Rethinking US Foreign Assistance Blog

This is a joint post with Rachel Silverman.

Since the launch of the Obama administration’s $63 billion Global Health Initiative (GHI) in May 2009, we have followed its ups and downs with great enthusiasm (see for example: here, here, here and here), trying to better understand its structure and role within the U.S. government’s complicated global health architecture. One recurring question we have continually raised has focused on leadership: who, exactly, was to be in charge of this massive undertaking? Who would be accountable for meeting the initiative’s eight high-level targets and adhering to its seven guiding principles?

Last December, the State Department’s Quadrennial Diplomacy and Development Review (QDDR) appeared to put those questions to rest. According to the 200+ page document, USAID would assume leadership of the GHI by September 2012, contingent upon fulfilling a set of 10 benchmarks to demonstrate its capacity. But upon closer inspection of the GHI over the last year, the QDDR provision only seems to have generated a new set of questions that are more difficult to resolve. While there are no easy answers, the administration should consider these issues as it thinks through the tough decision of pulling the GHI together under one leader and demonstrating success by meeting its targets:

This is a joint post with Connie Veillette. It is cross-posted on the Global Health Policy blog.

The QDDR pre-release consultation document says the Global Health Initiative will eventually be managed by USAID. For a number of reasons, it makes complete sense for USAID to lead the GHI.

Health is a core development mission. Consider that the FY2010 budget for health programs totals $7.8 billion, or more than 20% of the entire foreign assistance budget. We use development assistance dollars for global health as part of a broader development mission. President Obama’s Global Development Policy identifies the GHI as a key development initiative, so our premier development agency should surely be given the charge to lead the administration’s largest development initiative.

Health is more than just health. Health is about treating and preventing disease and improving health systems but it is also much more. It’s about improved nutrition and equitable access to food, clean water and sanitation, education, and investments in research and technology. These are sectors in which USAID has long worked, and they need to be integrated into a strategy that supports the GHI.

The GHI needs one leader, not three, for better decision-making and results (see related blog posts here and here). The administration points to the GHI as a new way of doing business and as a leading edge of aid reform efforts, but the current inter-agency consensus style leadership doesn’t seem to be working efficiently. While all U.S.G. staff at HQ and in-country are working fast and furiously, the lack of a leader at the top seems to be slowing decision-making at the highest levels. Some visible expressions of this lack of efficiency include the absence, a full year and seven months since the GHI was announced, of a final strategy, country strategies, or even a GHI website. For this new and ambitious approach to take off, the U.S. needs one leader that is able to tap the strengths of different government agencies that make unique contributions to the GHI.

This is a joint post with Miriam Temin.

In keeping with a women-centered approach to development, Hillary Clinton recently announced the Secretary’s International Fund for Women and Girls, “a State Department-led public-private partnership that aims to provide flexible, rapid, targeted and high-impact grants to NGOs working to meet critical needs of women and girls around the world.” The fund, managed by the Office of Global Women’s Issues (OGWI) intends to make women and girls a priority in everything from global health to climate change. It’s thrilling to see greater emphasis on women and girls, but in the absence of the long-awaited U.S. global development strategy, the announcement looks a lot like yet another new administration initiative to add to our fragmented aid system. Our hope is that there are clear plans for how the fund will prioritize women and girls across the wide range of U.S. development efforts—including the $63 billion Global Health Initiative (GHI)—to achieve broader foreign policy goals of global prosperity and security.

Aside from how the new fund fits in to the foreign assistance puzzle, there are a few other questions that potential investors will ask of the fund managers: