U.S. Global Health Initiative

The U.S. Global Health Initiative

Introduced by President Obama in 2009, the U.S. Global Health Initiative (GHI) is an overarching approach to U.S. global health policy that seeks to strengthen, streamline, and increase the efficiency of existing U.S. global health programs, including HIV/AIDS, maternal and child health, family planning, and neglected tropical diseases.

How the GHI Works

The GHI does not create new health programs that require additional funding. Rather,  it provides a guiding framework for existing U.S. global health programs to increase efficiency and effectiveness. The GHI is often associated with a total of $63 billion over six years, which is a reference to all of the existing funding and annually-requested funding increases for individual global health programs. For example, malaria programs and the President’s Emergency Plan for AIDS Relief (PEPFAR) account for 81 percent of the $63 billion, with the remaining 19 percent going to other global health priorities.

In FY 2012, the fourth year in the GHI’s timeline, cumulative funding has reached $35 billion, or 56 percent.

Why the GHI Matters

The GHI recognizes that sexual and reproductive health issues, including HIV/AIDS, maternal health, and family planning, are all interconnected, and that the health needs of women and girls are particularly urgent. Given that HIV was responsible for more than 60,000 maternal deaths in 2009, and is the leading cause of death for women of reproductive age, integrating services with a focus on women’s needs is both relevant and necessary.

See CHANGE's fact sheet Sexual and Reproductive Health and Rights and the U.S. Global Health Initiative

Major Principles of the GHI

When the Obama administration officials outlined the GHI, they delineated seven guiding principles. Three of these are particularly critical for advancing sexual and reproductive health: the focus on women, girls, and gender equality; country ownership; and integration of health sectors.

Integration of Health Sectors

A pregnant woman living in poverty is likely confronting multiple issues at once. She requires good prenatal care and nutrition throughout her pregnancy, and access to a skilled provider to educate her about healthy childbirth and attend her delivery. She may also already be infected or at high-risk of becoming infected with HIV. Her rights need to be respected in terms of pregnancy decisions, and in terms of HIV testing and treatment. If she wishes to postpone or stop childbearing following the pregnancy, she needs access to voluntary family planning services from a provider who respects her rights and listens to her concerns. Logic and evidence strongly suggest that this woman is much more likely to receive the care she needs when these services are offered in a single location or through seamless referral, and are grounded in respect for her human rights.

While women differ in the kinds of services they need at any given time, integrated sexual and reproductive health care is fundamental for preserving the wellbeing of all women and girls.

See CHANGE's Policy Brief The U.S. Global Health Initiative and Sexual and Reproductive Health and Rights: Integration

Woman- and Girl-Centered Approach

A woman- and girl-centered approach recognizes and addresses the disparate health needs and life circumstances of women and addresses them accordingly. It does not ignore or diminish the health needs of men and boys; rather it addresses the specific health risks women and girls face, along with the obstacles to health care access imposed by gender inequality. 

Creating an environment in which women can reach the highest attainable standards of physical and mental health will require the GHI to not only provide basic health services, but to recognize and address the economic, cultural, social, and legal barriers for women and girls accessing those services. This will require paying attention to gender inequality, violence against women, and the human rights violations that stoke the flames of disease and poor health.

A woman-centered approach is particularly critical in creating an AIDS-free generation, a stated goal of the Obama administration. Women now account for more than half of the world’s population living with HIV—we have to address their specific needs if we are going to make any progress against the HIV pandemic.

See CHANGE's policy brief, A Woman-Centered Approach to the U.S. Global Health Initiative

Country Ownership

“Country ownership” is a term that those working in the field of international development use to describe the idea that recipients of international aid should be involved in decision making about how aid is spent. It has been broadly recognized as a critical element of sustainable development because it ensures that multiple stakeholders within a country are invested in outcomes. GHI strategy documents emphasize that country ownership is not just alignment with recipient government plans and priorities, but includes engagement of civil society as well. The GHI Supplemental Guidance on Women, Girls and Gender Equality emphasizes the importance of consulting women’s and human rights groups in program design, implementation, and monitoring and evaluation.

Developing meaningful country ownership is tremendously complex given the many diverse opinions and priorities within any society. As elaborated in GHI documents, country ownership should:

  • Generate consultation with diverse sectors of recipient countries so that they are invested in the outcomes of global health programs
  • Not be merely a government-to-government relationship; to ensure sustainability, local civil society must be given the power to debate, shape, and monitor implementation
  • Include consultation, not just information sharing
  • Proceed rapidly and strategically, with careful deliberation and an eye to long-term sustainability

GHI Accountability

CHANGE is monitoring the GHI’s implementation to support adherence to the principles outlined above and advancement of the sexual and reproductive health and rights (SRHR) of women and girls. The input of civil society and the perspectives of those most affected by U.S. programs are absolutely essential to this monitoring process.

CHANGE recruited two organizations in Guatemala, Nigeria, and Ethiopia to form a “GHI Accountability Corps,” that are assisting in monitoring the implementation of GHI in these countries. The Corps members observe and report on any changes in how U.S. agencies operate in country as a result of the GHI, in terms of gender approach, attention to adolescent SRHR, incorporation of civil society input, integration of HIV/family planning/maternal health, and attention to marginalized groups/human rights. The assessment reports in this section examine the progress of the GHI in each country to date.

Progress Reports:

GHI Implementation and Sexual and Reprodutive Health in Ethiopia: A Progress Report

GHI Implementation and Sexual and Reproductive Health in Guatemala: A Progress Report

Additional resources:
THE WOMEN, GIRLS, AND GENDER EQUALITY PRINCIPLE OF THE U.S. GLOBAL HEALTH INITIATIVE (GHI): ASSESSMENT OF THE GHI PLUS COUNTRY STRATEGIES (The Henry J. Kaiser Family Foundation)