David Rieff and the Global Health Initiative
David Rieff’s recent blog post about the Global Health Initiative calls into question the wisdom of splitting oversight and programming for the $63 billion initiative across at least three government agencies, declaring that, “the administration has laid the groundwork for a bureaucratic calamity.” Looking at the GHI as a catalyst for development, Rieff raises the question of whether the Obama Administration has missed an opportunity to unite its broad development programs under the visage of an empowered USAID. Similarly, the administration’s food security initiative, Feed the Future, also lacks a single individual to serve as coordinator and final authority, with instead a joint-leadership of two deputies, one representing development, the other diplomacy.
Secretary Clinton calls on GHI “to save the greatest possible number of lives, both by increasing our existing health programs and building upon them to help countries develop their own capacity to improve the health of their own people.” The collaborative and multi-agency approach to addressing global problems should be applauded, as different parts of the government clearly have different areas of expertise that should be engaged. Questioning the wisdom of spreading oversight across so many agencies is also not a comment on the talents of any of the individuals involved in either of these inter-agency collaborations. Rather, the question is whether empowering USAID, as the lead development agency of the U.S. government, to play a larger role in the oversight and coordination of these efforts would ensure the best chance for success in achieving Secretary Clinton’s vision.
While the problems these initiatives seek to address require a multi-disciplinary approach, without clear authorities and accountability, including empowering USAID with a leadership role, these programs may inevitably, in Rieff’s words, “do quite a lot of good,” but fall short of being the transformative initiatives they are intended to be. Questions about the appropriate roles and missions for development and diplomacy are expected in the forthcoming recommendations in QDDR, due to be released in late September. Perhaps we’ll find out more there about how the administration will address the challenges of implementing its development goals.
While I agree with that the GHI should unite under USAID, there is the balance the President must walk with what can and should be done. USAID is currently not leading and while it’s improving it will be a while before Congress and the Secretary of State see it as THE leader. Uniting the GHI under USAID also is a budget issue since even it you unit it, AIDS sits outside of USAID and all budget authority for PEPFAR is though OGAC/DoS. Mr. Rieff’s piece is good but doesn’t delve into the politics that we must all acknowledge.