VIENNA, AUSTRIA — Oxfam strongly supports the Obama Administration’s Global Health Initiative (GHI). To address the growing scale of the epidemic change is needed. The US shift from the early days of PEPFAR to PEPFAR II and now the Global Health Initiative, acknowledges that the original PEPFAR model is unsustainable, and not enough to turn the tide.
According to UNAIDS, 33.4 million people around the world are living with HIV and there were 2.7 million new HIV infections in 2008 alone. The US has provided $32 billion in treatment and prevention since PEPFAR’s inception, yet new infections still far outpace the world's ability to add people to treatment: for every 2 people put on antiretroviral drugs (ARVs), another 5 become newly infected.
Treatment for HIV, TB, and Malaria cannot be provided in isolation from a functioning health system, particularly since people living with HIV and AIDS and their families need access to routine care, as well as proper nutrition, clean water, education, and livelihoods so that they have the money to spend on staying healthy.
“The Global Health Initiative represents an opportunity to change the way we do global health overseas: from a top-down, uncoordinated approach to country-owned, demand-driven health aid that saves lives both now and in the future,” said Gregory Adams, Oxfam America director of aid effectiveness. “The old model is a trap; if we keep trying to treat HIV while letting health care systems wither, we will never get ahead of the epidemic. Obama’s new investment in GHI scales up US efforts to fight HIV by helping poor countries confront this crisis head on.”
Ministers of health and health providers have voiced concern that the donor projects that have evolved in their countries have been more constituency-based than need-based. In countries like Mozambique and Uganda where HIV/AIDS and maternal and child mortality are both crucial health challenges, the US provides 76% of its health aid toward HIV and AIDS, but only 24% toward other health priorities like child and maternal health.
“Citizens need to be able to hold their governments accountable, and when donors bypass ministries of health and setup parallel HIV and AIDS programs, citizens give the credit or blame to donors, not their own government,” said Dr. Freddie Ssengooba, Ugandan health researcher at Makerere University. “The Global Health Initiative could be a step in the right direction,” said the former Mozambique Minister of Health Dr. Francisco Songane. “It is extremely important to take a comprehensive approach and in a long-term perspective, assisting countries in need in the implementation of their development strategies.”
Country ownership is not just about sustainability; it is also about saving lives. Increasingly, ministries of health are reporting that in addition to HIV, TB and Malaria, child health and non-communicable diseases like cancer and diabetes are the biggest public health threats to developing countries. Tackling these health problems requires a functioning health system that’s accessible to everyone. Said Jim Clarken, CEO of Oxfam Ireland and head of the Oxfam delegation to AIDS 2010, “Emphasis must be on country-level plans and should encourage donors to align their aid to countries’ health plans, where they exist, and to work with countries to develop national health plans where they do not.”
The US global health approach has suffered from a lack of coordination, which affects patients’ ability to access treatment at the clinic level. For example, there are over 12 different US government agencies implementing health programs overseas. The US Global Health Initiative is now seeking to tackle the disease more holistically. In June, the US government announced, as part of its Global Health Initiative (GHI), an eight country pilot program that would shift US aid for a new health strategy toward a whole-of-government approach.
By focusing on comprehensive health care, including HIV and AIDS, the Global Health Initiative can strengthen health systems in a sustainable way and therefore save more lives.