Posts Tagged ‘USAID’

The Interagency Youth Working Group worked with USAID to sponsor a meeting yesterday entitled “Protecting and Empowering Adolescent Girls: Evidence for the Global Health Initiative.”  The meeting featured a series of presentations from leaders in the global health field, which aimed to identify factors contributing to girls’ vulnerability to HIV and reproductive health risks, as well as to share effective programmatic approaches and research that address such risks.  In one of the panels, entitled “Empowering Adolescent Girls,” panelists spoke of their respective organization’s projects in developing countries, aimed at empowering young girls as a strategy to deal with the HIV/AIDS epidemic. 

Facilitator Victoria Collins, of Cardno Emerging Markets, discussed the need to invest in the development of young girls as a way to uplift entire communities.  Investing in young girls not only empowers them but empowers their families and ultimately, their whole communities.  Young girls and women in developing countries are often unable to negotiate sex on their terms and ensure their sexual safety, and are particularly vulnerable to being infected by HIV/AIDS as a result.  As HIV/AIDS is the leading cause of death among women of reproductive age worldwide, it is imperative that young women are equipped with the power and knowledge to protect themselves from being infected by the disease.

Worknesh Kereta, of Pathfinder International, spoke of her organization’s women and girl’s empowerment program in Ethiopia, in which they reached over eight million young girls and women with information about sexual and reproductive health, as one part of their multifaceted model to equip girls with the information, skills, and knowledge needed to empower themselves and their communities.  One of their aims is to reduce the prevalence of STI’s and HIV, and they plan to achieve this by spreading awareness of the disease. 

At the end of the program in 2009, 52 percent of women participating in the program had been tested for HIV, a 26 percent increase from the baseline.  In addition, 35 percent of the women were using modern contraceptives at the end of the program, up from 25 percent in 2007.  Kereta also emphasized the importance of reaching out to young boys before attitudes discriminatory towards women were formed as a way to promote gender equity in the future.

Betty Ochieng of Family Health International (FHI) discussed their “House-Girls Health and Life Skills Project” in Nairobi, Kenya, in which community development workers reached out to domestic workers, commonly known as “house-girls”, with the aim to equip these often illiterate and vulnerable young people with the skills and knowledge needed to ensure their sexual and reproductive health.  Of the 277 young women who directly participated in the program, half were sexually active, 12.5 percent had sex in exchange for money in the past, and seven percent had faced sexual violence.  

Because house-girls are often only allowed enough free time to attend church once a week, the program was implemented through churches, with congregation members acting as lead trainers.  In addition to the 277 that were reached through the program directly, 910 more were reached through 22 trained peer educators, and an estimated 27,830 were reached through media efforts.  HIV/AIDS and STI awareness greatly increased as a result of these efforts.

These projects illustrate how simple it can be to equip young women with the tools they need to empower themselves and consequently protect themselves from being infected by HIV/AIDS, and other STIs.

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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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The Center for Strategic and International Studies yesterday unveiled  a new “must-read” report for global health advocates, “Smart Global Health Policy.” While a panel at the Congressionally-chartered Institute of Medicine, made up primarily of scientists, issued recommendations on US global health policy last year, the CSIS panel is the first to involve high-level business leaders and sitting members of Congress.

The report drew on observations made during a study trip to Kenya, but it is unclear if consultation in developing countries went beyond that, for instance to include global representatives of affected communities and of developing country civil society, such as those on the boards of UNITAID and the Global Fund.

The report and the webcast of the launch event are available online.  Here are a few highlights:

The report makes a strong case that it is in the interest of the United States to continue and increase  our investment in global health and that the issue should matter to all Americans. It calls for keeping funding for AIDS, TB and malaria on a “consistent trajectory,” doubling spending on maternal and child health to $2 billion a year, forging a collaborative response to emerging heath threats, establishing strong coordination of global health policy across US agencies, and increasing support for multilateral efforts.

In 2009 there was a massive drop off in the expansion of treatment by US programs, and the report notes that AIDS advocates are “particularly anxious” at the slowing growth rate, a stalling that could also impact health systems.  The report suggests that funding is a concern for treatment advocates, yet, in fact, HIV prevention advocates have also been quite alarmed at the essentially flatline funding picture.

Despite World TB Day (March 24) being just a few days away, no mention is made in the report of immediate tuberculosis funding concerns, lowered TB targets in the 6-year Global Health Initiative or USAID’s role in responding to TB.  Instead, the report includes TB within a much longer timeframe, stating that “we can accomplish great things in the next 15 years:  We can cut the rate of new HIV infections by two thirds, end the threat of drug-resistant tuberculosis, and eliminate malaria deaths.”

