Obama’s Global Health Initiative: How does the world view America’s good intentions?

Ever since it was announced in May of last year, President Obama’s Global Health Initiative has been the buzz of the international development community.  In a press release, the president announced that he would ask Congress to allocate $8.6 billion for the 2010 fiscal year, and $63 billion over six years, for a new, comprehensive global health strategy.  $51 billion of these funds would be targeted toward AIDS, malaria, and tuberculosis, with the remaining $12 billion to address other issues such as neglected tropical diseases and family planning.  The strategy is intended to go beyond targeting specific conditions and to focus on strengthening health systems and improving maternal and child health, though 70% of the funding will continue to go to PEPFAR.

This new strategy has been enthusiastically received by international health and development voices.  The initiative has been praised for its emphasis on maternal and child health  and for its recognition that “our greatest plagues — HIV/AIDS, maternal and infant mortality, and poor sexual and reproductive health — are all interconnected, and they are all preventable.”1  Secretary of State Clinton has said that the initiative will become a crucial component of America’s foreign policy.2  It has not, however, been well received by everyone: PEPFAR advocates in particular have pointed out that the president has not lived up to his campaign promises to allocate funds for the program, choosing to provide his pledged $50 billion over six years, rather than five.3  An article published in the journal AIDS last week argues that PEPFAR and support for HIV/AIDS care supports the health sector in general and that cutting support for AIDS damages health systems.4  The authors maintain that funding maternal and child health initiatives at the expense of PEPFAR puts these two health priorities in competition with one another, which “lacks not only ethical legitimacy but also scientific merit.” 

Inevitably, any global health policy (and policy in general) will invite comments from supporters and detractors.  However, a blog entry by Bruce Nussbaum on humanitarian design caught the eye of several people in the international development community.  In several design conferences, he noted that professionals from developing nations often resented the fact that Westerners were trying to come in and solve their problems for them, particularly when they had their own ideas that they felt were more culturally appropriate.  Nussbaum, surprised, began to wonder if humanitarian design was being viewed as a new form of imperialism.  The stalled reconstruction in Haiti is another example of misdirected foreign intervention: ActionAid, a UK-based humanitarian NGO, argued last week that Haitians aren’t being included in reconstruction efforts, and that the current plan is more reflective of donor country interests. These observations raise the broader question of how the global health efforts of the U.S. are viewed by the world, and whether they are as altruistic as they present themselves to be, particularly when funds are pulled or frozen because domestic interests take precedence.  How the U.S. global aid policy is perceived is just as important as it its effectiveness.

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