This week marks the U.S. Global Health Initiative’s (GHI) second birthday, despite no celebration, no balloons, and no well-stuffed goody bags. It’s hard to believe that two full years have passed since President Obama announced the GHI on May 5, 2009. During this time, the administration has dedicated many hours of talented staff time just getting the GHI off the ground. The initiative was (and is!) a huge undertaking and while exciting for many reasons—including its focus on women and girls, increasing linkages between different global health programs, and working with countries to define their global health priorities and needs—questions continue to loom large about how this will actually take shape and deliver results. I did a quick look back at our key GHI blogs posts* and comments from our many smart readers. Here is a selection of key operational issues that came up over the last two years and a quick and dirty assessment of their current status:
- GHI Leadership: Check. Lois Quam was appointed as Executive Director in March 2011
- GHI Website: Check: The GHI Website went live in March 2011 with this information:
- Organizational Chart (well, page): Check
- GHI Principles: Check
- GHI Targets: Check
- Country Details: Check—sort of! Country pages are up with descriptions of the GHI in that country, but include no information on implementation progress
- Blog: Check (6 posts since March 2011)
- Final Strategy: Check: Finally posted in March 2011, a year after the draft consultation strategy was released in 2010.
- GHI + Country Strategies: Check: Released in March 2011, after what seemed like a long drawn out process after GHI+ countries were selected. These are high level strategies that lay out the general set of issues and areas of focus for each GHI + country.
Things are finally moving forward this spring, at least operationally, but when it comes to commenting on something that you can sink your teeth into about implementation progress and results there isn’t much. I’ve tried to stay positive about the GHI despite some recent comments from our readers on posts (here and here) suggesting that we are being too optimistic and idealistic about the GHI and that it isn’t working:
“Surely you jest. The GHI strategy is about as unstrategic as it could be. Stating principles and setting impressive targets is not a strategy. The Whole of gov’t approach is nonsense guaranteed to ensure a massive waste of time coordinating and fighting turf battles…..”
“…I find it hard to imagine how it could be done, but I know there was a big push to integrate family planning and repro health services into general primary care provision in a number of countries – and they may have had SOME if not all of the unfortunate donor related constraints. I wonder, are there any successes to give us hope? Or is this idea of achieving services integration with vertical funding and reporting just a pipe dream? or worse, a pretense (a la the famous emperor’s new clothes)?”
And one from a reader in the field who works for a USAID contractor: “… At the same time, the officially stated focus on integration has made it more difficult to disease-specific work. We’re stuck in both directions.”
And finally, one reader concluded his comment with this: “Really, I don’t want to be cynical, but I can’t ignore the realities.”
I don’t want to be cynical about the GHI…and I don’t want to ignore the realities. I want to believe in the GHI with information and evidence, not faith, because I think that its organizing principles and policies represent a pioneering U.S. effort to work with countries to respond to global health challenges in a more sustainable and meaningful way. I want to believe that the GHI will grow up fast to gain momentum and deliver results. Delivering doesn’t always mean succeeding, but doing what you said you would do and then showing others what’s working and what’s not. I’m looking for publicly available information on the specifics of GHI implementation and progress. Here are two suggestions for what I would like in my goody bag on the GHI’s 3rd birthday (or well before then!):
1) Progress on GHI Targets: The GHI has very specific targets, including treating more than 4 million HIV infected people; preventing more than 12 million HIV infections; averting 700,000 malaria deaths; ensuring nearly 200,000 pregnant women can safely give birth; preventing 54 million unintended pregnancies; and curing nearly 2.5 million people infected with tuberculosis. In the past two years, programs including PEPFAR, PMI, Family Planning, maternal and child health and NTDs have been well under way, under the overarching GHI, and continuing on with their earlier efforts. Surprisingly, I haven’t seen any reporting of progress towards these targets on the GHI website. I fully understand that it is difficult to report outcome and impact results such as decreased mortality or service coverage in the short run, but I would have expected to see some outputs or counts of activities achieved (that build toward a numerator of an outcome or impact measure). For example,
- How many additional people were put on ARV treatment every year since 2009? What outcome measure will this treatment enrollment count enable us to compute over a period of time?
- How many women were provided family planning services in 2009, 2010, and 2011? What outcome measure (coverage?) will this count enable us to compute over a period of time?
The GHI website needs a new page that shows progress-implementation, outcomes and eventually impact. I would start by showing progress toward GHI + country targets, slowly building up to show how the GHI is meeting its targets in aggregate terms.
2) Learning about GHI Principles and Design: The GHI architects set up key guiding principles for the GHI—women and girl centered, integrate programs, strengthen health systems, work with countries to create ownership etc. Some skeptics characterize these as feel-good and impractical principles because the GHI doesn’t have much to show us to date (even if it is happening in specific countries). But, I think that the GHI is an opportunity to find out if these principles can indeed be applied to the U.S. global health and development programs, and to what end. For example, using specific GHI + countries, the initiative can tell us how country ownership is being defined in each country. Does it work or not to improve the design and delivery of programs, and results where it is possible to assess this? How does the women centered approach translate into operations? It is increasing the proportion of women and girls who have access to health services? How is the integration of programs—for example, HIV/AIDS with family planning and maternal and child health—working or not?
The GHI should be given some room to fail so that we can really learn—what works and what doesn’t—from this endeavor. As I said in this radio interview in 2010, current technology and communication platforms can enhance our levels of learning and sharing in global development in a transformative way. The GHI must fully exploit these advancements so that a learning agenda generates useful and timely information that can be shared between countries and across a range of stakeholders.
Moving forward, I’m keeping my fingers crossed because I really want to stick to my belief—albeit an evidence based one!—that the GHI is not just a new way of doing global health business, but one that delivers to save millions of lives. The biggest threat to the GHI isn’t just the potential funding cut from Congress, but its own ability to show incremental progress in a tangible way.
*List of CGD GHI blog posts 2009-2011 (most recent on top):
Thanks to Christina Droggitis for her help with this post.