Refocusing Global Health Sector Aid…But to Where?

by guest blogger Patricia Orozco

global-health1Secretary Clinton’s speech earlier this month about the future of development policy suggested some interesting changes in US efforts to advance the global health sector —

 “Through our new Global Health Initiative, we will build on our success with PEPFAR and other infectious diseases, and we will focus more attention on maternal, newborn, and child health, where there is still a long way to go. We will invest $63 billion over the next six years to help our partners improve their own health systems and provide the care that their own people need…”

The CGD blogs that Secretary Clinton is right in pointing out the need to invest in the health systems of recipient countries—a move that steers health sector assistance away from its “too narrow a focus” of simply increasing the number of antiretroviral treatment beneficiaries.

What’s appealing about this potential “re-balancing act” is its sustainable, localized perspective. By helping to strengthen systems, recipient countries can take ownership of caring for their populations. I like how specific Secretary Clinton is in describing the future direction of the US’s work in this sector. Yet this move towards supporting health care systems and focusing efforts on improving maternal and child health in the developing world also raises a critical question: Has the US considered all potential options for refocusing efforts to advance global health?  Where else can global health sector assistance go?

The US has concentrated a huge amount of global health efforts, financially and otherwise, on HIV/AIDS. But is there too much emphasis on battling this disease? What about targeting other diseases that also have huge burdens on the populations and yet are easier to treat? A recent NYT article stated “Diarrhea kills 1.5 million young children a year in developing countries — more than AIDS, malaria, and measles combined — but only 4 in 10 of those who need the oral rehydration solution that can prevent death for pennies get it.” Pneumonia is another leading killer of children and can also be treated inexpensively, as opposed to AIDS which requires lifelong medication. So while PEPFAR has successfully provided antiretroviral treatment to the neediest populations and no one can deny the impact it’s made and I’m not advocating for PEPFAR to wean off from supporting these programs, I just wonder how some of these resources can be redirected to also address these other critical diseases.

I also have to question how PEPFAR has supported partner health systems and whether the US is really equipped to expand these efforts. In many ways, PEPFAR’s approach to global health aid is directly aligned with GW’s Four Principles of Aid Effectiveness. PEPFAR’s “partnership frameworks” are framed around supporting transparency, accountability and local ownership; it provides publicly available documents delineating funding allocations; targets partner countries who have the highest HIV/AIDS adult prevalence rates; etc.  But in what ways can PEPFAR improve how it helps partners? Global Health Council’s President/CEO Dr. Jeffery L. Sturchio argues for the strict inclusion of family planning and gender considerations in guiding PEPFAR managers in the field. He thinks this approach, integrating reproductive health services and HIV/AIDS, will help remove crucial barriers preventing more infections.