Category: Aid Effectiveness

What’s next for US global health funding?

by Jean Armas, posted in Aid Effectiveness, APHA IH Section, Policy and Advocacy

On April 30th, a bipartisan budget deal was passed which will keep the US government funded through the end of September this year. Although funding for global health programs remains largely intact this year (in some cases, budgets have even increased), the future of US global health funding is looking pretty bleak.

Trump’s “skinny budget” proposal for fiscal year 2018 includes steep cuts of nearly 30% to foreign aid and diplomacy delivered through the Department of State. Additionally Trump’s budget proposes cuts to the United Nations and its affiliated agencies, multilateral development banks like the World Bank, and the complete elimination of funding for the Fogarty International Center. And while we can all breathe a collective sigh of relief knowing that malaria programs, PEPFAR, the Global Fund, and Gavi have been spared, the proposed 25% cut to global health programs is disconcerting to all of us within the international development and global health community.

Although such dramatic cuts in US foreign aid spending impacting global health are rightfully shocking, a recent study published in the Lancet shows that financing for global health programs by all development agencies (which includes bilateral (government to government) assistance, multilateral development banks, international NGOs, and others) has already been slowing significantly in recent years. Between 2010 and 2016, development assistance for health grew annually at only 1.8% compared to 11.3% in the first decade in the millennium and 4.6% in the 1990s.

The United States is currently the largest contributor (in absolute dollar amounts) of bilateral foreign assistance even though we spent only 0.18% of our gross national income (GNI) in 2016 on foreign assistance. As a comparison, the OECD country which spent the most of its GNI on foreign assistance, Norway, spent 1.11%. (Just in case you’re curious, most of our federal tax dollars are budgeted toward defense, social security, and major health programs.)

With Trump touting an “America First” agenda and Americans grossly bigly overestimating the amount the US spends on foreign assistance (on average, those polled guessed 26%), it is probably safe to guess that the general public knows little about how foreign assistance can help contribute to a safer America. Although a majority of US foreign aid goes toward funding critical global health programs (including being the largest funder of HIV/AIDS projects), foreign aid isn’t completely altruistic. Foreign aid also helps bring peace and stability to countries where we can benefit from open trade and less volatile economies. In addition, foreign aid helps keep Americans healthy by preventing the global spread of deadly diseases.

In a recent op-ed for Time magazine, Bill Gates provides the proof in the pudding:

According to one study, political instability and violent activity in African countries with PEPFAR programs dropped 40 percent between 2004 and 2015. Where there was no PEPFAR program, the decline was just 3 percent.

….. A more stable world is good for everyone. But there are other ways that aid benefits Americans in particular. It strengthens markets for U.S. goods: of our top 15 trade partners, 11 are former aid recipients. It is also visible proof of America’s global leadership. Popular support for the U.S. is high in Africa, where aid has such a dramatic impact. When you help a mother save her child’s life, she never forgets. Withdrawing now would not only cost lives, it would create a leadership vacuum that others would happily fill.

As global financing for international health programs is expected to continue to slow, it is critical that the United States continues to provide foreign assistance not only because it keeps Americans safe and our economy healthy, but also because it is the right thing to do. While it’s true that foreign aid is in desperate need of extensive reform and that at some point a few low-income countries will be able to start financing a majority of their own health programs, change doesn’t happen overnight. Another Lancet study found that global spending on health is expected to increase from $9.21 trillion USD in 2014 to $24.24 trillion USD in 2040 with low-income countries growing at 1.8% and per capita spending expected to remain low. Failing to support global funding for health at adequate levels has serious consequences not only for the health and well-being of the millions of vulnerable individuals around the world who depend on our support, but in a world where we are inextricably linked, it also endangers the health and well-being of the American people.

The bipartisan deal reached by Congress provides a small glimmer of hope that Trump’s proposed cuts may be dead on arrival, but in such an unpredictable political climate, our collective cynicism is teaching us to expect the unexpected. Trump’s full budget proposal is expected to be released the week of May 22nd. Until then, let’s make sure we are fully prepared to fight in this uphill battle.

A New Context for Development Effectiveness

by scanyatonwu, posted in Aid Effectiveness, APHA IH Section, Trade and Health

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For those of you interested in the past, present, and future of international aid and development, this blog post will provide you with an introduction to frameworks and partnerships that have evolved over the past few decades. It will also highlight an organization that caught my interest when I stumbled upon its “Aid in Danger: the Perils and Promise of Humanitarianism” series.

