GHC Senior Policy Manager Craig Moscetti breaks down the President’s global health budget numbers

President Obama released his Fiscal Year 2013 budget request yesterday, showing an essential flat-line in international affairs funding, but a $300 million cut to U.S. global health programs, a 4% decrease from levels enacted last year. Most global health issues were requested at levels 3-5% lower than FY2012 enacted levels, though several accounts received much deeper cuts, notably bilateral funding for HIV/AIDS and neglected tropical diseases. There were exceptions, including a continued emphasis to support women and girls through family planning and reproductive health, which received a modest 1.1% increase. A more detailed breakdown of accounts under Global Health Programs (which replaces the Global Health and Child Survival Account) is below.

 


A closer look at the numbers reveals potentially dramatic implications for how the U.S. approaches global health specifically and aid effectiveness generally. The President, including in the GHI, has embraced a much stronger multilateral approach to foreign affairs. Within the GHI, this means a commitment to supporting partnerships like the Global Fund and GAVI. To achieve multi-year pledge to both – which are both positive steps from an aid effectiveness perspective – the FY2013 request includes significant increases for both – the Global Fund received a 27% increase from FY2012 levels, and 12% for GAVI.

The concerning part is a possible classic instance of robbing Peter to pay Paul. In the case of the Global Fund, the offset appears to come from bilateral HIV/AIDS funding. But does this move fail to recognize the complementary elements of U.S. bilateral HIV/AIDS programs and the Global Fund? The Global Fund and GAVI are recognized as two of the most efficient and effective global health institutions, but will this type of significant resource shift effect the balance between Global Fund and PEPFAR in the field?

In stepping back, however, the largest concern is with progression towards stated goals of the GHI, particularly the funding goal. Despite assurances that the President’s budget request supports a comprehensive approach to global health, funding for the Global Health Initiative is severely lagging behind its stated funding goal of $63 billion between FY2009 and FY2013. This year’s request still leaves a $20 billion gap for the GHI heading into its final year. Many in the global health community support the Administration’s strong embrace of efficiency and innovation, but will the huge funding gap prove too great to overcome for the Administration to achieve its stated global health goals?

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On Burn Awareness Week, Johnson & Johnson highlights the work of a clinic in Johannesburg

Our skin both protects us from the world and lets us experience it. It fits us perfectly, stretches as we grow, warns us of danger, allows us to feel wind and sun. But it is also delicate. In low-resource areas, where women and children are more likely to spend time around open fires and cooking stoves, serious burn victims experience a trauma that leaves them vulnerable in a way most of us can’t imagine.

Twenty-one years ago, the Johnson & Johnson Burn Treatment Center opened its doors at the Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa. The hospital is located in Soweto, a primarily poor urban neighborhood of Johannesburg whose residents were subject to discrimination and violence under apartheid. When it opened, the burn treatment center was the only one of its kind in Africa, and in an area more commonly known for poverty and racial tensions. In two decades, the center has seen nearly 12,000 patients and performed more than 9,000 procedures.

Today, doctors from around the world visit the clinic in Soweto to learn new skills in burn management, and the medical and nursing staff there share a special understanding of the needs of the world’s most vulnerable people at their most vulnerable moments. It was this understanding that led Victoria Makalima, assistant director of nursing at the center, to return to school for training in psychiatry so she could counsel her patients and provide them with emotional support to accompany their physical healing. “We measure the success of burn injury management by the successful assimilation of the patient into the community after injury. If we accomplish that, I say we have achieved our goal,” Victoria says.

In October, we were privileged to take part in a special professional development workshop at the center, supported by the South African Burn Society, to highlight advancements in burn treatment and management. The symposium featured two surgeries, including one to treat a pediatric burn patient. Both procedures were streamed live to 80 other surgeons and burn health professionals – a remarkable reminder of how health and technology can intersect to improve access to health information and care all over the world.

