Strategy Shifts on Global Health. 1/2/10

HIV/AIDS Remains Priority, but New Emphasis Is Planned for Tropical Diseases and Efficient Care

1 February 2010
By Betsy Mckay

The Obama administration is expected to propose in its fiscal 2011 budget Monday new funding to combat preventable and tropical diseases, malnutrition and other conditions afflicting the world's poor, as part of a strategy to broaden its approach to global health.

The new policy, details of which the administration plans to release along with the budget, retains HIV/AIDS as the administration's top funding priority, but will devote new funding to reducing deaths from complications related to pregnancy or childbirth, poor nutrition and common treatable illnesses that kill millions every year, particularly women and children, according to people familiar with the new plan.

The strategy also seeks to work more closely with individual countries to help strengthen their own health-care systems, and to integrate programs that are now focused on individual diseases. The hope is to make care more efficient and easy, so that, for example, a woman doesn't have to go to one clinic for AIDS treatment, another for prenatal care, and still another for her young child's care, people familiar with the plan say.

Improving health systems has taken on new urgency in the aftermath of the earthquake in Haiti, where thousands may have died because of a lack of adequate hospital care, and women and children are now at particular risk of disease, global health experts say.

The details of the new plan will fill in a pledge by President Barack Obama in May to request $63 billion between 2009 and 2014, including $51 billion to combat HIV/AIDS and malaria, and $12 billion for other priorities, including maternal and child health.

While the bulk of funding will go toward HIV/AIDS, AIDS advocates are concerned the administration is scaling back an aggressive initiative launched by President George W. Bush in 2003. Funding for HIV/AIDS programs is still rising, but the increase has slowed. Mr. Obama's fiscal 2010 budget requested a $165 million increase in funding for the President's Emergency Plan for AIDS Relief, or Pepfar, the program established by Mr. Bush. The government committed nearly $19 billion for the program between 2004 and 2008, and it had enrolled about 2.4 million people into drug therapy by the end of last year.

Advocates said they would be watching closely on Monday for details of the new plan. A broader global health strategy is "great, but not at the expense of AIDS spending," said Paul Zeitz, executive director of the Global AIDS Alliance.

Administration officials declined to discuss specific funding requests before Monday's release of the proposed budget. But they stressed that HIV/AIDS remained the cornerstone of the administration's global health strategy, and said the new plan wasn't meant to trade one priority off against another. Further reducing deaths from AIDS, malaria and tuberculosis will require strengthening health systems in individual countries, they say, giving them greater capacity to fight these killer diseases.

"This isn't a trade-off; this is a holistic view of health," said a senior administration official, calling it "absolutely consistent with building and strengthening the Pepfar program."

Preventing mother-to-child transmission of HIV will be an important part of the new policy's focus on maternal and child health, for example; approximately 60% of those infected with HIV in sub-Saharan Africa are women, the official noted.

Some global health experts praised the new attention the U.S. is devoting to maternal and child health. Focusing on the health needs of mothers and children will improve health systems overall, they say. "It's not something you can do on a campaign basis, like polio," said Nils Daulaire, professor of global health at the University of Washington, who was president and chief executive of the Global Health Council and a senior official in the Clinton administration. "You've got to have an operating, capable health system open 24 hours a day, seven days a week."

Among initiatives targeted for increased funding are family planning, to prevent some of the 52 million unintended pregnancies each year, and the reduction or elimination of tropical diseases such as lymphatic filariasis, a parasitic disease that affects more than 120 million people world-wide, and onchocerciasis, or river blindness.

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