The Overseas Development Institute (ODI) is an independent think tank located in the United Kingdom (UK). For more than fifty years, the institute’s main focus has been on informing policy and practice that result in poverty reduction and sustainability in international development as well as humanitarian efforts. ODI hosted its 2016 Center for Aide and Public Expenditure (CAPE) conference from October 18th-19th, with the goal of updating the Global Partnership for Effective Development Co-operation’s development effectiveness agenda to reflect a new context that has emerged over the past 10 years. This context involves additional evidence that has been gathered on development effectiveness implementation, a commitment to the Sustainable Development Goals (SDGs), positive changes in donor-recipient relationships, and an increased number of finance providers. Although developing countries now have a broader selection of finance providers to assist them, including actors in the private sector, these new players may not be familiar with the Monterrey Consensus  or High Level Fora on Aid Effectiveness that were developed to cast vision and establish commitment to development co-operation and improvements in the quality of aid delivery. As a result, if these new finance providers do not adhere to or are not aware of key discussions that have taken place to improve overall aid and development initiatives, then it makes it difficult to evaluate their impact.

The Organisation for Economic Co-opertation and Development works with key players such as governments and multilateral organizations to “improve the quality of development co-operation.” Despite international development effectiveness and co-operation partnerships being greatly shaped by the High Level Fora on Aid Effectiveness, time and budget constraints, unattainable goals, and mixed political motivations have prevented lasting change from taking place. More specifically, traditional development effectiveness principles have been based on the Paris Declaration of Aid Effectiveness  and the Busan Partnership for Effective Development. The common set of principles previously defined as having contributed to improved quality of aid was reinforced by the Busan Partnership, which went a step further and developed the following action points for implementation:

  • Use results frameworks designed with the needs of the partner country in mind as a common tool, and using country-led coordination arrangements.
  • Untie aid to the maximum extent possible and – in 2012 – review plans to achieve this.
  • Use country public financial management systems as the default option for development financing, and support the strengthening of these systems where necessary.
  • Strengthen transparency and approve a common standard for the electronic publication of data on development co-operation, to be fully implemented by 2015
  • In 2012, establish common principles to prevent the proliferation of multilateral organisation and global programmes and funds, also in 2012 establish common principles to tackle the issue of countries that receive insufficient assistance (aid orphans).
  • By 2013, provide recipient countries with regular, timely, indicative three-to-five-year forward expenditure plans.
  • Increase support given to parliaments and local governments in carrying out their functions. Foster an environment for civil society organisations as independent development actors.

More recently, ODI research has shown that developing countries are more likely to pick and choose which effectiveness principles to implement and that there are priorities outside of effectiveness principles that also influence countries.

Overall, the conference focused on two main questions:
1) How does the private sector play a role in development and is it effective?
2) What is the role of external support as the SDGs focus on development for all people everywhere and policies that “leave no one behind?”

Stay tuned for more….

Results for Children: Save the Children Introduces New Format for Providing Program Information

by ihsection, posted in Aid Effectiveness, Information and Social Media

This is interesting. In this video, Save the Children’s president and CEO Charlie MacCormack explains that the organization is moving toward a new way of sharing information and updates about their various projects and activities. They plan on moving from an annual report to a quarterly one and changing the format of their reporting. On their Results for Children page, they explain:

We proudly present the first issue of Results for Children, an update showcasing Save the Children’s impact on the lives of children in more than 120 countries worldwide. With this report, we hope to more dynamically communicate with supporters: In place of our former annual report, Results for Children—a quarterly publication—brings you the latest results from our programs based on project data, stories and feedback from children in their own words.

They are also encouraging individuals to submit feedback to results@savechildren.org.

There is No Silver Bullet

by Jessica, posted in Aid Effectiveness

There is no silver bullet and frankly you probably don’t need one. It is far more important to be able to find the right kind of gun, be able to load the gun, be able to aim the gun, and perhaps most importantly, be able to figure out where the werewolf is. –Matthew Oliphant

Vampire Selene uses bullets with silver nitrate to fight off werewolves in "Underworld." Unfortunately, we do not have "silver nitrate bullets" for global health problems.

I always scratch my head a bit when the global health community is dismayed at the revelation that one of its previously hailed “silver bullets” is revealed to not be the miracle cure it was thought to be. The latest disappointment making its way across the blogosphere right now is microfinance: after shady lending practices and harassment of borrowers (driving some to suicide) were uncovered on the part of commercial microlenders in India, the development community began wringing its hands at the unfolding political scandal. The forced retirement of Muhammad Yunus, founder of the Grameen Bank, Nobel laureate, and pioneer of the microfinance institution, looks like the proverbial nail in the coffin of microfinance’s status as the one-stop solution for ending poverty. Now experts are holding panel discussions to debate whether or not microfinance “works.”

This is not the first time we have found ourselves crestfallen at the failure of a silver bullet. When evaluating the results of his “Grand Challenges in Global Health,” Bill Gates admitted that the organization had been “naïve” in its expectations of breakthroughs in vaccine development. He underestimated the time it takes to move new products from the lab through clinical trials and manufacturing. “I thought some would be saving lives by now,” he said, “and it’ll be more like in 10 years from now.” Tell me about it: I worked for a biotechnology start-up in college, and the time it took to get approval for phase I clinical trials allowed bad management to completely unravel the company – it took less than five years. By the time we got the green light from the FDA, the company was being bought out, and we never got to test the product.

