The past decade has seen tremendous growth in global health funding; total health aid went from $11 billion in 2000 to $27 billion in 2011, with the emergence of new public-private partnerships (Global Fund, GAVI), private foundations (Bill and Melinda Gates Foundation), and steadily increasing bilateral contributions. The United States gradually increased its dominance in the field, with disbursements totaling 19 percent of all health aid in 2000 to 31 percent in 2008, largely due to increased funding to HIV/AIDS via PEPFAR.
But the honeymoon is over: donor spending began to flat line in 2008 with the financial crisis. As funding for health stagnates, the inefficiencies of U.S. global health aid architecture become increasingly visible and will become even more so if funding decreases in the future.
The Global Health Initiative was intended to address many of the challenges in the U.S. government's approach to global health. However, the Initiative emerged without clear and aligned institutional and budgetary arrangements, weak accountability mechanisms, and little attention to value for money. In this report, Amanda Glassman and Denizhan Duran summarize the rationale for continued U.S. investment in global health, look into the evolution of the GHI, and recommend a re-boot for the whole enterprise.