The ability to restore health and wellness that is more than skin deep is what is so rewarding about this work. The partnership that made the burn center possible is at the core of the Johnson & Johnson commitment to saving and improving lives, building the skills of those who serve community health needs, preventing diseases and reducing stigma. Our vision of making life-changing and long-term improvements in human health continues to be realized through the hard work and dedication of the multidisciplinary specialists who make the burn center the success story it is today.

Roger Crawford is executive director, Government Affairs and Policy, Johnson & Johnson, and recent recipient of the Lifetime Acheivement Award by the South Africa Burn Society. Conrad Person is director, Worldwide Corporate Contributions, Johnson & Johnson.

Posted by: blog4globalhealth | 02/07/2012

NEGLECTED TROPICAL DISEASES: BUSINESS IS NOT AS USUAL

GHC Research Associate Katie Rosecrans outlines the new campaign to address NTDs, the first in a series on the topic

“Business is not as usual,” said Dr. Lorenzo Savioli, director of the World Health Organization’s Department of Control of Neglected Tropical Diseases (NTDs), regarding the new collaboration Uniting to Combat NTDs announced Jan. 30 in London. Thirteen pharmaceutical companies, the Bill & Melinda Gates Foundation, donor and recipient governments, the World Bank, and several NGOs have committed to work together to reach the targets outlined in the WHO’s new publication, Accelerating Work to Overcome the Global Impact of Neglected Tropical Diseases: A Roadmap for Implementation. The roadmap does not set new targets, but compiles existing resolutions and sets out common strategies for integrated NTD prevention and treatment programs.

The campaign surrounding Uniting to Combat NTDs highlights ten NTDs targeted for eradication, global elimination, or control by 2020:

Eradication
• Guinea worm

Elimination
• Blinding trachoma
• Leprosy
• Human African trypanosomiasis (sleeping sickness)
• Lymphatic filariasis

Control
• Soil-transmitted helminthes (ascariasis, hookworm, and trichuriasis)
• Schistosomiasis (snail fever)
• Visceral leishmaniasis (kala-azar)
• Onchocerciasis (river blindness)
• Chagas disease

Though the WHO roadmap includes 17 NTDs, nine of 9 diseases above (the exception being Guinea worm) have been selected as priorities because they will benefit from increased drug donation by the pharmaceutical industry. In an unprecedented partnership brokered by Bill Gates, companies will maximize the impact of their donations by addressing the burden of NTDs together, instead of piecemeal by disease. Looking beyond their individual corporate social responsibility objectives, companies are combining efforts to achieve broader health goals set out by the WHO.

Pharmaceutical companies will not only provide more medication, they will also shareintellectual property, both among industry partners and with the academic research community, and will pursue development of new technologies and improved formulations of existing medications to address NTDs. “I have never seen so many competitors working together,” said WHO Director-General Dr. Margaret Chan. Though this is certainly not the first public-private partnership in global health, the scale of cooperation, especially among private companies, is unprecedented. If the partners are able to achieve the WHO targets, this initiative could serve as a model-a new way to do business in global health.

The new donations mean that availability of the drugs themselves will no longer be the primary barrier to access, but there is still the hard work of delivery left to do. And drugs alone will not eliminate these diseases. Lack of clean water and sanitation, among other conditions of poverty, are what allow NTDs to continue to plague the most vulnerable. Uniting to Combat NTDs is just one piece of what is needed in an integrated development strategy to alleviate poverty, but it is an important and necessary piece.

This post is part of a blog series about neglected tropical diseases.

The Global Health Council endorses the London Declaration on NTDs. To learn more about NTDs, read the Global Health Council’s NTD position paper.


Kathryn Rosecrans, MPH is a research associate at the Global Health Council.


Posted by: blog4globalhealth | 01/30/2012

INFOGRAPHIC: REACHING NTD GOALS BY 2020

As an historic partnership to combat neglected diseases is announced, a visual representation of the burden and strategy

Click on the image for a larger view.

Source: Uniting to Combat Neglected Tropical Diseases

Posted by: blog4globalhealth | 01/27/2012

THE INTERNATIONAL AIDS CONFERENCE BEGINS TO TAKE SHAPE

As the International AIDS Conference returns to the U.S., Craig Moscetti shares some of the names that will shape the agenda

Today the organizers of the XIX International AIDS Conference (IAC) announced 15 plenary speakers and presentations that will help shape the overall conference theme “Turning the Tide Together.” Many global health advocates are excited to see the conference back in the United States after a 22-year ban on entry into the U.S. for people infected with HIV/AIDS was overturned by President Obama in late 2009. The conference also comes as a critical time for global health financing generally, and efforts to reaffirm U.S. leadership specifically. Coming just six months after a speech by Secretary Clinton to recommit the to helping achieve an AIDS-free generation, and President Obama’s World AIDS Day commitments, the IAC and the G8 Summit being held in Chicago are shaping up to be two huge political stages for the U.S. and its future positioning in global health.

Here are the 15 newly released plenary presentations and speakers – a combination of several long-standing challenges in trying to turn the tide on the epidemic, but also a more pronounced focus on HIV and broader global health issues, including the intersection with growing challenges like non-communicable diseases. What are your thoughts? Please leave your thoughts and comments.

Monday, 23 July: Ending the Epidemic: Turning the Tide
Ending the HIV Epidemic: From Scientific Advances to Public Health Implementation
Anthony S. Fauci, the National Institute of Allergy and Infectious Diseases (NIAID), United States

The U.S. Epidemic
Phill Wilson, Black AIDS Institute, United States

Turning the Tide in Affected Countries: Leadership, Accountability and Targets
Sheila Tlou, UNAIDS

Tuesday, 24 July: Challenges and Solutions
Viral Eradication – the Cure Agenda
Javier Martinez-Picado, AIDS Research Institute – IrsiCaixa, University Hospital “Germans Trias i
Pujol”, Spain

Implementation Science: Making the New Prevention Revolution Real
Nelly Mugo, University of Nairobi and Kenyatta National Hospital, Kenya

What Will It Take to Turn the Tide?
Bernhard Schwartländer, UNAIDS

Wednesday, 25 July: Turning the Tide on Transmission
Vaccines
Bart Haynes, Duke Human Vaccine Institute, United States

Turning the Tide for Women and Girls
Geeta Rao Gupta, UNICEF

Turning the Tide for Children and Youth
Chewe Luo, UNICEF

Thursday, 26 July: Dynamics of the Epidemic in Context
Turning the Tide for MSM and HIV
Paul Semugoma, Global Forum on MSM and HIV, Uganda

The Tide Cannot Be Turned without Us: HIV Epidemics amongst Key Affected Populations (Public Health, Human Rights and Harm Reduction)
Cheryl Overs, Monash University, Australia

Expanding Testing and Treatment
Gottfried Hirnschall, WHO

Friday, 27 July: HIV in the Larger Global Health Context
TB and HIV – Science and Implementation to Turn the Tide on TB
Anthony Harries, International Union Against Tuberculosis and Lung Disease, France

Intersection of Non-Communicable Diseases and Ageing in HIV
Judith Currier, University of California, Los Angeles, United States

Optimization, Effectiveness and Efficiency of Service Delivery – Integration of HIV and Health Services
Yogan Pillay, National Department of Health, South Africa

Craig Moscetti is the senior manager for policy at the Global Health Council.


Posted by: cmoscetti | 01/19/2012

Questions on the future financing for global health

The latest snapshot on global health financing is in. Dr. Chris Murray and colleagues from The Institute for Health Metrics and Evaluation presented today the findings from IHME’s third annual report on global health financing, titled Financing Global Health 2011: Continued growth as MDG deadline approaches. Yes, the report states the well-known trend that global health financing has transitioned out of the “massive scale-up phase” (many arguing with huge consequences) and into a period of slower growth, similar to that seen during the 1990’s. But some of the latest tracking data shed light on some interesting trends, prompting many key questions.

