in perspective

April 8, 2011 By Vidal Seegobin

This contribution is cross-posted with The Stimson Center’s Will and the Wallet blog.

The president’s announced his new Global Health Initiative (GHI) nearly two years ago and ever since the public health community has been waiting for details on how the administration was going to weave together the US’ portfolio of disease specific interventions in global public health. On March 15th, the newly minted executive director of the GHI Lois Quam launched, a website that serves as the initiative’s communication hub for how the GHI will make good on its mandate.

In many ways, there’s a lot for public health professionals to be pleased with. provides information on key personnel associated with the GHI, its mandate and strategy document. The website also features country strategy plans that highlight surprisingly detailed focus of US public health interventions in a select set of focus countries.

The country strategies prioritize USG health activities on two to three health sectors that address the most pressing challenges for the recipient country. In Ethiopia, for example, the GHI seeks to improve the delivery of health services for maternal and child health, prevent infectious diseases like HIV and malaria, and improve human resources for health, logistics management and infrastructure.

For monitoring and evaluation enthusiasts, the strategy documents detail multiple quantifiable health targets to measure the success of US intervention. The content focuses on outcomes, tailoring strategy to local context and establishing synergies are considered good development practice.

These inroads are an important first step toward coordinating the evolving, complex world of health assistance. Since 2003, the USG has rolled out a steady list disease-specific interventions ranging from the multi-billion dollar President’s Emergency Plan for AIDS Relief (PEPFAR) to Presidential initiatives on neglected tropical diseases and malaria.  These programs are, of course, in addition to the Center’s for Disease Control and Prevention (CDC) and USAID’s long-standing work in nutrition, sanitation and maternal and child health.

While the increased focus and funding for health in the developing world was lauded by development and public health professionals, over time many grew concerned that the billions of the health dollars from the American tax payer were doing little to develop the internal health capacity in recipient countries and are posing a significant communication and coordination burden

The GHI promises to act as an umbrella for USG global health activities. Managed by an executive director installed at the State department and guided by an Operations Committee comprised of the Director of the CDC and the USAID administrator, the inherently inter-agency framework promises to coordinate a “whole of government” approach to public health and oversee the transition of its management to USAID.

The website content does not, however, explain what the GHI is doing differently. Before 2008, US health assistance heavily skewed towards HIV and AIDS spending. In the 2011 budget request, bilateral HIV/AIDS spending accounts for close to 60% of GHI assistance (excluding money to the global fund for AIDS, TB and malaria) with the usual suspects following suit (neglected tropical diseases, malaria, tuberculosis, maternal and child health.)

Furthermore, one of the main goals of the GHI is to integrate disease specific interventions. Unfortunately GHI documents only discuss health system strengthening superficially.  Improving the delivery of health care, by its very nature, is long term oriented, focused on the development of human and physical capital. It requires sustained, country-owned financing to build and maintain infrastructure and the health workforce.

While certain country strategies acknowledge that brain-drain severely compromises the sustainability of a robust health sector, very little within the US health intervention portfolio can stop the migration of professional to richer countries or reduce the time and investment needed to train human resources for health.

Moving forward, as the government operationalizes and measures health system strengthening, a concrete set of monetary and non-monetary interventions aimed at improving workforce retention will be absolutely necessary.

The above challenges are well understood by the GHI executive.  The true success of GHI will rest on its ability to coordinate programs so that they achieve the measureable goals codified in the strategic plans. On the whole, the initiative may not be doing health assistance differently but it is making concrete attempts to be smarter. As Ms. Quam builds on the GHI the website, it will become an important resource for monitoring and understanding US investment in health throughout the globe.


Vidal Seegobin is a Research Associate with the Stimson Center’s Global Health Security program.