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Posts Tagged ‘Kaiser Family Foundation’

The Kaiser Family Foundation (KFF) and the Center for Strategic International Studies (CSIS) held a panel discussion Wednesday to assess the global health outcomes of the G8 and G20 summits held in Canada last month, where world leaders pledged to reduce maternal and child mortality through the Muskoka Initiative for Maternal and Child Health.

Participants discussed the financial commitments made by G8 nations to reach Millennium Development Goals (MDG) 4 and 5, which deal with reducing child mortality and improving maternal health, respectively. HIV/AIDS was not addressed. Panelists included Jennifer Kates of the Kaiser Family Foundation and J. Stephen Morrison of CSIS. They were joined by Leonard Edwards, the Canadian Prime Minister’s Personal Representative to the G8 and G20 summits, and by Mark Abdoo, Director for Global Health and Food Security on the White House National Security staff.

G8 members committed to contributing an additional $5 billion for the next five years, which will be used to strengthen country-led national health systems in developing countries. Funding will enable delivery on key interventions along the continuum of care, from pre-pregnancy to early childhood.

G8 leaders anticipate that the Muskoka Initiative will mobilize more than $10 billion over the next five years. Already the governments of the Netherlands, New Zealand, Norway, the Republic of Korea, Spain, and Switzerland have collectively pledged $800,000, while the Bill and Melinda Gates Foundation has pledged $1.5 billion over the next five years.

In the past, the global health focus of the G8 has been on reducing the prevalence of HIV/AIDS. However, G8 members have fallen way short of their commitments. In 2005, G8 nations pledged to achieve full universal access to HIV/AIDS treatment by 2010, and pledged to expand HIV/AIDS budgets by $50 million by this year. Jeffrey Sachs, special advisor to the UN Secretary General on the MDG, reports that G8 nations have fallen $30 million short on their pledge.

In 2007 in Norway, G8 leaders pledged $1.8 billion to achieve universal access for children to HIV/AIDS treatment by 2010. UNICEF estimates that an additional $649 million is needed to meet their pledge.

HIV/AIDS is the leading killer of women of reproductive age worldwide. The G8 pledged to reduce the number of maternal deaths by 64,000 in the next five years. However, that goal cannot be achieved without integrating HIV/AIDS care into maternal health frameworks. HIV/AIDS prevention and treatment must be included in all discussions of improving maternal and child health, or else the goals set out will not be achieved and the G8 will continue to fail to meet their commitments.

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At the start of a forum today on the Obama Administration’s Global Health Initiative, Jen Kates, the Kaiser Family Foundation’s director of global health policy and HIV, laid out eight major questions about the proposal—queries that will go a long way toward determining whether the initiative is a success or not.

After a 90-minute discussion, most of those key questions—such as how much funding the GHI will get, how the money will be divvied up, and how its goals will be measured—remained unanswered. But we did learn a few things from the U.S. government panelists who are developing and overseeing the implementation of the GHI, the White House’s controversial initiative calling for a more integrated, comprehensive approach to funding global health.

Amie Batson, the deputy assistant administrator for global health at USAID, had the most news to share. On governance of the GHI, she said a “strategic council” had been established, and it would serve as a forum for pulling together all the government agencies that have expertise in achieving the GHI’s goals. The group has partners from a gamut of federal agencies—from the departments of the Treasury and Defense to NIH and CDC.

At the more operational level, she said, there was a “trifecta” of leaders– USAID Administrator Rajiv Shah, CDC director Thomas Frieden, and Global AIDS Coordinator Eric Goosby—charged with developing and executing the GHI. “They are tasked with defining a shared or joint operational plan,” she said, and each of them has a deputy charged with delivering on that plan.

Batson also said the Administration would release a final GHI plan by early summer. And by the end of this month, officials would announce the first ten “GHI Plus” countries; those countries will then get additional technical, management, and financial resources to implement integrated programs and make investments across health conditions. (The list of GHI Plus countries will be expanded to 20 in later years.)

“We’re now engaging very actively with the countries,” she said. The GHI Plus countries will offer a sort of field test “where we have an intensified learning effort.”

Today’s forum, hosted by the Kaiser Family Foundation and available online here, was the most extensive public discussion yet of the GHI, a $63 billion six-year plan announced by President Obama nearly one year ago.  It has been the subject of much debate because, while the plan includes many lofty and significant goals, some advocates fear it will not be adequately funded and that it may shift focus away from critical programs, such as PEPFAR. Key officials crafting the plan say the U.S. needs to turn its attention to other health problems, such as child and maternal health, but they do not seem to fully grasp or acknowledge the links between specific diseases, such as HIV and TB, and women’s health.

The shift could have serious repercussions on the ground in the developing world. For example, the GHI’s goals on TB represent a significant step back from more aggressive targets laid out in the Lantos-Hyde Act that reauthorized PEPFAR, even though TB claims 1.8 million lives a year.