In terms of overall funding, the report calls for less spending in the near term than either the IOM panel or the Global Health Initiative coalition did; instead, the CSIS document endorses the President’s proposed funding of $63 billion by 2014.  While the IOM called for specific increased funding levels on AIDS, TB and malaria consistent with Lantos-Hyde, the CSIS report does not delve into specific funding levels, with the exception of maternal and child health.  Instead, taking the long view, it calls for $25 billion in annual spending by 2025.

One exciting aspect of the CSIS report is that it endorses innovative financing as a means of raising funds for global health.  The report does not touch on the concept of innovative taxation for health, recently championed by maternal health advocates at Family Care International and many other groups. However, it identifies some specific mechanisms, such as borrowing the money needed through an international finance facility, and it urges the US National Security Council to review the most promising ideas on innovative financing and develop a US position.

Admiral William J. Fallon kicked off the launch event, stating that global health is a “bipartisan enterprise… which can unite US citizens in collective action.”  He stated the importance of maintaining forward momentum, noting that “we do not want to coast or slide backward.”  Helene Gayle said that global health efforts are showcasing the American spirit of generosity and said “we need forward momentum even in a period of constrained resources.”

Jack Lew, the top State Department official developing the US Global Health Initiative, spoke about the Administration’s goals in developing the new strategy. He said that the Administration’s aim was to “challenge a way of doing business by moving beyond a primary focus on disease treatment.”  He said the goal was “not to do harm to existing programs.”

Advocates for effective HIV prevention have felt stymied in recent weeks by the lack of specific HIV/AIDS guidances from the Administration to the field and have noted that Kenya’s Partnership Framework with the US even appears to rule out family planning integration.  Family planning came up at the event when Dr. Michael Merson, of Duke University, criticized the Canadian government’s rejection of the inclusion of family planning as a part of its maternal health initiative.

But Lew’s presentation did not delve into details — and there was no opportunity at the event for questions from the floor.  He stated that program integration was crucial to meet the needs of women, and he commented on the importance of having family planning and HIV/AIDS services in one location.

The report is particularly noteworthy for the very strong focus on measurement for accountability in delivering services. Business leaders at the event decried the reporting burden on health programs and, along with Dr. Merson, called for a common set of impact indicators.

Rajeev Venkayya, Director of Global Health Delivery at the Bill and Gates Melinda Foundation, said that measurement matters because it allows us to maximize efficiency and stretch dollars while identifying what works and what doesn’t.  In addition, measurement allows us to hold accountable institutions, organizations, and even individuals, which in turn allows for greater project improvement.  Exxon Mobil Chairman and CEO Rex Tillerson agreed, and cited a Lancet article which said that evaluation must be a top priority for global health.

Robert Rubin, former US Treasury Secretary and former head of Citigroup and Goldman Sachs, told the audience that global health leaders “face wrenching choices” as a result of US fiscal problems.  He asked two members of Congress, Rep. Keith Ellison and Senator Jeanne Shaheen, whether global health is an issue that can “break through the mire” on Capitol Hill.

Senator Shaheen said that the issue can succeed, but it is crucial to explain to Americans that international affairs spending is only a tiny fraction of the US budget, much less than people realize.   She said it was cheaper to spend on global health than on war, noting Bill Clinton’s recent statement about the appreciation of PEPFAR expressed by Muslim residents of Tanzania.  She also said the current committee structure in Congress is an impediment and endorsed the recommendation included in the report for a consultative body that would work across committees.

Congressman Ellison also voiced strong support for greater US action on global health, stating that “infectious diseases know no borders.”  He said that while in Kenya, he made good progress in persuading Kenyan leaders of the necessity of stepping up their own contributions.  He suggested that by reducing US spending on outmoded weapons systems the US could improve its budget outlook and make global health spending easier.

Gayle Smith, the NSC official leading the development of the US Global health Initiative, was the concluding speaker at the event. She said global health was a bipartisan issue and that in fact President Obama specifically directed that the achievements of the previous Republican Administration be recognized.  She praised the CSIS report, and said that its ideas were remarkably congruent with those of the Administration.

She said the Administration’s commitment to fighting global HIV/AIDS was “absolute” and, she added, “this will grow over the life of the initiative.” She said the Administration’s plans for the Global Health Initiative “include an ambitions set of targets in terms of outcomes.”

