The Boston Globe examines the U.S. strategy towards global health aid. “President George W. Bush scored major advances in his administration’s worldwide campaign against AIDS,” and “[t]he Obama administration believes it can leverage Bush’s successes into an assault against a much broader array of diseases that afflict poor countries,” writes the Globe.

Last month Obama pledged a total of $63 billion over six years for global health projects that he said would maintain current HIV/AIDS, malaria and tuberculosis campaigns, “while increasing and enhancing” U.S. efforts “to combat diseases that claim the lives of 26,000 children each day.” The Boston Globe reports that Obama’s plan “would still fall well short of the Institute of Medicine’s recommendation last month of an increase to $15 billion a year for global health aid alone. The budget is just one source of the frustration among those agitating for Obama and Secretary of State Hillary Rodham Clinton to take ambitious steps.”

According to Jack Lew, deputy secretary of state, the U.S. can use the health delivery systems it has built for more than 3 million HIV-positive people to treat pregnant women and children with other, often fatal, medical problems. Lew said, “It’s not glamorous to treat diarrheal diseases in small children, but we know it saves a lot of lives,” adding, “If you’ve got somebody who’s coming into a facility that treats mothers with antiretroviral drugs, you’ve already got the capacity to treat their children. … If the capacity is there, it ought to be relatively easy to expand the scope of services provided.”

The Globe reports that an audit conducted for Sen. Richard Lugar (R-Ind.) asserted that in some countries with very active PEPFAR programs “doctors and nurses are being drawn into HIV/AIDS care ‘at the expense of primary and maternal health, [leading to] the unintended consequence of weakening a country’s overall health infrastructure.'” According to the Globe, a Council on Foreign Relations study recently found that U.S. foreign aid “programs continue to operate through legislated stovepipes, putting resources and cash into efforts, regardless of – and often in opposition to – the primary needs on the ground in recipient countries. . . . All too often, foreign assistance increases dependency, and aims at the wrong targets.”

The newspaper writes that almost “everyone agrees on the need to revitalize USAID,” which has seen a good deal of privatization and outsourcing over the years, and more development programs that have been “shifted to other departments, notably the Pentagon. … In 2006, USAID was effectively folded into the State Department.” Senate Foreign Relations Committee Chair John Kerry (D-Mass.) said recently of U.S. foreign aid, “We need a more balanced approach, and a comprehensive development strategy to determine which agency is in charge, what we hope to achieve, and how best to accomplish our goals.”

Lew said the administration recognizes that the need for improved coordination and planning for U.S. foreign assistance. He said, “We’re taking the view that even with the current structure, and assuming you didn’t change any of the laws, there’s an enormous coordination of programs that ought to be happening at country level, where we really ought to see our ambassadors as true chiefs of mission, not just in title, but as CEOs who have the ability to look across all the programs and manage more effectively.”

Maurice Middleberg, a policy analyst at the Global Health Council in Washington, said, “I’m not sure the ambassador is the right person.” Middleberg said there should be “a loud and clear voice for development” and that there should be an arm’s-length relationship between the State Department and global development.  

Oxfam America President Raymond Offenheiser, said, “There’s a lot of confusion in Washington at this point.” He added, “We see Secretary [of State Hillary] Clinton making speeches, and very compelling speeches, about the importance of effective development, of building civilian capacity and supporting rural development in many regions of the world, and the importance of poverty alleviation. The problem is we just haven’t seen that translated into specific commitments” (Smith, Boston Globe, 6/14).