Health Alliance International

Global Health Recommendations for the Obama Administration

Posted: Mar 01, 2009 · Posted by: HAI

The United States is poised to reassert progressive leadership on a wide range of global sexual and reproductive health issues. The Obama administration has already laid the groundwork by committing the United States to restoring support for the United Nations Population Fund (UNFPA) and repealing the "Global Gag Rule" that prohibited U.S. support of organizations that counsel women on family planning or reproductive health choices. President Obama has lauded and pledged to expand presidential initiatives to fight HIV/AIDS, tuberculosis and malaria, recognizing the sizeable effect they have had not only in saving hundreds of thousands of lives, but also in improving U.S. foreign policy. He has clearly stated that the United Nations Millennium Development Goals (MDGs) will become American policy under his administration.

To coincide with the U.S. presidential transition, Health Alliance International and our partners developed a set of Global Health Recommendations for a New Administration and Congress. Partners included Partners In Health; the François-Xavier Bagnoud Center for Health and Human Rights; Physicians for Human Rights; RESULTS; and ActionAid. The group examined the United States' commitment to global health and articulated a vision for future U.S. investments and activities in global health. It outlines how the U.S. government can improve global health under the leadership of a new administration.

Repeated polls in the U.S. have shown that health now ranks among Americans' top priorities for development assistance-not merely to protect U.S. interests, but also as a way of promoting human development worldwide. While the U.S. financial crisis is likely foremost on the minds of many, the current global crisis threatens to worsen the extreme privation suffered by those in the developing world. At the writing of this document, 25% of the developing world lives in dire poverty and 80% of the world lives in countries where income inequality is worsening. This reflects on the meager progress made towards achieving the MDGs. The U.S. government role in providing aid for health and development has never been more critical.

U.S. health and development assistance should address both the root causes of ill health-poverty and inequality-and be directed toward building public sector institutions to help governments respond to the needs of their people. The new Administration and Congress have a unique opportunity to redefine foreign aid policy to help those most impoverished and to save lives. Implementing the recommendations of this paper would have an enormous impact.

Key Recommendations

Improving Means of Funding

Commit to a comprehensive approach to health:

• Increase Official Development Assistance to 0.7% of gross national income (GNI) and proportionately increase funding for all global health programs. Commit to comprehensive health care approach and end vertical funding.

• Develop sustained financing to effectively and efficiently disburse funds to health programs with multi-year funding cycles rather than annual appropriations.

Address inefficiency in aid:

• Develop a framework to better evaluate programs and measure their effectiveness and efficacy in terms of money flows and the variability of impact so as to determine more efficient multilateral mechanisms and NGOs through which to channel money.

• Institute a policy of complete transparency in U.S. foreign aid, shedding light on the costs that significantly decrease the percentage of aid reaching recipient countries.

Build local / national capacity:

• Direct more U.S. aid to recipient country public sectors to develop health systems. This should include funds to refurbish facilities, hire and train new clinical and administrative staffs, compensate existing Ministry of Health staff, and waive patient user fees.
• Increase total number of health workers in resource-poor areas and provide full support for pre-service training and retention of new health professionals.

• Revise U.S. policy regarding compensation of community health workers for their services, moving beyond an unsustainable model that relies on local residents to volunteer their time.

Reduce child mortality:

• Support child health programs with an integrated approach focusing on family, clean water, nutrition, health care, education, and social protection to adequately address the essential elements of children's lives.
• Continue the investments in vaccination campaigns in resource-poor areas.

• Combat malnutrition by enhancing preventive efforts as access to food is a vital component in improving child health.

Improve women's health:

• Increase funding for reducing maternal mortality, family planning, and reproductive health services; revise the ABC ("abstinence, be faithful, use condoms") policy using scientific evidence; and repeal the Mexico City Policy (i.e. the Global Gag Rule).

• Remove financial barriers to care, specifically user fees for prenatal and obstetrical services, since maternal mortality is strongly correlated with poverty and also address the social and economic determinants of health.

Combat HIV/AIDS, tuberculosis and malaria:

• Fully appropriate the authorized $48 billion for HIV/AIDS, tuberculosis, and malaria for 2009-2013 (PEPFAR).
• Create a presidential initiative on global tuberculosis.
• Fully fund U.S. bilateral tuberculosis and malaria programs through PEPFAR and other sources, and contribute the U.S. fair share of funding to programs such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.
• Remove social and economic barriers to treatment adherence by providing "wrap-around services" such as nutrition, clean water, housing, and childcare support.
• Fund development of new prevention and treatment technologies and support provision of effective diagnostic tools and drugs for the three diseases.

• Scale up coordinated TB-HIV services and require PEPFAR recipients to incorporate the Three I's (intensified case finding, isoniazid preventive therapy, and infection control) into programming in high TB-HIV burden countries.

Decrease extreme poverty and hunger:

• Fund additional emergency food assistance and track food aid to ensure its efficient and effective delivery.
• Direct the State Department, Department of Agriculture, USAID, Treasury, and other agencies to assist governments in developing food sovereignty by supporting small-hold farmers, improve market access in developing countries, and utilize protective tariffs for food production.
• collaborate with recipient countries to institute progressive policies on land reform and agricultural development.

Revise Development Policies and Financing Architecture

Redefine foreign aid policy and goals:

• Instruct the Department of Treasury to work with the International Monetary Fund (IMF) Executive Board to review and change the restrictiveness of IMF macroeconomic policies, and widely publicize such policy changes.
• Develop increased public spending policy options, which have been fully vetted by a broader group of stakeholders.
• Require U.S. government contractors to adhere to the principles of the NGO Code of Conduct for Health Systems Strengthening.

Recognize the Full Scope of Human Rights

Ratify the currently signed treaties:

• International Covenant on Economic, Social and Cultural Rights; Convention on the Elimination of All Forms of Discrimination Against Women ; Convention on the Rights of the Child; International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families; International Labor Organization Conventions; International Criminal Court and Kyoto Protocol.

In the past decade knowledge regarding disease prevention and treatment and access to care in resource-poor settings has expanded to a certain extent. Countless studies, focus groups, and field projects have given those committed to ending poverty and securing health for all a detailed roadmap to securing these aims for all. What remains is the need for an impassioned U.S. administration and Congress to apply this knowledge on a global scale with the necessary and appropriate zeal for justice and live up to its humanitarian responsibilities, despite current pressures on the U.S. economy.

For further details related to each recommendation, read the full recommendations at globalhealth2009.