She did not respond to concerns submitted to the Administration by the Global Center, TAG, the Global Health Council, and the GHI Working Group that the Administration’s targets regarding tuberculosis contradict a directive from Congress approved in 2008 as a part of Lantos-Hyde.  In fact, it was surprising that the event unfolded without  reference  to the consultative process which numerous NGOs have engaged in regarding the US Global Health Initiative or to the detailed analyses these groups have submitted to the Administration.

There were a range of reactions from health NGOs to the event.  Eric Friedman at Physicians for Human Rights noted the “surprisingly little attention in the report to human resources for health and health systems, and no mention of including civil society in the development of country compacts.” He praised the report for “proposing that the Administration develop a long-term, 15-year framework for making progress in and committing the United States to improving global health, a good idea so long as it does not set the stage for underambition, and is flexible to respond to changes in the years ahead. ” He also would have liked to see “a recommendation that the United States should deliberately integrate a right to health approach throughout U.S. global health programs, including the consistent focus on equality, accountability, and participation that this entails.”

Matt Kavanagh at Health GAP praised what he heard from the report, which included an emphasis on keeping up the fight against HIV/AIDS, especially important for the health of African women. But he noted with concern that “some of the Administration comments that seemed to favor prioritizing ‘cheap’ interventions that do not work in the long term, such as single dose nevirapine instead of treatment for HIV positive mothers, an approach abandoned long ago as ineffective in wealthy nations.”

The American Medical Students Association’s Farheen A. Qurashi said that the report “takes a bold, but necessary, approach to U.S. global health planning by insisting upon a 15-year comprehensive plan.”  She said, “Unfortunately, the Commission’s report does not appear to specify the need for scaling-up of PEPFAR investments versus the dangers of flat-funding, and instead uses language that suggests that a continuation of current levels of funding without annual growth is sufficient.”

On health systems, she said that “though integration and health systems strengthening is mentioned in general terms, and the need for training and retention of health care workers is noted, there is no detailed analysis of the measures, funding, and support necessary to establish and retain adequate numbers of health professionals and other health care workers.”

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This post is by John Donnelly, a former Boston Globe reporter and regular contributor to Science Speaks. 

Less than two months ago, Secretary of State Hillary Clinton declared an increased US government commitment to international family planning and reproductive health programs, saying, “In the Obama administration, we are convinced of the value of investing in women and girls, and we understand there is a direct line between a woman’s reproductive health and her ability to lead a productive, fulfilling life.”

So what does that mean in terms of programs and funding, and how will it affect the administration’s efforts in fighting HIV/AIDS, the largest bilateral health assistance program overseas?

One way to find out: On Monday, the Aspen Institute will host a panel discussion titled, ”Women and Health: Today’s Evidence, Tomorrow’s Agenda.”

Featured will be two top US officials who will oversee women’s health programs – Susan K. Brems, deputy assistant administrator of the US Agency for International Development, and Michele Moloney-Kitts, assistant US global AIDS coordinator for the President’s Emergency Plan for AIDS Relief. Julio Frenk, Dean of the Harvard School of Public Health and former Minister of Health in Mexico, will also be on the panel, along with Peggy Clark, Aspen’s vice president of policy programs and executive director of the newly formed Global Health & Development program, and Tonya Nyagiro, director of the World Health Organization’s Department of Gender, Women and Health.;

Brems and Moloney-Kitts will likely talk about how USAID, the Global Health Initiative and PEPFAR plan to strengthen health systems to better meet the needs of women’s health, particularly family planning and reproductive health issues. But critics worry that the Administration’s proposed GHI, while including a welcome and needed broader focus, will come at the expense of the robust response envisioned for HIV through the Lantos-Hyde Act, which reauthorized PEPFAR. 

The Aspen program runs Monday from noon to 1:45 p.m. We’ll plan to blog from the meeting.

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The Obama Administration’s Global Health Initiative has not been fully fleshed out yet, but the effort got a new leader today. Amie Batson will head up USAID’s efforts on the GHI and serve as deputy assistant administrator for global health, according to an announcement from USAID chief Rajiv J. Shah.   

The notice said Batson “will be responsible for coordination of USAID’s work in support of this important initiative,” referring to Obama’s six-year $63 billion proposal that envisions a more comprehensive approach to global health and promises a more intensive focus on women and children.

Global TB and HIV advocates seem to have a positive impression of Batson, who has worked on global health issues for two decades and has a strong background in vaccines and innovative financing mechanisms for global health. She has worked on these issues at the WHO, UNICEF and the World Bank. 

“Although her career has focused primarily on vaccines and financing issues, Dr. Batson has a wealth of expertise that she will be able to draw on in her new position,” said Peg Willingham, senior director for external affairs at Aeras Global TB Vaccine Foundation. “She is a technocrat in the best sense of the word – someone whose academic and professional background have prepared her well for this new role at USAID.”

