Making sense of the Global Health Initiative

What’s the best-kept secret of Obama’s first term?

It has nothing to do with his birth certificate. But if you follow international development work—or if you’re a nerd for health policy, like I am—one of Obama’s global aid programs is up there on the list.

An upcoming GlobalPost series, including this blog, is set to explain the inner workings of the Global Health Initiative (GHI), the Obama administration’s health aid program. According to GlobalPost reporter John Donnelly, GHI has brought little-known but big changes to the complex world of international health aid.

You may have heard of PEPFAR, or the Bush administration’s President’s Emergency Plan For AIDS Relief. Bush’s most public success came with PEPFAR, a popular, bipartisan program that funneled billions towards the AIDS pandemic. But since 2009, Obama’s team has backed away from Bush policies, instead coming up with the broad-reaching but poorly-funded GHI.

The GlobalPost series kicked off with Donnelly’s two-part series earlier this month. But for those readers who need a primer in GHI, and all the context around it, here are some ideas and stats to get you up to speed.

GHI in a sentence: “We’re shifting our focus from solving problems, one at a time, to serving people, by considering more fully the circumstances of their lives and ensuring they can get the care they need most over the course of their lifetimes,” said U.S. Secretary of State Hillary Clinton in a 2010 speech at Johns Hopkins University.

What does that mean? In the past, U.S.-funded health programs overseas have been organized by disease: AIDS, malaria, tuberculosis. Under GHI, the strategy is to work with each country to streamline and improve basic care. This doesn’t mean abandoning the fight against AIDS and other diseases, according to Clinton, but taking a longer-term view instead of attacking a series of health emergencies.

The program’s other goal is to improve women’s and children’s health: lowering the rate of mothers who die giving birth and trying to address malnutrition, malaria, and other health problems that are devastating in childhood.

Praise: GHI has the right ideas, many health experts say. “We can do better for people and get better results… if we deliver services that are targeted to delivering happy healthy families, not tackling a disease,” said Dr. Mark Dybul, former U.S. Global AIDS Coordinator under Bush, in a March panel discussion. Using evidence-based care, focusing on mothers, and thinking about the long term are all goals that excite health experts following GHI.

Criticism: GHI has been slow to start, hasn’t been clearly defined, and will likely be under-funded in today’s tough budget environment, said health policy experts who spoke to Donnelly for his series. Its sluggish pace has sapped some of the bipartisan support for health aid funding that helped make PEPFAR a success, political observers told Donnelly.

By the numbers: GHI vs. PEPFAR

$63 billion – the amount that, in 2009, Obama said he planned to spend by 2015 through GHI.
$53 billion – the biggest amount that Obama could realistically get, according to analysts looking at the current budget environment, writes Donnelly.
$48 billion – when Congress reauthorized PEPFAR in 2008, the amount allocated until 2013.
70% – roughly, the proportion of the GHI budget made up of funding tied to PEPFAR, according to the Kaiser Family Foundation

We don't know too many more concrete details of GHI, but that's what this series is for. GlobalPost team of reporters will be posting on the blog as they begin investigating GHI from on the ground. Also, stay tuned for posts from the Global Health Council Conference in Washington DC this upcoming week. Send us your questions, comments, and check back often!