  • What’s the appropriate balance between government and non-governmental? – The 2011 IHME report just begins to scratch the surface of a critical choice having to be made by financers of global health – ‘should this sum of money be channeled through a national government or some non-governmental organization?’ With difficult trade-offs having to be made at the donor level, which route is going to provide the biggest return on investment, particularly with more calls to demonstrate the results generated from dollars spent? This question gains even more complexity when thinking about what gets funded, as Cristian Baeza, Director of the World Bank’s Health, Nutrition, and Population program, described at today’s event. With greater fiduciary oversight and a movement to link resources with results, Dr. Baeza expressed real concern about returning to practices of a decade ago, when donors “focused on commodities in the value chain, rather than systems.”
  • Are developing countries stepping up? – Yes, the rate of growth for bilateral health funding is decreasing. Some are voluntarily backing away from previous commitments to the Global Fund. Others, like the US, are in a position where government spending cuts both scores political points in an election year, but are also a stark reality under the Budget Control Act of 2011. But, despite all of this, public investment in health continues to grow in many of the poorest regions around the world, namely East, Central, and West sub-Saharan Africa. In fact, government health expenditures as a source of financing nearly doubled in East sub-Saharan Africa between 2000 and 2009 ($1.69 billion to $3.26 billion). With continued calls for more country ownership, isn’t this the trend we should be most focused on improving? At the same time, however, “subadditionality” strongly persists, which shows funding intended for a Ministry of Health isn’t totally additional. Instead, the finance minster redirects intended MoH funding to another sector because of the incoming donor support for health. This naturally leads to another question of weighing health spending vs. non-health sector spending.
  • Is health sector spending the more efficient and effective way to produce health? – UN member states gathered in Brazil late last year and declared their commitment to “take action on the social determinants of health.” Just a month earlier member states were in New York to agree on collective action to address the growing burden from non-communicable diseases, including through a “health in all policies” approach. So to achieve both aims, do we need to spend in health to produce health? As the question was rhetorically posed at today’s event, “If greater reductions for child mortality come from girls education, should we focus our increasingly constrained spending here?” Should we not prioritize funding for the things that produce the greatest health outcomes? Maybe, but in an era of “demonstrating results” and “returns on investment,” this becomes more complex trying to trace dollars and causality from one sector to another.
  • What to do about shifts in the “bottom billion”? – Unfortunately, I didn’t hear anything on the issue today, but as Amanda Glassman and colleagues argued in a recent Center for Global Development working paper, our conceptualization of financing programs targeting the poorest and most vulnerable populations may require some re-conceptualizing. With donors often under stipulations regarding the types of countries they are able to give money to (this means middle-income countries, though they are now home to the largest population of poor people), will this at all influence preferred channels of assistance?

Dr. Murray and his colleagues continue to do great work providing a depiction of the increasingly complex network of actors and how global health dollars pass between them. Post your comments and let me know your thoughts on the emerging challenges in global health resource tracking.

Posted by: blog4globalhealth | 01/19/2012

QUESTIONS ON THE FUTURE FINANCING OF GLOBAL HEALTH

Craig Moscetti responds to the latest findings on global health financing from IHME.

The latest snapshot on global health financing is in. Dr. Chris Murray and colleagues from The Institute for Health Metrics and Evaluation presented today the findings from IHME’s third annual report on global health financing, titled Financing Global Health 2011: Continued growth as MDG deadline approaches. Yes, the report states the well-known trend that global health financing has transitioned out of the “massive scale-up phase” (many arguing with huge consequences) and into a period of slower growth, similar to that seen during the 1990s. But some of the latest tracking data shed light on some interesting trends, prompting many key questions:

  • What’s the appropriate balance between government and non-governmental?
  • Are developing countries stepping up?
  • Is health sector spending the more efficient and effective way to produce health?
  • What to do about shifts in the “bottom billion”?

Read the full blog.