At today’s forum, Ann Gavaghan, chief of staff in the Office of the U.S. Global AIDS Coordinator, said the GHI should be viewed as an opportunity to build on the stunning successes achieved in fighting global AIDS and other diseases over the last decade, not as a step back from those efforts. “The GHI is not designed to take away from any of those successes but to say let’s recognize what’s been done … and let’s figure out a way to really build those best practices,” she said.

But wide-ranging questions from the audience signaled there is still deep concern about the initiative and how it will be implemented and funded. Several attendees asked about why TB, for example, appeared to be getting short shrift in funding and focus. Gavaghan and Deborah Birx, director of CDC’s Global AIDS Program, both tried to assure advocates that the Administration was committed to combating TB and understood how much of a threat it presents, but neither one specifically addressed the underfunding or weak targets.

Another advocate asked about the apparent contradiction between the Administration’s rhetoric about wanting more international collaboration and its proposed cut to the U.S. contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Gavaghan said the White House had made a robust request for the Global Fund and remained fully committed to its success, including active U.S. participation on the organization’s board and in country-level coordination.

Several attendees asked about how the GHI would deal with the severe health care workforce shortage in the developing world, noting that the GHI blueprint issued in February did not offer very many details about that critical piece of health system strengthening.

Batson said that’s because the solution to that problem is country-specific and will have to be dealt with in a focused way in each place. “Many of the governments have put this as No. 1 on their lists, so I think you will see a lot of innovation,” she said.

To learn more about the GHI, read our earlier blog posts here and here analyzing the GHI’s consultation document. In addition, Kaiser has this nice analysis/overview—including the 8 outstanding questions—of the GHI.

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During a live interactive webcast today hosted by the Kaiser Family Foundation, an expert panel agreed that tuberculosis poses a grave global health threat and demands an innovative, multifaceted response—from new drugs to scaled-up treatment to better infection control.

The lively forum, available here, highlighted the need for an aggressive approach to the global tuberculosis epidemic just as the US government is putting the finishing touches on its five-year global tuberculosis strategy. But it’s far from clear the US will provide the leadership and resources needed.

Cheri Vincent, senior public health advisor in the Infectious Diseases Division, Bureau for Global Health, at USAID, said her agency is now mapping out its five-year TB strategy, working in conjunction with PEPFAR, the Department of Defense, and other agencies. One key objective, she said, is to halve TB prevalence by 2015 from 1990 levels. Another goal is to get at least 90,000 patients with multi-drug resistant TB on treatment, she said, noting that right now, very few MDR-TB patients are being treated in adherence with international guidelines.

“We also need to build on the health system platform and make sure we’re doing it in a cost effective and integrated approach,” Vincent said.

Christine Sizemore, Ph.D., chief of the Tuberculosis and other Mycobacterial Diseases Section in NIAID’s Division of Microbiology and Infectious Diseases, noted that in 1985, the research institute’s budget for TB was only $160,000 a year and the disease had fallen off the medical community’s agenda. It popped back up in the 1990s, when an outbreak of drug-resistant TB in the U.S. made scientists realize this was a continuing threat.

Now, she said, the National Institute of Allergy and Infectious Diseases has made a “fairly significant investment” in TB, spending about $140 million a year on TB related research. But, Sizemore said, “We need to start looking at the disease in a larger context.” She said discussions are underway to move toward what NIAID director Tony Fauci has called a “transformative” research agenda for TB. For more on Fauci’s vision, read this post.

Christine Lubinski, director of the IDSA/HIVMA Center for Global Health Policy, said while these steps are vital, the US government’s response still does not reflect the urgency of the epidemic. She noted that when Congress reauthorized the global AIDS initiative, known as PEPFAR, in 2008, lawmakers authorized $4 billion over five years for TB control, but decision-makers are not on track to fulfill that funding commitment.

In the last budget proposal from the White House, “we did not see … even remotely a down payment on that,” Lubinski said. (more…)

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The Kaiser Family Foundation will hold a live, interactive webcast on Tuesday, Sept. 28, at 1 p.m. EDT on the threat of tuberculosis and the U.S. strategy for combating this ancient deadly disease.

An expert panel is set to discuss this growing global health threat, including two of the U.S. government’s top infectious disease specialists and renowned South African physician Robin Wood, who has been on the frontlines of HIV/AIDS treatment, prevention, and research for the last two decades. As director of the Desmond Tutu HIV Centre at the Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Dr. Wood will be able to give his perspective on new strategies needed to combat global HIV/AIDS and TB. 

The Center for Global Health Policy is bringing Dr. Wood to Washington next week for series of community forums, policy meetings, and press interviews. The trip is part of the Global Center’s efforts to make the voices of developing country physicians heard in American policy debates.

Joining Dr. Wood for the Kaiser webcast will be Christine Sizemore, of the National Institute of Allergy and Infectious Diseases; Cheri Vincent, of the U.S. Agency for International Development; and Christine Lubinski, director of the Center for Global Health Policy. Both Dr. Sizemore and Ms. Vincent play lead roles in the U.S. government’s global TB programs. The forum will be moderated by Kaiser Family Foundation Vice President Jen Kates. (more…)

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