Ideas to Action:

Independent research for global prosperity

US Development Policy

CGD experts track US development policy and offer ideas and analysis to improve its impact on developing countries. Also check out our Views from the Center blog and Global Health Policy blog.

 

Ambassador Deborah Birx speaking at CGD. Photo by Kaveh Sardari

PEPFAR’s New Targets for Local Implementation: Commendable in Theory, Complicated in Practice

In July, United States Global AIDS Coordinator Deborah Birx made a striking commitment: under her leadership, the President’s Emergency Plan for AIDS Relief (PEPFAR) would direct at least 40 percent of its funding to host country governments or organizations by the end of 2019—rising to 70 percent by the end of 2020. The bottom line: PEPFAR’s local targets are commendable in theory, but we suspect their application in practice will prove complicated. Below is our take on the related issues—and some recommendations for PEPFAR to forge the most effective path forward.

Comments Needed: A Better Deal to Protect Americans’ Health under the Trump Administration

We would argue that investing in global health, at least along certain dimensions, is entirely consistent with President Trump’s philosophy of America First—a real opportunity for his administration to improve the security of the American people by pushing through some much-needed reform. In that spirit, we’ve put together a proposal for a new executive initiative under the Trump Administration. We call it PAHAA: Protecting America’s Health at Home and Abroad.

Global Family Planning Funding—What Should Funders Be Thinking About Now?

The new US administration may put US funding for family planning—comprising nearly half of all bilateral contributions—at risk. The family planning community still has time to make the case for sustained US funding, protecting the gains that it has already achieved. But smart advocacy should also be accompanied by contingency planning—what would it mean for the United States (US) to substantially cut its support?

Getting It Right: USAID and the President’s Malaria Initiative

This is a joint post with Victoria Fan.

While PEPFAR and the Global Health Initiative (GHI) have dominated the global health community’s attention over the past few years, the President’s Malaria Initiative (PMI) has largely flown under the radar. Surprisingly little had been written about the PMI; still the few available materials painted a reasonably positive picture. But just this month, the PMI released the results of an external evaluation which confirms what we’ve long suspected: PMI is doing a remarkably good job and generating “value for money” in U.S. global health efforts. Such results are all the more impressive in light of the common criticisms of USAID past and present – that it is ineffective, incompetent, and hampered by a complex and arcane bureaucracy. The PMI is a USAID success story that helps validate its ongoing efforts to reform and rebuild into the U.S.’s premier development agency.

Originally conceived in 2005 as a five-year, $1.2 billion scale-up of America’s malaria control efforts, the PMI was extended and expanded by the 2008 Lantos-Hyde Act, receiving $625 million in funding for FY2011. While its funding pales in comparison to PEPFAR, which received almost $7 billion for the same period, the PMI is among the largest global donors for malaria, aiming to halve the burden of malaria for 70 percent of at-risk populations in sub-Saharan Africa. Led by USAID under a U.S. Global Malaria Coordinator, the PMI is jointly implemented with the Centers for Disease Control (CDC).

Is USAID Being Set Up to Fail on the GHI?

Since the launch of the Obama administration’s $63 billion Global Health Initiative (GHI) in May 2009, we have followed its ups and downs with great enthusiasm (see for example: here, here, here and here), trying to better understand its structure and role within the U.S. government’s complicated global health architecture. One recurring question we have continually raised has focused on leadership: who, exactly, was to be in charge of this massive undertaking? Who would be accountable for meeting the initiative’s eight high-level targets and adhering to its seven guiding principles?

Last December, the State Department’s Quadrennial Diplomacy and Development Review (QDDR) appeared to put those questions to rest. According to the 200+ page document, USAID would assume leadership of the GHI by September 2012, contingent upon fulfilling a set of 10 benchmarks to demonstrate its capacity. But upon closer inspection of the GHI over the last year, the QDDR provision only seems to have generated a new set of questions that are more difficult to resolve. While there are no easy answers, the administration should consider these issues as it thinks through the tough decision of pulling the GHI together under one leader and demonstrating success by meeting its targets: