Global Health Initiatives

Global Health Initiatives (GHIs) are humanitarian initiatives that raise and disburse additional funds for infectious diseases– such as AIDS, tuberculosis, and malaria– for immunization and for strengthening health systems in developing countries. GHIs classify a type of global initiative, which is defined as an organized effort integrating the involvement of organizations, individuals, and stakeholders around the world to address a global issue (i.e.: climate change, human rights, etc.). Global Health Initiatives (GHIs) are humanitarian initiatives that raise and disburse additional funds for infectious diseases– such as AIDS, tuberculosis, and malaria– for immunization and for strengthening health systems in developing countries. GHIs classify a type of global initiative, which is defined as an organized effort integrating the involvement of organizations, individuals, and stakeholders around the world to address a global issue (i.e.: climate change, human rights, etc.). Examples of GHIs are the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the World Bank's Multi-country AIDS Programme (MAP), all of which focus on HIV/AIDS. The Gavi (formerly the GAVI Alliance) focuses on immunization, particularly with respect to child survival. In terms of their institutional structure, GHIs have little in common with each other. In terms of their function – specifically their ability to raise and disburse funds, provide resources and coordinate and/or implement disease control in multiple countries – GHIs share some common ground, even if the mechanisms through which each of these functions is performed are different. PEPFAR - an initiative established in 2003 by the Bush Administration - and PEPFAR II (PEPFAR’s successor in 2009 under the Obama Administration) are bilateral agreements between the United States and a recipient of its development aid for HIV/AIDS – typically an international non-government organisation INGO or a recipient country’s government. The Global Fund, established in 2002, and the GAVI Alliance, launched in 2000, are public-private partnerships that raise and disburse funds to treat AIDS, Tuberculosis and Malaria, and for immunization and vaccines. The World Bank is an International financial institution. It is the largest source of funding for HIV/AIDS within the United Nations system and has a portfolio of HIV/AIDS programmes dating back to 1989. In 2000, the Bank launched the first phase of its response to HIV/AIDS in Sub-Saharan Africa – the Multi-Country AIDS Program (MAP). This came to an end in 2006 when a second phase – Agenda for Action 2007-11 – came into effect. Tracking funding from GHIs poses challenges. However, it is possible to determine the amounts of funding GHIs commit and disburse from sources such as the OECD CRS online database, as well as data provided by individual GHIs (Figure 1). Since 1989, the World Bank has committed approximately US$4.2bn in loans and credits for programs, and has disbursed US$3.1bn. Of this total, the Bank's MAP has committed US$1.9bn since 2000. Through bilateral contributions to HIV/AIDS and Tuberculosis programmes and donations to the Global Fund, PEPFAR has donated approximately US$25.6bn since 2003. In July 2008, the U.S Senate re-authorised a further US$48 bn over five years for PEPFAR II, of which US$6.7bn has been requested for FY 2010. During the period 2001-2010, donors have pledged US$21.1bn to the Global Fund, of which US$15.8bn has been paid by donors to the Fund. Gavi has approved US$3.7bn for the period 2000-2015 The amount of political priority given to Global Health Initiatives varies between national and international governing powers. Though evidence shows that there exists an inequity between resource allocation for initiatives concerning issues such as child immunization, HIV/AIDS, and family planning in comparison to initiatives for high-burden disorders such as malnutrition and pneumonia, the source of this variance is unknown due to lack of systematic research pertaining to this subject. Global political priority is defined as the extent to which national and international political leaders address an issue of international concern through support in the forms of human capital, technology, and/or finances in order to aid efforts to resolve the problem. Global political priority is demonstrated through national and international leaders expressing sustained concern both privately and publicly, political systems and organizations enacting policies to help alleviate the issue, and national and international agencies providing resource levels that reflect the severity of the given crisis. The amount of attention a given global initiative receives is considerably dependent on the power and authority of actors connected to the issue, the power and impact of ideas defining and describing the issue, the power of political contexts framing the environments in which the actors operate to address the issue, as well as the weight and power of issue characteristics indicating the severity of the issue (i.e.: statistical indicators, severity metrics, efficacy of proposed interventions, etc.). Factors including objective measurability, scalability of the issue and proposed interventions, ability to track and monitor progress, risk of perceived harm, as well as simplicity and affordability of proposed solutions all contribute to the degree to which a given global initiative is likely to receive political attention. However, case studies have shown that the likelihood of global initiatives garnering public and political attention is not limited to the aforementioned factors. For example, initiatives concerning polio eradication continue to receive substantial resources in spite of the relatively small global burden of disease as compared to chronic diseases such as cancer, cardiovascular disorders, diabetes, and some communicable diseases such as pneumonia which comparatively attract fewer worldwide resources irrespective of the high morbidity and mortality rates associated with such diseases. These cases highlight the need for extensive research methods and evaluative measures to assess the relative causal weights of factors used to determine how global political priority is attributed to global health initiatives. Existing debates also attribute factors such as the increasing influences of economic globalization, international organizations, and economic actors with little to no previous health remit as each contributing to the evolution of global health governance.