Posted by: blog4globalhealth | 01/19/2012

VOICES ON OWNERSHIP: TEDROS ADHANOM GHEBREYESUS

The second of a series of pieces on country ownership by John Donnelly features Ethiopia Minister of Health Tedros Ghebreyesus

This is the second of a series of perspective pieces on country ownership from the “Advancing Country Ownership for Greater Results” roundtable organized last week by the Ministerial Leadership Initiative for Global Health (MLI), a program of Aspen Global Health and Development. It attracted 50 people, including senior officials from developing countries, the U.S. government, development partners and NGOs. These stories will run every day this week.

The second of four pieces covers the perspective of Ethiopia Minister of Health Tedros Adhanom Ghebreyesus.

Minister Tedros said for many years he has been pushing for more country ownership. His approach is consistent: One vision, one set of priorities, and one group — donors, partners and countries – working together.

“When donors enter into a discussion with developing countries, they need to enter the conversation with a sense of respect for country priorities,” Tedros told the group last Thursday. “When things don’t mesh, donors should reconsider…and build on the priorities of the developing countries.”

Read the full blog.


Posted by: blog4globalhealth | 01/17/2012

VOICES ON OWNERSHIP: ADMINISTRATOR RAJIV SHAH

USAID Administrator Rajiv Shah weighs in on the issue of country ownership during a roundtable organized by MLI

This is the first of a series of perspective pieces on country ownership from the “Advancing Country Ownership for Greater Results” roundtable organized last week by the Ministerial Leadership Initiative for Global Health (MLI), a program of Aspen Global Health and Development. It attracted 50 people, including senior officials from developing countries, the U.S. government, development partners and NGOs.

The first of four pieces covers the comments of USAID Administrator Rajiv Shah.

Rajiv Shah opened MLI’s meeting by saying that the U.S. government was committed to country ownership, but that it needed to find ways to improve its support of country-led plans.

He cited several examples that showed how integral country leadership was in producing results. One was a 2011 Demographic and Health Survey in Ethiopia that showed a 30 percent reduction in under-5 mortality. He attributed that in large part to the leadership of Minister of Health Tedros Adhanom Ghebreyesus.

“What we don’t appreciate as much is the driving force for that result was Minister Tedros’ leadership and the Ethiopian political will to get that done by deploying 30,000 health extension workers, seizing upon what we call in our culture ‘low-hanging fruit'” and finding “opportunities to save children’s lives.”

Read the full blog. Photo by Dominic Chavez, courtesy of MLI.

This is a guest blog by Greg Paton, Policy Manager, NCD Alliance

This past December representatives from various UN agencies met in New York to discuss UN wide collaboration on Non-communicable Diseases (NCDs). The release of the meeting’s report last week drew little attention from the global health world. This is understandable given the gauntlet of NCD themed ministerial meetings, stakeholder dialogues and civil society hearings in 2011 which culminated with the High-Level Meeting (HLM) on NCDs and nearly 50 side events in New York last September.

The World Health Organization (WHO), tasked by member states to coordinate the UN wide response to NCDs, has large expectations to live up to. The responsibility of implementing the long list of actions set out in the HLM Political Declaration is made no easier by the fact that barely a handful of member states have pledged additional resources to strengthen WHOs NCD work. The organizations well publicized budget woes have forced the NCD Department to make difficult decisions amongst a backdrop of shrinking resources and the loss of key staff positions. Richard Horton, Editor of the Lancet, recently gave voice to the concerns whispered by many: ‘It will consult member states. Discussion papers will be written. Options Documents will be drafted…Unless the [WHO] Director-General makes NCDs a signature initiative; there is little likelihood that gains made at the UNGA will be sustained, let alone advanced”.

