bangladesh, Guatemala, Mali, Nepal, and Rwanda. Then from the success of these countries, 10 more will be selected and given increased assistance and implementation in fiscal year 2013. However, action taken by the government, with large amounts of spending, comes with its fair share of critics and criticisms.
Christine Lubinski, Center for Global Health Policy, and Michele Moloney-Kitts, U.S. Global AIDS coordinator, openly criticized the GHI adopted by the Obama administration. Lubinski stated, “the president’s proposed budget for global health would shortchange PEPFAR and provide little additional money for new priorities such as maternal and child health.” Looking at the goals and targets, the GHI stresses maternal and child health, concurrently, with a women and girls centered approach. Without new funding to change priorities, there is a possibility of seeing no change in the statistics for maternal and child health and mortality rates.
The 2008 World Health Report put forth five distinct and pertinent problems when trying to deliver public health care. Primarily, because most public spending often benefits the rich, but not the poor, there are serious risks that such programs strengthen the gap between the rich and the poor in terms of availability and quality of public health care. Next, the issue of payment for health services presents a looming challenge. Then, with an increase in topically-focused health services, the continuity aspect and holistic approach to health care diminishes. The health services provided to the poor and marginalized populations lack the proper resources, equipment, money, and training, to be an adequate resource. In this regard, AFJN supports a more community-based/primary care approach to health care. Instead of basing medical treatment around clinics or hospitals, staffers should train local medical personnel, traditional health care attendants and midwives, to fill the knowledge gap. Educating the village medical staff will further strengthen the medical infrastructure for a country; however, the primary care piece is absent from the GHI proposed by President Obama.
Lastly, the WHO stated that unsafe care, poor hygiene and sanitation levels, and misdirected care were issues that inhibited successful health care delivery. These are legitimate concerns for most advocates within the global public health sector, but AFJN hopes that with funding levels exceeding President Bush’s GHI by 133% there will be more opportunities for expansion and improvements on all fronts.
Overall, AFJN agrees that, as Secretary of State Hillary Clinton put it, “bringing better health to people around the globe is an avenue to a more secure, stable, and prosperous world.” We celebrate the funding increases and the commitment to creating an opportunity to provide health systems for the people in the most destitute of conditions. We also know that there are real challenges and obstacles to the implementation of such initiatives; AFJN encourages the administration to ensure that voices on the ground and African civil society are given primacy in that process and calls on our members to remain engaged. If all goals and targets are achieved by 2015, the health systems in Africa and globally have the potential to be stable, legitimate, and transparent. Within the next five years, it is possible to see a decline or elimination of the inequality vignette.
By Josh Perry