An Argument Against the Obama Global Health Initiative

A new article in the journal AIDS argues against the Obama Global Health Initiative. The authors make the argument that the AIDS epidemic has a substantial impact on health systems, and that PEPFAR and support for HIV/AIDS care supports the health sector in general. They point out that “In Southern Africa, where HIV prevalence is the highest worldwide, HIV-related diseases monopolize more than half of all hospital beds.

Cutting support for AIDS, they argue damages health systems.  Health funding should not pit one health issue against another. And HIV is huge factor in general health, “In the five countries with the highest adult HIV prevalence worldwide, HIV is the single leading cause of underfive mortality and responsible for 41–56% of deaths.”  They also discuss the impact of HIV on health sector workers. 40% of midwives in Zambia, for example, are HIV positive. So is 16% of South Africa’s healthcare workforce.

Therefore, they posit, “that HIV/AIDS Global Health Initiatives (GHIs) such as PEPFAR can advance and

synergistically reinforce MCH and the overall healthcare infrastructure of the recipient country… Funding from PEPFAR has revitalized health facilities, increased the availability of qualified healthcare personnel, and enabled the expansion of ancillary support services such as pharmacies and diagnostic laboratories.”

I remain unconvinced. It’s a powerful article and it makes some good points. And I certainly agree that integrated health system support is the best way forward on global health. I still don’t believe, though, that PEPFAR is the best way to provide that support. Their final conclusion, though, is one that I can totally get behind. They make a “more pie” argument: we need more funding for global health, so we can stop pitting one health condition against another.