06 July 2012

Is the GHI Dead? GHI's Strange Announcement and Change

An announcement this week on the Global Health Initiative (GHI) website points towards a murky future the organization. The wording is a bit confusing and vague. Tom Paulson agrees writing, "I’m not at all clear about what is happening here. This Administration can sometimes be particularly stunning in its use of vague language and double-speak — especially when it comes to issues of global health and foreign aid."

Here is the main thrust of the announcement:
The Quadrennial Diplomacy and Development Review (QDDR) provided a forum for review of the structure of GHI. After careful consideration of evolving U.S. global health leadership needs, we have reached several key conclusions that will help guide the next phase of GHI:
  • First, we continue to recognize the capabilities of our global health agencies. Each has critical leadership responsibilities that must be maintained in the next phase of GHI as we seek greater impact and efficiency from our collective whole-of-government efforts to implement our health programs.
  • Second, we believe that a continued emphasis on country-level leadership of our global health activities will best achieve improved USG coordination of programs in the field, stronger country partnerships and ownership, and innovation for results.
  • Third, we recognize the critical role of health diplomacy to increase political will and resource commitments around global health among partner countries and increase external coordination among donors and stakeholders.
As a result of our analysis and conclusions, we have made a collective recommendation to close the QDDR benchmark process and shift our focus from leadership within the U.S. Government to global leadership by the U.S. Government. This recommendation has been accepted.
The announcement goes on to say that PEPFAR and the CDC will continue to go strong in their respective international work.

Fortunately, the GlobalPost went to State for some clarity on the announcement. GHI Executive Director tells John Donnelly, "By shifting from what was too often an internal focus to a strong external focus, we feel this diplomacy focus is important in order to bring more resources to achieve GHI targets. Diplomacy allows us to work with partner countries and donor countries in a stronger way. I’m very pleased about this."

Donnelly adds his read on the situation
GHI, in actuality, was a tiny operation: just four fulltime workers, plus another half-dozen temporarily assigned officials, nestled inside the sprawling State Department building. Quam now will aid in the transition.

The move into the State’s global diplomacy office “lifts up the GHI to the highest levels of diplomacy in the US government,” Quam said. “This will support our ambassadors and teams in the field. This is the step that moves this forward.”

Perhaps. But the promise surrounding the May 5, 2009 announcement has long since faded, global health observers agree. The administration has given more attention to maternal and child health, but observers wonder if that is because of GHI, or due to the administration’s global health leanings in the first place? Now all that’s left is the strategy. Washington has one less institution, leaving those existing to battle over funding and policy as they did before.
GHI has been a bit of a punching bag in the global health world, but it appears to be in a loving I-wish-you-could-be-better sort of way. Some worried that State would end up as the home for GHI. From Devex:
The structure and position of GHI within the U.S. government has been the topic of much debate among global health advocates, many of whom question whether the State Department, now headed by Hillary Clinton, is the right home for it. In an op-ed published by the Center for Global Development last October, for instance, Nandini Oomman and Rachel Silverman argued there are two reasons placing GHI under the State Department “doesn’t make sense”: Global health is not among the department’s strong points, and the move is a potential “public relations nightmare” that could also derail the administration’s efforts to transform USAID into a premier development agency.
A Storify collected by Jaclyn Schiff on the announcement features tweets from Laurie Garrett of the Council on Foreign relations that provide a succinct summary and analysis.

The final question is an important one. Being an election year, the decision could be held up in congress. If power were to change to the Republic party, who has made it clear that they are not fans of international aid, the process could be drawn out further.

I'd love to hear more on the inner-working on the battle for GHI.