Over the next few weeks, appropriators will be engaged in the challenging task of evaluating U.S. foreign assistance funding, including how effectively Congress’ global health investments are being used.
As organizations funded in part by the U.S government to implement global health programs in the field, we agree that every effort should be made to ensure that funding is used efficiently and distributed in a timely manner. But we also see firsthand how U.S. global health programs are working, and why now is not the time to cut multilateral and bilateral funding for these efforts.
Congress’ decadelong investment in improving global health has been more successful than most of us in this field could have ever imagined. Millions of people are alive today because of signature multilateral programs such as the GAVI Alliance and the Global Fund to Fight AIDS, Tuberculosis, and Malaria and U.S.-led bilateral initiatives including the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, and assistance for tuberculosis and maternal and child health. This success has taken place in parts of the world where progress once seemed unlikely, and often within health systems once thought to be beyond repair.
In regions where little hope existed just 10 years ago, U.S. global health funding has paved the way for dramatic gains against HIV/AIDS, tuberculosis, malaria and maternal and child mortality — and has transformed the lives of millions in the process.
More than 3.3 million HIV-positive adults and children are receiving life-saving antiretroviral medication — including 1.3 million HIV-positive pregnant women receiving services to prevent transmission of HIV to their babies — raising for the first time the possibility of an AIDS-free generation. The U.S. and its partners have distributed millions of antimalarial treatments and insecticide-treated mosquito nets, contributing to a 50 percent reduction in reported malaria cases from 2000 to 2010. TB infection and mortality rates worldwide are falling, and U.S. investments in maternal and child health programs have dramatically increased pediatric immunization rates and decreased maternal and child mortality. Deaths in children under the age of 5 have dropped from more than 12 million in 1990 to 7.6 million in 2011.
And while these numbers are impressive, it is the innumerable personal stories of hope and survival that we encounter every day that show us the real effect of this investment.
Unfortunately, tough economic realities and questions about funding pipelines could result in drastic cuts to many of the programs directly responsible for this success. As global health implementers working on the ground, we believe that our work is most effective when both multilateral and bilateral HIV, TB, malaria and maternal and child health programs have strong financial support and work in conjunction with each other.
Bilateral funding has enabled programs to quickly move to scale, and they have been designed to allow the United States to monitor the use of these funds and see dollar-for-dollar the effect of U.S. investment in health outcomes. Multilateral funding complements bilateral funding by leveraging investments by other donors, helping build country-level commitment and strengthening capacity to deliver programs.
Working together, these bilateral and multilateral disease-specific funding mechanisms and programs have reached millions with life-saving services. In Ethiopia, the U.S. Agency for International Development helped train the health workers who deliver GAVI Alliance vaccines to children in hard-to-reach areas. In Lesotho, PEPFAR is expanding access to services that prevent mother-to-child transmission of HIV using antiretroviral drugs purchased with Global Fund dollars. PMI, which fills in when Global Fund disbursements are delayed or disrupted, helped six countries fill emergency gaps in malaria commodities in 2010 alone.
The United States is able to do more with less because of the strengths of these partnerships. These funding mechanisms enable America to focus on what it does best — finding and implementing innovative approaches to delivering care to those who otherwise would not be reached. U.S. programs have also prioritized the strengthening of national health systems, ensuring that over time countries will be able to sustain and ultimately take ownership of efforts to prevent and treat these devastating diseases.
Funding streams have their strengths and weaknesses, but the United States is committed to implementing global health programs in the most effective and efficient way possible, and we are proud partners in this effort.
While these programs encompass a variety of health issues and approaches, they all share the same over-arching mission: saving the lives of as many people as possible. The impact of multilateral and bilateral global health investments has been nothing less than transformational, and they deserve continued strong Congressional support.
Charles Lyons is president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation. Molly Joel Coye is interim president and CEO of PATH. Carolyn Miles is president and CEO of Save the Children. Richard Stearns is president of World Vision.