Economists are not global health’s most popular human resource. They usually show up to dampen enthusiasm by nattering on about budget constraints, trade-offs and incentives. In the HIV/AIDS field in particular, health economists and their work have been viewed with profound skepticism. At a recent debate, talking about choices and budget constraints was labeled “dangerous” to fundraising by one participant.
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.
Yesterday’s family planning summit seems to have mobilized new funding commitments totaling USD 414.5 million between now and 2015. Without going into whether this increased funding will displace spending on other global health and development priorities, no one seems to have mentioned what organization will actually allocate and spend these additional resources.
Announced in May 2009 by President Obama, the Global Health Initiative (GHI) promised a new way for the United States to do business in global health. Fragmented U.S. programs would be united under a single banner; vertical structures would be dismantled in favor of an integrated approach; and narrow, disease-focused programs would transition toward a focus on broader health challenges, such as maternal health, child survival, and health systems’ strengthening.
One result of President Obama’s visit to the UK last month was a statement on the UK-US Partnership for Global Development in which the U.S. President and Prime Minister David Cameron “reaffirm [their] commitment to changing the lives of 1.2 billion poor people in the world today." In the statement they promise to work together on a range of important development issues: economic growth, conflict and fragile states, aid (accountability, transparency, results), global health, girls and women, and climate change.