Why the Global Health Council folded, and what’s next

Twenty-twelve marks an important year for the Global Health Council — 40 years since it was founded. But instead of celebrating that milestone, GHC will shut its doors in the coming months and forgo its annual conference for the first time since 1973. The council’s announcement Friday, April 20, that it will cease operations leaves a vacuum in the global health community. Described as the professional association for groups involved with global health and the convener of the community, GHC members will be left without a neutral broker, inviting questions about what went wrong and what comes next. The simplest explanation for why the council is shutting its doors is money. GHC’s operations were largely funded by membership dues in the 1980s and ’90s, but the organization relied more heavily on grants over the last few years, including a three-year Bill & Melinda Gates Foundation grant that made up the majority of GHC’s budget. Changing priorities at the council and the Gates Foundation made it clear that the grant wouldn’t be renewed once it ended last year, insiders say. So to make up the shortfall, the council approached organizations like the Macarthur and Hewlett foundations as well as its own members for funding, according to Susan Higman, GHC’s director of research and analysis who became interim co-CEO last August. “We heard a lot of positive responses, but it was hard to have that translate into dollars,” Higman says. Initial donations would have been used to go ahead with the conference. Writing on the wall? Why the council ended up in such a desperate financial situation has to do with a leadership void after its former CEO and President Nils Daulaire left at the beginning of 2009, some industry experts suggest. Under his leadership, GHC helped groups work together with U.S. policymakers. His replacement could not replicate that success, says Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations. “Sadly, GHC could not survive [Daulaire’s] departure,” she says. Asked if he thought his successor mismanaged the organization, Daulaire points to Obama administration ethics rules, noting that his current role as director of the U.S. Department of Health and Human Services’ Office of Global Health precluded interacting with his former employer. “Looking after the business of keeping the GHC viable and sustainable was a 24-hour-a-day job when I was there,” he says. “I really can’t say what went wrong afterwards.” But Daulaire acknowledges the “loss of internal capacity” — due to management decisions — played a role in the council’s demise. He says after the membership staff was let go, it became increasingly difficult for GHC to focus on its bread and butter. Some in the global health community also say GHC suffered from a lack of focus in recent years. Between the conference, advocacy round tables and other efforts, the council might have been spread too thin. Daulaire readily admits there was some miscalculation while he ran the show, but he says that comes with the territory. “Any organization that is going to succeed is going to misfire,” he says, “but you have to learn and adjust quickly.” Jeffrey Sturchio, who succeeded Daulaire at the council and left in August 2011, and members of GHC’s board of directors did not respond to interview requests for this article. GHC, for its part, has pointed to the general shift from a “broad-based health agenda” toward disease-specific approaches as a reason for its shutdown. “The fundamental shifts in the health landscape have led the Board to revisit the relevance of the organization and determine that the Council’s current operating model is no longer sustainable,” the press release on its imminent closing reads. Higman, who joined GHC in 2007, acknowledges the council might not have done enough to adapt over the years. “Organizations can get locked into their own way of doing things,” she says. “To some extent, that happened with the council.” What next? But perhaps the biggest question in the aftermath of GHC’s announcement is what — if anything — will bring the community together like the council did. At this stage, the answer is elusive. Everyone consulted for this article was either unsure which group would assume this responsibility or suggested that a new group or a coalition needs to form. “It is not always easy to see the value of membership organizations — until they are gone,” says David Olson, who was the director of policy communications at the council until last August. Jack Chow, a U.S. ambassador on global AIDS during the Bush administration, suggests a group like GBCHealth or Friends of the Global Fight Against AIDS, Tuberculosis and Malaria might be in a good position to fill a broader convener role. The American Public Health Association’s international health section is also a contender. Just one day after the council’s announcement, there was discussion on the APHA IH listserver about obtaining GHC’s membership list, according to Kate Tulenko, deputy director of CapacityPlus. It’s a decent option, but APHA is a different beast, Tulenko notes. “One of the main challenges is that GHC had positioned itself as a global organization (hence the change form National Council on Internal Health to Global Health Council) whereas the APHA is obviously American,” she says. While that may still be a reasonable fit for some of GHC’s members, the fate of the council’s individual members is perhaps even murkier. “There is a great need for a place to mentor young global health specialists, especially those who may find themselves in institutions not wholly devoted to global health,” Tulenko says, adding that she encountered “wonderful” members when she first joined GHC as a young medical student in 1994. Higman said the council is “looking at some possible things and trying to figure out which organizations might be willing to pick up certain components of the council,” but would not name which groups have been approached.