Global health becomes more deeply anchored in US State Department

Eric Goosby has been chosen to head the U.S. Department of State’s new Office of Global Health Diplomacy in an important step to get the office off the ground. But the announcement had some global health experts concerned over its implication on the future of U.S. global health programs.

The appointment will be on top of Goosby’s role as U.S. global AIDS coordinator, through which he oversees the U.S. President’s Emergency Plan for AIDS Relief. He will be joined at the global health diplomacy office by former Ambassador Leslie Rowe, who will be in charge of daily operations.

A number of experts, including the heads of the Joint U.N. Program on HIV/AIDS and health organization Population Services International, commended the appointment given Goosby’s experience and record with PEPFAR, which disburses a huge chunk of U.S. global health funds. Goosby, PSI President and CEO Karl Hofmann told Devex, provides a welcome “steady hand” particularly in the expected transition between secretaries of state.

But some experts are nonetheless concerned that Goosby might soon find himself overstretched as he oversees two high-level offices. His appointment has also prompted some of the same questions raised when the U.S. government first unveiled plans to create the global health diplomacy office, which from the start had drawn criticism for essentially ending plans to shift U.S. global health programs to the U.S. Agency for International Development.

Foremost among global health experts’ questions are: Why are Goosby’s powers concentrated within the State Department and what does this mean for USAID global health programs?

Laurie Garrett, provided some insight when she took to Twitter Dec. 15 shortly after Goosby’s new assignment was announced. The creation of the office and Goosby’s appointment suggest other agencies initially involved in the Global Health Initiative — USAID, the Centers for Disease Control and Prevention and the President’s Malaria Initiative — are being pushed to the background, the expert said on the popular social media channel. It also seems ties between health and development are being diminished “just when the trend is opposite on the ground,” she added.

For implementers and nongovernmental organizations, meanwhile, Garrett said a potential implication could be confusion over how to operate. Do NGOs approach ambassadors or go through Washington first, she asked of the “confusing and evolving” process.

Most members of the international development community are, in general, concerned over how more power over U.S. global health efforts and other foreign aid areas is shifting to the Department of State. Their view is that USAID should still take the lead.

Three key functions

Goosby did offer some clarification on the role of his new office in a blog post released shortly after his appointment: “providing diplomatic support in implementing the Global Health Initiative’s principles and goals.”

The ambassador named three specific functions:

• Support U.S. ambassadors on the ground by providing the expertise and tools they need to work effectively with partner country officials on pertinent health issues.

• Strengthen the sustainability of health programs by building local capacity and political will.

• Foster shared responsibility by helping improve coordination among donors, private sectors, multilateral institutions and other stakeholders, with partner country officials taking the lead.

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