Many are also astounded at the current descent from grace of Greg Mortenson, of Three Cups of Tea fame. Details of his inspiring Quixote-esque story of building schools for girls in rural Pakistan and Afghanistan are now being questioned, and donors are appalled at reports of mismanaged funds and schools being used as storage sheds. But don’t we already know that graft happens, and rookies make (sometimes colossal) mistakes? How reasonable was it to expect the Central Asia Institute, Mortenson’s charity, to “fix” Afghanistan by building schools? On the other hand, why are countries and large-scale donors pulling funding and creating a fuss over the graft that the Global Fund revealed through its own investigations?

Why are we continually disillusioned when the simple solutions to the complex problems of global health and poverty turn out to not be so simple? Part of the problem is marketing. Saundra Schimmelpfennig, who has made it her mission to point out and tackle issues surrounding charity (mis)representation and shady fundraising practices, points out that

Whether it’s TOMS A Day Without Shoes or CAI’s Pennies for Peace, schools and teachers are using what are essentially commercials for a charitable product to teach children about the larger world and philanthropy. As is the case with most commercials, these “awareness raising activities” often distort or over-simplify the problems faced in ways that benefit their own organization.

This is extremely worrying as the children brought up on these myths and misconceptions are going to turn into businessmen, philanthropists, and lawmakers. How will the decisions they make be impacted by a distorted view of what the world is like and how to really help?

Another part seems to be that despite each revelation, we are constantly drawn to the prospect that we will somehow still find that magic “something,” that the next innovation or big idea will be the much-sought-after silver bullet. Despite coming to terms with his naiveté, Gates is now saying that energy innovation is the key to beating climate change. Programmers are busily developing cell phone apps in the hope that cell phones can help end poverty.

The problems that we devote our careers to tackling are nowhere near simple, and it is unreasonable to expect to find simple solutions to them. Heck, we don’t even adequately fund the silver bullets we already have. As professionals more knowledgeable than me continually point out, our best bet is to strengthen health systems, focus on measurable improvements, admit and learn from failure, and – perhaps most importantly – have a little patience.

Annual Meeting, Day 3: NTDs, Kids, and Careers

by Jessica, posted in Aid Effectiveness, APHA IH Section, Maternal and Child Health

I started off my morning with two unpleasant experiences: a burnt cup of coffee from my hotel’s breakfast buffet and a session on neglected tropical diseases (NTDs). Please don’t misunderstand me – the session, hosted by Dr. Hélène Carabin, was very interesting, but pictures of the clinical manifestations of those worms will make even the sturdiest of young professionals’ skin crawl. I learned more than I ever wanted to know about onchocerciasis, or river blindness (did you know that those worms can live for 14 years in the body?); helminthes; baglisascariasis, or raccoon roundworm (in Brooklyn, of all places); neurocysticercosis, and trachoma. These diseases have rightly earned their designation as NTDs – they are inexpensive and easy to treat and prevent, yet most people have never heard of most of them. (Alanna Shaikh has a theory that giving them more descriptive and graphic names will attract attention to them – you can read her proposed naming scheme here.)

Next up was a session hosted by Dr. Elvira Beracochea on aid accountability and effectiveness. There were several very insightful talks and an interesting discussion (Dr. Beracochea always likes to involve the audience, which can be fun). After a lunch of Vietnamese fast food, I attended a session on child survival and child health, to which I was invited by Ms. Beth Charpentier (Ms. Katherine Robsky’s colleague from Global Health Access Program). While I believe that maternal and child health is very important (and I am thrilled that it is enjoying so much attention from Secretary Clinton and other development advocates), I am not very familiar with that area, so I learned a lot.

Finally, I attended the “Careers in Global Health” panel that is organized by Dr. Carabin every year. There was a very useful presentation on the key knowledge areas and skills that currently global health leaders identified as crucial to the incoming workforce. Ms. Carol Dabbs provided some practical information on the different points of entry with USAID, and then Dr. Eckhard Kleinau told his incredible story of breaking into global health after finishing his residency (he and his wife sold everything they owned and drove to Burkina Faso – from Germany! – in a VW van). If you would like any of this information, please contact me by e-mail at jmkeralis [at] gmail [dot] com.

Finally, the section held its closing business meeting at 6. After committee updates, Dr. Miriam Labbok was recognized for her hard work as section chair for the past two years. I personally will always remember her as a very welcoming face when I attended the annual meeting for the first time last year as a CDC fellow – she encouraged us “newbies” to jump right in.

Tomorrow’s Global Health Luncheon promises to be a real treat (though I probably will not be able to attend – I will have to navigate public transportation back to the airport). The malaria session is always well-attended, however, and it is in the morning – so hopefully I will see you there!