Declining budgets are not the only reason for concern. One of the biggest shortcomings in many countries response to NCDs has been the difficulty in getting non-health ministries to step up their efforts (and resources) for NCDs. The early days of the HIV/AIDS epidemic faced similar challenges – according to a UNAIDS publication detailing the history of the AIDS epidemic, UN staff in the early 1990s “tried hard to take a multisectoral stance but, as part of WHO, they inevitably had to work with ministries of health that were wary that multisectoralism would take power and money away from them. The concept of multisectoralism was accepted by countries but rarely put into operation.” The HIV/AIDS community has made great strides since then, driven by the establishment of UNAIDS to lead the international response and the Three Ones Principle (one HIV/AIDS plan, one coordinating board and one M&E system) to lead the national response. Major progress in the fight against NCDs will require replicating the success of the AIDS community in bringing a diverse group of partners to the table, including UN agencies, government ministries, civil society, people living with NCDs and the private sector.

This is why December’s meeting of UN agencies, if properly followed up, will come to be regarded as a key turning point in the global fight against NCDs. It could set off a chain of actions second in importance only to the HLM itself. It was a similar process initiated by UN agencies in 1989 that paved the way for an effective UN wide response to the HIV/AIDS epidemic. According to the UNAIDS publication, this process was a key factor in greater cooperation and multisectoralism on HIV/AIDS at national level.

It is therefore critical that both member states and civil society have a strong stake in the follow-up to this meeting and that UN agencies show leadership in turning the promises made on paper into action. The agencies that did not attend should be reminded of their commitment to act, as set out in the HLM Political Declaration. Many of the meetings outputs could be of major significance to the global NCD response. Highlights include:

  1. Integration of NCDs into National UN Frameworks:  UN agencies committed to a joint initiative headed by the UNDP and WHO to formalize integration of NCDs into UN Development Assistance Frameworks (UNDAF). This would start with the 20+ countries scheduled to launch new frameworks in 2012-2013. These frameworks serve as national roadmaps for the work of UN country offices and are developed by recipient governments based on national priorities. They are often backed by major resources – in November the UN announced funding of $375.7 million for the Philippines UNDAF.  This would be supported by training and additional technical assistance for UN country teams to strengthen their capacity to implement NCD programmes.
  1. Acknowledgement of the need for a UN wide roadmap for NCDs: Many organizations, including the NCD Alliance, agree that a new UN agency on NCDs would create further disease silos and is not the answer to addressing the NCD crises.  If done correctly, developed in consultation with key stakeholders, and backed with adequate resources, such a roadmap could have a major impact and provide a framework for scaled up responses at country level. It could also ensure that NCDs are included in the post 2015 MDG framework.
  1. Increased integration of NCDs into UN agency programmes: All of the agencies in attendance committed to exploring the development of joint NCD projects and each agency shared a list of possible project areas. This has major resource implications if UN agencies integrate NCDs into their planning processes and programs. The UNDP alone has an annual budget of over $6 billion dollars, as does the World Food Programme. The core UN budget, which doesn’t factor in most of the agencies who attended the meeting, is over $13 billion dollars annually. Even if no new money is pledged, mainstreaming NCD interventions into the projects those funds currently support could have a major impact.
  1. A network to coordinate the UN response to NCDs:  Participants agreed to establish an informal network to coordinate NCD activities among UN agencies. Several years ago, NCDs were rarely recognized as a development issue in mainstream global health circles. Many donor organizations still mistakenly believe that the causes and impact of NCDs have little bearing on poverty. This informal network is therefore an important first step in changing this. The WHO was requested to send a letter to all UN agencies at the meeting outlining details for this collaborative arrangement. Participants also agreed that following an initial period, ‘it may be opportune to formalize arrangements in the establishment of an UN Ad‐Hoc Coordination Mechanism on NCDs’. This is the first time UN agencies have suggested the possibility of a formal cooperation mechanism on NCDs. Civil society and NCD advocates should monitor this closely and ensure that such a mechanism would have inclusive representation.

By bringing together UN agencies to help define the post HLM landscape, WHO has shown strategic leadership and initiated an important first step in what has the potential to be a game changer in the future fight against NCDs. Whether the potential will be reached is a question of debate, but if the AIDS experience is anything to go by, a UN wide plan of action with buy-in and ownership from key UN agencies will be an essential factor.

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