Last week, the Obama administration scrapped plans to shift one of its signature aid programs, the Global Health Initiative, to the U.S. Agency for International Development, opting instead to anchor it more firmly in the State Department.
The aid community’s reactions have been mixed: Some appear to have accepted the official line that it would be easier for the top U.S. diplomat to secure funding than the top U.S. aid official. Others snicker at the mere mention of GHI, arguing it hasn’t produced real changes on the ground. Many, however, are wondering what the soon-to-be created Office of Global Health Diplomacy would mean for the aid community. Here’s what a few experts say could happen:
Possibly, not much: In an October op-ed, Nandini Oomman and Rachel Silverman said GHI leadership does not entail budget or decision-making authority since there are three unique agencies that comprise the initiative. “Essentially, the GHI leadership as we see it holds a vague mandate to ‘coordinate’ the GHI agencies,” they wrote. But these authors foretold that moving GHI to the State Department could create a “public relations nightmare” for the latter, which would have to do damage control, and for USAID, which would lose some credibility.
This could take a while: The soon-to-exist Office of Global Health Diplomacy — set to lead the initiative from its perch within the State Department — begins without staff and leadership. Appointing these people, and approving the statute of the office itself takes time and Congressional approval, as Laurie Garrett pointed out in a comprehensive blog post.
This won’t hurt a bit: “If I’m going to be optimistic, I would say this could be beneficial for the issue of health in poor countries,” Family Care International President Ann Starrs told Science Speaks, adding that making global health a core diplomatic issue with developing countries “would have an important impact in terms of political commitment to this issue.” Putting global health more concretely in the hands of the diplomatic representatives around the world might mean less bureaucracy and meetings and a more productive interface that produces better information, GHI Executive Director Lois Quam has argued. And elevating global health to a key U.S. diplomatic concern could help the initiative achieve its goals in a way it simply wasn’t able to before.
This is disappointing and worrying: The Office of Global Health Diplomacy, Center for Global Development’s Director of Global Health Policy Amanda Glassman says, represents a lack of political will in addressing agency fragmentation. The “diplomatization of U.S. global health” is worrying, Glassman notes, because the State Department will not always be led by someone interested in advancing global health issues.
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