Erin Hohlfelder: New global health reports leave us wanting more

The following post is by Erin Hohlfelder, ONE’s Policy Manager for Health, specializing in global health issues including infectious diseases and maternal and child health and originally appears on the ONE blog.

The Obama Administration released eight interim reports last week measuring results achieved in core elements of our US global health programs through the Global Health Initiative (GHI). For those of you keeping track at home since 2009 (I know you’re out there!) this is a long-awaited outcome for those of us looking to monitor the GHI’s progress since its announcement three years ago.

Nurse prepares the pneumococcal vaccine
A nurse prepares the pneumococcal vaccine, launched in Kenya by the GAVI Alliance, a US-supported global health program. Photo credit: Morgana Wingard/ ONE.

When the GHI launched, it represented an ambitious policy agenda on global health, seeking to integrate the US’ many disease-specific programs through a more unified approach on the ground. The idea was that better-integrating these programs would make them more straightforward for people trying to access health services and more cost-effective for the American taxpayer.

We applauded this announcement back in 2009 and praised the policy in 2010 when more details were released, including ambitious and results-based targets through which we could measure real progress. Yet by 2011 — in spite of what we understood to be much ongoing work in the field — many in the health advocacy community were frustrated by a lack of clarity and information, and we called for specific updates on GHI’s progress toward achieving the targets we had lauded.

With the release, we were excited to finally to sink our teeth into updated GHI data; with more than a year of anticipation, however, the first read of the data was a bit disappointing. While the targets on each of the 8 core areas were specific (ie: “Halve the burden of malaria for 450 million people, representing 70 percemt of the at-risk population in Africa” or “Reduce under-5 child mortality across assisted countries by 35 percent”), the data in the reports was a bit of a muddled mess.


In many cases, rather than tracking progress toward the target based on an outcome, GHI officials reported out on basic inputs, such as number of people protected by bed nets or number of countries introducing the rotavirus vaccine. So, while we can see through the reports that the US is indeed delivering more inputs through GHI, there is no serious attempt made in most of the reports to correlate those inputs to the outcome targets originally outlined. This is particularly striking in reports where a specific subset of countries was outlined in the target (ie: “Reduce maternal mortality by 30 percent across assisted countries”) and yet there is no effort to go country-by-country and report out on what the reductions have been — only a map to show us where those countries are.

There were also some instances where data was simply outdated or inconsistent. The AIDS progress report, for instance, uses 2010 global AIDS data and 2011 PEPFAR treatment figures, when newer (and more impressive) data is available for both. The AIDS, TB and malaria reports also make no reference to the US’ multilateral contributions to the Global Fund, to which the US is by far the largest donor and supporting additional outcomes, but the child health report does make reference to the US’ multilateral support for vaccines through the GAVI Alliance.

Finally, the reports jump back and forth between a reliance on global aggregate data and data for which the US can claim full credit; the authors acknowledge this, but the jumps make it difficult to make real comparisons between programs and to judge the US’ impact.

To their credit, the Administration prefaced the release by saying “The data is still preliminary inasmuch as our aim is to consult with key stakeholders, in and out of government, on improvements we can make to the methodology, format, and usability” and by acknowledging that the data set was imperfect but needed to be out for discussion. Also in their defense, the GHI and its targets were devised under the framework of $63 billion in overall funding, which we now know we will not come close to attaining. If anything, we should welcome this release as the starting point for real and meaningful dialogue with the Administration about what the GHI has achieved, how we should measure it and report on it moving forward, and what additional results we can attain with new resources in the years ahead. We look forward to continuing the conversation.