Willingham noted that Batson has worked on a broad array of health issues over the years, including child survival as part of the Children’s Vaccine Initiative, and HIV/AIDS, including serving for several years on the International AIDS Vaccine Initiative’s Policy Advisory Committee.  (More on Batson’s resume details below.)

Batson will be getting right into the thick of things, as she is scheduled to meet with global health advocates and other USG officials on Friday about the Global Health Initiative consultative document, released on Feb. 1. Read more about that here.

Batson’s appointment comes Secretary of State Hillary Clinton testifies before Congress today and tomorrow about the FY 2011 budget and US foreign policy priorities. Clinton is set to speak before the Senate Foreign Relations Committee today and the respective House panel on Thursday.

It’s unclear how much time she’ll spend talking about global health vs. Afghanistan, Iraq, and other hot-button international issues on her plate. But we’re hoping for a few more details on the GHI. Stay tuned.

Here’s the rest of Batson’s resume, from to the USAID notice of her appointment.

“Ms. Batson joins USAID after a 20-year career in global health that has included positions in the WHO, UNICEF, and most recently, the World Bank.  As one of the original drivers behind the creation of the Global Alliance for Vaccines & Immunization (GAVI Alliance) she led the World Bank’s efforts in vaccine financing, including the establishment of new financing mechanisms like the Advance Market Commitment and the use of donor financing to “buy-down” loans from the International Development Assistance program.  Together these efforts have provided billions of dollars of new funding for global health and helped to vaccinate millions of children against polio, pneumonia, diarrhea, and other vaccine preventable causes of death.  In 2002, in recognition of her work on financial innovations for health, she received the President’s Award for Excellence in Innovation from World Bank President James Wolfensohn.

“More recently her leadership efforts have been directed toward improving health systems through the use of results-based financing mechanisms. 

“Prior to joining the World Bank, Ms. Batson was a joint WHO/UNICEF staff member in the WHO Global Program for Vaccines, where she led efforts to develop public-private partnerships for vaccines and to further investment in vaccine manufacturing and development.  She has published nearly two dozen articles, mostly in the domain of the applied economics of vaccine production and commercialization.”

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Dr. Eric Goosby, the US global AIDS ambassador, spoke with John Donnelly about a number of issues surrounding PEPFAR and the Obama administration’s new Global Health Initiative, including how the administration hopes to ramp up treatment and prevention efforts with small increases in overall funding and how PEPFAR is constantly responding to emergencies in the field – including the move in December to give the South African government $120 million after the country had an unexpected funding shortfall in nine provinces.   

Q: Roxana Rogers, USAID’s South Africa health team leader, said recently in South Africa that, “US government funding is going to come down dramatically over the next five years.” True?

A: No, it’s not true. Every year there’s been an overall increase in funding for PEPFAR, and we’ve also not been in a situation where we’ve had a decrease in any country, certainly not in South Africa. Our funding for South Africa is over a half billion dollars a year. Our resources that go into South Africa are having a huge impact, and I’m not understanding that (comment by Rogers).

We also committed to $120 million recently over two years to specifically address an unexpected shortage of funding for antiretroviral drugs in South Africa in nine provinces. The South African government asked us to be silent (about it during that time.) … It made a lot of sense for us to fund it for the simple reason that we not allow services to be interrupted and allow South Africa to respond to the increase in demand.

Roxana’s statement is based on the fact – I think – that she was used to PEPFAR funding that went up in huge increments every year — so much so they scrambled to find meaningful applications to use the funding for programs. Now we are in an economic crisis, with nowhere near the increase in funding like that, so on a relative level it may feel like a drop in funding.

Q: What happened in South Africa’s shortfall of funding for treatment?

A: PEPFAR has not run out of any antiretroviral drugs in any country, including South Africa. .. But for multiple times we’ve been asked to bail out a country for one or two months (because of drug shortages in the national program or funding shortages). South Africa had run out of resources to pay for the medication in nine provinces, starting in November. It was a significant outlay of resources for us and a real example of cooperation. In addition, we were able to work with the government to ensure their Treasury picks up the bill thereafter, so it doesn’t happen again.

Q: You have said, “Our commitment to universal coverage hasn’t wavered.” With the increase in demand for treatment and prevention around the world, how can you make that commitment with just a $141 million increase in your budget – and with some of that money earmarked for the Global Health Initiative?

