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HEALTH: U.S. Urged to Double Aid to Global Projects

Matthew Berger

WASHINGTON, Oct 29 2009 (IPS) - As the effort to achieve universal health coverage within the U.S. crawls forward in Washington, a new report by a coalition of global health organisations details how the U.S. can "help lead the world to universal access to comprehensive health care in developing countries".

Their recommendations, released Thursday, follow President Barack Obama's call earlier this year for a six-year, 63-billion-dollar global health initiative, the details of which are still being worked out and which the report's authors hope to influence.

"The Future of Global Health: Ingredients for a Bold & Effective U.S. Initiative" focuses especially on building upon the increases in funding begun under the George W. Bush administration and on new commitments to areas such as maternal, newborn and reproductive health as well as investing in the health workforce necessary to carry out these efforts.

These goals are "very much in the grasp of this administration, but require additional funding which in turn can leverage funding from other donors," said Asia Russell of Health GAP, one of the 25 organisations involved in the report, Thursday.

The report calls for doubling U.S. aid to global health projects from the current level of nearly eight billion dollars a year to 16 billion by 2011. It then foresees an annual increase leading to a six-year total investment of 95 billion dollars.

This is significantly higher than the president's proposed figure of 63 billion dollars, but, it says, 40 percent of the 32-billion-dollar difference would go toward ensuring there is a health workforce in place to properly carry out the programmes. This health workforce, says the report, "could make or break the effort".

In a conference call Thursday, Rep. Jim McDermott, a Washington Democrat, echoed this sentiment. "Part of the real problem is how to develop an effective workforce," he said, "because if you're going to deal with child and maternal welfare you're going to need physicians."

"You can't deliver tuberculosis treatment under the [World Health Organisation's recommended] directly observed therapy programme unless you have people to do that," McDermott said. "So I think one of the big questions is having a workforce."

Among the goals the report lays out as achievable and which it says U.S. efforts can ensure by 2014 are 35 million more births in facilities that can handle both normal and complicated births, quality prenatal care for 40 million more women, quality postnatal care for 35 million more women and newborns, and access to modern family planning for 10 million more couples.

The organisations would also like to see further developments in areas in which successful efforts have been over the past decade – HIV/AIDS, TB and malaria prevention.

While they say more needs to be done, they also point to success stories that illustrate just how effective U.S. leadership in global health can be.

In the Thursday teleconference, Dr. Peter Mugyenyi, director of Uganda's Joint Clinical Research Center, described his surprise upon entering the nearly empty rooms of a hospital that had, in the past, been full of children afflicted with malaria. He said he was told most children had been given bed nets.

"Every time the world has invested in health in poor settings, the results have come through," said Jeffrey Sachs, special advisor to the U.N. Secretary-General on the Millennium Development Goals and director of Columbia University's Earth Institute, Thursday.

Earlier this week, the Bill and Melinda Gates Foundation touted similar achievements in global health at a presentation in Washington. "Dollar for dollar, global health is America's best investment for saving lives," said Bill Gates. "U.S.-supported global health programmes are saving and improving the lives of millions of people, at a remarkably low cost."

U.S. spending on health programmes abroad has increased from 1.5 billion dollars in 2001 to 7.7 billion dollars this year, according to the Gates Foundation.

Yet it, too, sees this increase as only a starting point.

"We're not quite there yet, but were getting there and I think this report takes us another step toward those goals," said Sachs.

He believes that an investment of one-tenth of one percent of the "rich-world GDP" – the U.S. and other relatively wealthy nations – would create a total fund of around 40 billion dollars that could save tens of millions of lives every year.

"We've gone from one cent per hundred dollars to three cents and we need to get to 10 cents," Sachs said. "We've gotten about one-third of where we need to be in terms of global health in the poorest places in the world."

The report also sees this investment as not only for the benefit of peoples' health but also for national and global security.

"This is an initiative which is very much in line with the values of the American people, with increasing global health and stabilising very unstable parts of the world," noted Sachs.

McDermott pointed out this is "not a partisan issue. People recognise that global health is really in the U.S.'s best interest and is the humane thing to do."

As only six years remain to reach the Millennium Development Goals, a set of eight poverty-reducing objectives agreed to at the U.N. in 2001, the report also says a U.S. global health initiative should ensure the country contributes its "fair share" to reaching the four health-related goals.

Since the Obama announced the initiative in May, the U.S. contributed 75 million dollars to the Global Alliance for Vaccines and Immunisation – the largest contribution in its history.

Additionally, the Lantos-Hyde U.S. Global Leadership Against AIDS, TB and Malaria Reauthorization Act was passed in February 2008 to provide roughly 54 billion dollars over five for AIDS, malaria and TB programmes.

In addition to these commitments, the report's authors call for not only a new emphasis on maternal, reproductive and child health but more attention for 14 neglected tropical diseases, including sleeping sickness and the parasite-caused leishmaniasis and chagas.

"The administration needs to step up efforts in areas that have not yet been the focus," said Sachs. "So far there has been a lot of focus on AIDS, malaria, immunisation through GAVI and some on tropical diseases, but there has been little funding to keep mothers healthy in childbirth or newborns alive."

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