What Trump’s ‘Groundhog Budget’ Reminds Us About Global Health Trends

by Karl Hofmann, President & CEO, PSI

The Trump Administration’s just-released 2019 budget blueprint was depressingly similar to its 2018 offering.  It’s Groundhog Day all over again.

President Trump stuck his head up, cast a budget shadow, and the US Government budget has to endure six more weeks of winter.

Surprisingly, the 2019 proposal contains some relative improvements over 2018.  For example, rather than zeroing out support for international family planning and unilaterally ending America’s leading role in helping women and families plan the families they desire, Trump this year proposed over $300 million for this account.  It’s less than half what the Obama Administration and previous budgets approved – but I guess we can take this “half a loaf” gesture as progress.  Sort of.

Thankfully, like last year, I expect the bipartisan consensus in the US Congress which is largely in favor of US global engagement, including US investments in global health, to prevail.  The 2019 Trump budget is again “dead on arrival” on Capitol Hill.

The deeper reality remains what last year’s Trump budget gave us:  a wake-up call.

Here are three Trump-era trends we shouldn’t ignore.

1. The global South will cover more of its health expenditures; the North and global institutions will cover less.

It’s time to plan for a future where global health spending comes from a wider variety of sources, including where appropriate from consumers themselves, and from domestic resources raised by host governments for global health programs.  The traditional bilateral funders will be less important in the future.

U.S. Agency for International Development (USAID) Administrator Mark Green recently said, “I believe the purpose of foreign assistance should be ending its need to exist.” Similarly, the new head of the UK’s DFID, Penny Mordaunt, recently argued for developing countries to do more to fund their own health priorities. “I want the governments of developing countries to step up and take responsibility for investing in their own people, in healthcare or education, for example,” she said. “If it chooses not to, that will inform our decisions.”

Together, the two largest bilateral aid agencies are pushing to accelerate global health toward a self-reliance model – one where developing countries have more skin in the game and make substantial investments to wean themselves off aid.

The health consumer in developing countries will receive less subsidy and will cover more of her own health needs.  Fortunately, in many parts of the global South, her financial outlook is getting better.

2. We better listen to youth when thinking about their contraceptive needs.

The largest cohort of young humans ever are entering their reproductive ages and making health choices that will shape their lives, their families’ lives – and all our lives.  We had better be creative about how to meet this new demand, and old recipes may not suffice.  The stakes are high for all of us.

Even as we cheer sustained investments in “family planning,” it’s time to recognize that term is severely limiting for the people we are trying to reach.  Young people everywhere are more interested in contraception that’s relevant and accessible, rather than family planning in a clinic setting.

Furthermore, as note to President Groundhog, contraception is just about the most cost-effective global health investment if we aim to save women, give kids a healthier start, reduce abortions, and grow the productive workforce.  Let’s hope spring comes soon.  Enough of the short-sighted budget winter for the small but mighty global health accounts.

3. New technologies can effectively put more care and control directly in health consumers’ hands, even in the least developed parts of the world – but regulatory and funding hurdles need to be overcome.

The introduction to HIV self-testing in many countries in Africa is helping people learn their HIV status in a way that works for them: on their own, with access to information and referrals.  Much as home pregnancy tests put more information directly in the hands of women, HIV self-testing can help millions more know their status faster, but regulatory obstacles remain in many countries.  Self-administered long-acting contraception through tools such as Pfizer’s Sayana ® Press could help unblock access to this vital and women-powered therapy, but funding gaps and administrative obstacles persist.  If new diagnostic and therapeutic technologies, plus access to online information and referrals, are to have the positive disruptive effect they promise on universal health coverage, we need to get out of their way.