Posts Tagged ‘global health aid’

The Global Gag Rule, a harmful human rights violation

March 12, 2017

The Global Gag Rule (GGR) is harmful to women and families and violates human rights. Originally known as the “Mexico City Policy” because it was enacted by Ronald Reagan in 1984 at a conference in Mexico City, the policy is more commonly known as the Global Gag Rule because of how it silences NGOs and health care workers. Specifically, the original policy dictated that no USAID family planning funds could be awarded to organizations that performed or promoted abortion and therefore prohibited them from even speaking about abortion.

The GGR is highly partisan- every Democrat president since Reagan has rescinded the policy and every Republican has reinstated it. The current administration, however, has not only reinstated the GGR but has dramatically expanded the funds that are affected.

Reagan’s version applied to USAID family planning funds; G.W. Bush’s version limited the GGR by exempting USAID HIV/AIDs related work. The latest iteration, however, greatly expands the affected funds to cover all foreign aid arising from any agency or department. The current version restricts up to $9.5 billion in aid, or 16x the amount of funds that would have been affected by previous versions.

Worse yet, beyond being a clear example of religious overreach in US politics and a violation of human rights, evidence suggests that the policy reduces sex education and contraception use while increasing both abortions and the proportion of abortions that result in health complications- maternal, family, and child health all suffer. There is a large coalition of organizations that oppose the GGR. You can take action today by learning more information about the GGR and volunteering or donating to organizations like IPPF, PAI, and the Bill and Melinda Gates Foundation who, together with UN member countries, are attempting to counteract the extreme funding deficit.


Investing in Essential Surgery: An emergency(care) public health issue

March 4, 2015

Uganda, like many other African countries, has been growing rapidly. With this growth has come an even greater increase in the number of motor vehicles. Every year thousands of Ugandan’s die as a result trauma, most commonly from motor vehicle crashes. Unfortunately for Ugandans, studies show that an individual is more than 4 times as likely to die from trauma on their streets, than that of the streets of the United States, putting an immense burden of injury on the people and accounting for a quarter of the deaths at the largest hospital in the city. Surgery is an important aspect of injury care, however as the burden of injuries grows Uganda is actually losing surgeons to countries abroad with better salaries and resources.

Surgery is Global Health

Surgery is Global Health

In many ways, trauma represents a very visible and acute example of how surgery can be used for public health, however other surgeries, such as hernia repair, birth defect repair, or obstetric surgeries are equally deserving of attention. The recent launch of the 3rd edition of the Disease Control Priorities (DCP-3) Volume 1 suggests that in today’s world access to surgical services save an estimated 1.5 million deaths per year (1 million of them due to trauma) and some of the interventions have been shown to be as cost-effective as vaccination.

Several years ago, surgery was famously described as the “neglected step-child” of global health by Dr. Paul Farmer of Mountains Beyond Mountains fame and Dr. Jim Kim, now director of the World Bank. Interest among trainees in the US and academic surgery has never been higher with special commissions in the Lancet and NGO organizations, such as Surgeons OverSeas (SOS) investing in data driven research and advocating the public health benefits. Advocacy has gone on through film, such as The Right to Heal (trailer below) or through lobbying members of United States Congress. It’s clear, global access to surgery is needed, however funding remains auspiciously absent as global funders such as The Bill and Melinda Gates Foundation or USAID largely avoid surgical programs.

A generation of global surgeon’s-in-training waits, ready and willing to invest their time and considerable abilities into partnership with colleagues in low and middle-income countries to discover novel and cost-effective ways to prevent deaths, but without the support of funders their passion cannot be harnessed. Thousands and thousands more healthy and productive members of society, like those in Kampala, will die unnecessarily or live with life altering disease and conditions which could be addressed had they been lucky enough to have been born in a developed country. Surgery is essential to primary public health in low and middle income countries, it’s time we invest in it.

Sign a petition to WHO and Global Health Leaders to include Essential Surgery

U.S. Government: Invest in health systems

August 14, 2014

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.

Are global health leaders in Uganda effectively strengthening local public health systems?

October 23, 2013

Global health leadership in Uganda is linked with the provision of billions of dollars via large-scale global health aid NGOs.  Generally, most of this aid is distributed into vertical programs, focusing on specific diseases.


The Baylor College of Medicine-Bristol-Myers Squibb-Texas Children’s Hospital-Children’s Clinical Centre of Excellence at Mulago Hospital, Kampala, funded by PEPFAR

 As well as their specific goals, most of the NGOs explicitly incorporate health system strengthening into their objectives. But are they doing enough to ensure that the rhetoric becomes reality? It is difficult to be convinced of the contrary, when one observes the disparities between the provision of high-quality care to patients enrolled in NGO-funded programs, to that which members of the same community receive in the public health system.

ImagePublic health system-funded ward at Mulago

A roughly two-fold situation may exist: NGOs may not be effectively strengthening local public health systems as well as they might; in addition there may exist some potentially adverse (while inadvertent) consequences of vertical programs on public health systems.

 Clearly, strategies to ensure Ugandan health system strengthening must be a collaborative effort between donor and recipient. The 2008 NGO Code of Conduct for Health System Strengthening was created to serve as a guide for NGOs working to limit their harmful effects and maximize their contributions to strengthening public health systems. In addition to this, the Ugandan Ministry of Health has launched the Uganda Health System Strengthening Project, a government initiative set out to assist the country achieve the Uganda National Minimum Health Care Package, with a focus on maternal health, newborn care and family planning.

 While applauding the undeniable progress made by vertical programs funded by today’s global health leaders, in the future we must strive to build on these efforts while ensuring true health system strengthening and ‘Health for all’.