U.S. Government: Invest in health systems


Health Center in Tigray, Ethiopia (taken by Anne Batchelder)

Health Center in Tigray, Ethiopia (taken by Anne Batchelder)

In Fiscal Year (FY) 2001, the United States Government (USG) contributed $1.7 billion in global health funding.  By FY 2010, global health funding had ballooned to five times the FY01 investment, while the funding has remained nearly constant for the last four years, as shown in Figure 1.  Global health spending, appropriated by Congress, is designated by health element.  Over 50% of funding is earmarked for HIV/AIDS, as shown in Figure 2.  (Both of these figure are from the Kaiser Family Foundation).  Over the years, Congress has passed many bills, from authorizing the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003 to the President’s Malaria Initiative (PMI) in 2005, and increased the money appropriated for particular elements.

Global Health Funding, FY 2001 – FY 2014

Global Health Budget Request by Sector, FY2014

As shown above, HIV/AIDS funding is the majority of health funding. In 2014, the President’s budget request represented a 3% decrease in HIV funding and HIV Advocates at the AIDS Healthcare Foundation, claimed that “Never before has a President sought to actually reduce America’s commitment to fighting the AIDS epidemic globally.” On the other hand, the ONE Campaign applauded Obama’s budget proposal, “for keeping America at the forefront of the global fight against HIV/AIDS and other preventable diseases. We applaud his 2014 budget request for $1.65 billion for the Global Fund to Fight AIDS, TB and Malaria.”

While increases in health funding have enabled government agencies like USAID, USG partners, and their implementing partners to increase the impact of their health investments, many organizations are advocating for more strategic investment in global health.  Organizations like NEPAD, IHP+, and the Center for Global Development have advocated for investments in health systems.  USG investments that incorporate health systems will ensure that HIV/AIDS spending makes each dollar invested reaches more people infected or impacted by HIV/AIDS.

As the Washington Post reported, the recent African Leaders Summit in Washington, DC demonstrated that budgets will not continue to grow at the rate that they have in the past.  Therefore, investments in health need to be more strategic and focus on sustainable investments in health systems.


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