Moderator Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, began a session on Sunday at the 2010 Aspen Ideas Festival by asking how a decade of momentum for global health improvement could be sustained in the face of the economic downturn and what is seen by some as waning financial commitment from donor nations. Nigel Crisp, an independent crossbench member of the U.K.’s House of Lords, Ezekiel Emanuel, a senior White House advisor on health, and Francis Omaswa, founder and executive director of the African Center for Global Health and Social Transformation, participated in the discussion.

Omaswa said he’s never been as hopeful about global health as he is today. A medical doctor who has served in Uganda’s health ministry, Omaswa asserted, “Unless we strengthen governments in our own countries to be better stewards of money, we will not get very far.” He also called on donor nations to listen more to developing countries’ needs and said foreign aid should support civil society and governing capacity to instill accountability and build up country ownership of health programs.

Omaswa also noted that donor funding streams and models can sometimes unintentionally tear down functional health initiatives already existing in recipient nations.

Emanuel discussed the key components of President Barack Obama’s Global Health Initiative (GHI), including the need for metrics, monitoring and evaluation to assess if a program is “making a dent in improving health.” He also noted that only looking at the amount of money spent “is not the way to measure a program.” Other key elements of the GHI, according to Emanuel, include focusing on women and children, coordination of care, country ownership and building up health systems.

Both Emanuel and Omaswa addressed reports from Uganda that the U.S. has reduced antiretroviral (ARV) funding for HIV/AIDS patients. Emanuel said, “We are not cutting back contrary to the charges. You can have your own opinions, but not your own facts.” Emanuel added that there has been an overall increase in funding from the U.S. as PEPFAR expands treatment to 50,000 people a month. Emanuel also discussed building on PEPFAR’s successes and improving efficiencies. “PEPFAR produced an excellent supply chain. Why just antiretrovirals? If the supply chain is working, let’s maximize it,” he said.

Omaswa noted the effect that WHO’s most recent guidelines on ARV treatment initiation will have on access as more people meet the treatment criteria. “The AIDS ARV situation is extremely complicated,” Omaswa said.

The panel also discussed ways to address the global health worker shortage, including with more targeted training based on a country’s needs. The voluntary code for health worker migration adopted at the World Health Assembly in May was also applauded.

Crisp, who used to lead Britain’s National Health Service, said health worker migration is a contributing factor to major shortages in the developing world. But, he explained, that Africa needs 1.5 million health care workers, “so even if every African [now working abroad] went home, you’d be dealing with maybe 10 to 15 percent of the problem.”

“The biggest thing we can do in richer countries is support the training of health workers in Africa as long as it is the right kind of training,” Crisp added. He also emphasized that local countries know what is needed in their health care systems and that training should not just be for doctors and nurses, but also technical health care workers.

Crisp asserted that “even developed country health care systems are in crisis” and reminded the audience that “global health is not foreigners’ health” because of the world’s interdependence.

Reproductive Health, Foreign Aid Efficiency, Food Security

Peggy Clark, executive director of global health and development at the Aspen Institute, moderated a panel discussion on Friday about the state of global reproductive health efforts with New York Times columnist Nicholas Kristof, Global Fund for Women President and CEO Kavita Ramdas and former UNICEF Executive Director Ann Veneman. Among other issues, the panelists examined the economic benefits of improving women’s health, as well as the relationship between women’s health and child survival; controversies over abortion and family planning; successful maternal and child health initiatives in various countries, including Rwanda, Mozambique and South Africa; and how reproductive health will figure in to Obama’s GHI.

Clark also moderated a discussion Friday with the heads of three major organizations providing health care in the developing world: International Medical Corps President and CEO Nancy Aossey, Doctors Without Borders-USA Executive Director Sophie Delaunay and Mercy Corps CEO Neal Keny-Guyer. The three discussed their opinions on how well funding mechanisms and foreign aid work on the ground as well as the GHI’s efforts to better coordinate the care of different diseases.

A panel moderated on Saturday by journalist Michael Specter featured a discussion about the challenges of meeting global food demand with Jason Clay, senior vice president of market transformation at the World Wildlife Fund, Hugh Grant, president, chairman and CEO of Monsanto and Howard-Yana Shapiro, global director of plant science and external research at Mars, Inc. Panelists addressed genetically modified organisms; how to help improve crop efficiencies, especially for poor farmers; and how governments, NGOs and corporations can collaborate.

Additional sessions included International AIDS Vaccine Initiative President and CEO Seth Berkley, PATH President and CEO Chris Elias, and Global Health Council President and CEO Jeffrey Sturchio, who discussed the future of vaccines. Founder and Director of the Global Viral Forecasting Initiative Nathan Wolfe, Elias and Veneman participated in a panel about some of the most important threats to global health. Global health expert Lyndon Haviland moderated both of these discussions. Video or audio of all the sessions will be made available on the Aspen Ideas Festival website (Balderas, 7/12).

Kaiser Video Interviews Available

Kaiser Daily Global Health Policy Report Managing Editor Jill Braden Balderas conducted a series of interviews with global health leaders attending the conference: Nigel Crisp, member of the U.K. Parliament’s House of Lords; Sophie Delaunay, executive director of Doctors Without Borders-USA; Hugh Grant, chairman, president and CEO of Monsanto Company; Francis Omaswa, executive director and founder of the African Center for Global Health and Social Transformation; Kavita Ramdas, president and CEO of the Global Fund for Women; and Ann Veneman, former executive director of UNICEF which are now available online.