Global Health Policy

This is a joint post with Heather Lanthorn, a doctoral candidate at Harvard School of Public Health.

In mid-July, amidst the busy global-health month of July, in between the Family Planning summit and the AIDS conference, the near-final draft of the independent evaluation of the Affordable Medicines Facility - Malaria (AMFm) was released.

This month, both Health Affairs and the Journal of Acquired Immune Deficiency Syndrome (JAIDS) released special thematic issues on the US President’s Emergency Plan for AIDS Relief (PEPFAR) in which the articles – mainly commentaries but some analyses – provide an exceptionally positive readout on PEPFAR’s past performance and future direction. In principle, this is great – any insights into PEPFAR are always welcome, and it’s clearly valuable to discuss and disseminate lessons learned from the program. If these articles were posted on the PEPFAR website, or released as official PEPFAR reports, we wouldn’t bat an eye. But within scientific, peer-reviewed journals, the articles read more like PEPFAR PR rather than commentary and analysis from independent, third-party observers and stakeholders. A quick skim of the titles in the table of contents illustrates this point (see word cloud of selected title excerpts), and a closer look at the contributors sheds some light on why this may be the case: most authors of the articles are somehow affiliated with PEPFAR or with organizations that have received money from the program.

Global health has not figured prominently in the US presidential campaigns so far. Jobs and the economy are the major issues, and the weak growth in new jobs from the most recent report has done nothing to change that. And like all recent Presidential elections, this one is likely to be determined by voters in a small number of swing states.

Afghanistan accounted for 15 percent of all U.S. economic assistance allocated in FY2012, amounting to 2 billion dollars. USAID has contributed at least 15 billion in aid to Afghanistan since 2001, with cumulative investments in the health sector at nearly 1 billion. But the impact of these investments has been difficult to judge because of lack of reliable data and accurate measurement, leaving many wondering: What have these funds achieved? In particular, has this economic assistance improved the health of Afghans?