A: We are committed to universal access. We are partnering with implementing countries to mount their response. Our expectation was never that we would be the sole source of funding to fight the epidemic. … PEPFAR or any other single funding line will not be able to successfully respond to the unmet need. … It’s not within one single program’s ability to mount that response.

I don’t know if PEPFAR ever presented itself that it was going to cover the entire need for prevention, care, and treatment for any country. We are definitely providing larger than the bulk of the funding – 50, 60, or 70 percent of it– in our focus countries already.

Q: You have talked in the past about finding savings in PEPFAR’s budget that would free up additional funds for treatment and prevention. What are you doing in finding these savings, including in trying to reduce the price of ARV medication?

A: We have been in long-term negotiations in every country we’re in to have the predominant purchasing (for drugs) occurring with generic manufacturers. We saw a shift two years ago, and now we’re in the high 80s, low 90 percent (of all drugs being generics) We have had discussions with South Africa … and they needed to move from  about a 65 percent brand dominance to somewhere down to 10-15 percent range, which they have started to do.

We are engaged with the Clinton Foundation to look at generic pricing arrangements, toward a commitment that creates and introduces a competitive component to generic pricing. After that initial deal is cut (in a country for generic drugs) competitive pressure from another generic manufacturer in that region will continue to drive that price down.

For other efficiencies, we have looked at the Clinton Foundation and Synergos (Institute in New York City) and other organizations that have a history of this type of work. We try to understand how we can use the experiences they have had with other countries, not with PEPFAR, to learn lessons that enable us to identify efficiencies for treatment and for prevention interventions.

Q: You are now helping to create partnership forums with countries on the HIV/AIDS response. How will you be able to ensure the representation of civil society groups in situations like the one unfolding in Uganda now – with the proposed law that would outlaw homosexuality?

A: PEPFAR has played a central role in being the dominant response in Uganda to the epidemic. We are now and always have been treating gay men in Uganda. Whether the country has admitted that or acknowledged that is a different issue — they never have. From day one, the Infectious Diseases Institute and TASO (The AIDS Support Organization) have been central in that response, and that will continue. In addition, PEPFAR is in a position to play a role in the partnership frameworks to engage in a substantial dialogue with country leadership about the public health impact from such a law. … With such a law, there is a fear that this will stop the flow of patients into testing and into treatment. We will always fight against that in the way our programs are implemented. PEPFAR also has an opportunity to identify – and fund – higher risk populations.

Q: How does that strategy work?

A: We could fund non-governmental organizations that do outreach, that create support groups. … Then there is a growing number of individuals who feel safe and who are willing to take those risks who coalesce in a group that can be funded as a separate NGO. In China now, there is an increasing number of NGOS created specifically for high-risk groups, especially men who have sex with men. … There is a need in creating these safe islands of safety so they can be tested and treated.

Q: For many years, you were on the outside of government, an activist, giving advice to those in power. What should activists be focusing on today?

A: Activists have played from the beginning of the epidemic a central role in reflecting a conscience for policymakers and for governments to understand their responsibility in orchestrating an effective response to this epidemic.

What I think is most needed today is for advocates to look at the larger picture of responsibility, i.e., who is responsible for the response, and to start to talk about it as a shared responsibility, not just dependent on any one country to model a response, but (about the US) playing an appropriate needed role as a world power, an economic power, a political power.

Also, the advocacy originally in the US was by those most impacted by the disease. There needs to be advocacy now coming from the infected and affected communities in countries where we’re most engaged.

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Although Administration officials have said PEPFAR would be the “cornerstone” of its Global Health Initiative, HIV advocates and experts are worried that PEPFAR and the Office of the U.S. Global AIDS Coordinator could actually have less visibility and authority under the GHI.

The Administration has not yet detailed what the GHI’s governance will look like, but there’s apparently some discussion about moving PEPFAR to USAID, instead of keeping at the State Department. Advocates worry this would be disruptive for a program that has been so successful, in part because of its streamlined, singular focus.

The Global Center and other groups sent a letter to Secretary of State Hillary Clinton today asking her to “preserve the autonomy” of PEPFAR by keeping at State and reporting to her.

“Subsuming OGAC and the administration of the PEPFAR program within a new GHI organizational structure could set back the Administration’s global agenda,” the letter states. “OGAC and PEPFAR’s success are a testimony to what streamlined processes and a nimble structure can accomplish.  Its programs are lauded around the world for making a difference while respecting countries’ autonomy.  We must not disrupt or undermine the program’s operation, including its important leadership and coordination role among the agencies that now implement programs, and within countries where continuity of leadership and funding sustains life-saving programs.”

Click here to read the full document. Letter to Sec Clinton re PEPFAR within GHI (2)

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