Is the GHI Dead, or Is This a Wake up Call?

President Barack Obama and Republican presidential candidate and former Massachusetts Gov. Mitt Romney participate in the sec
President Barack Obama and Republican presidential candidate and former Massachusetts Gov. Mitt Romney participate in the second presidential debate at Hofstra University in Hempstead, N.Y., Tuesday, Oct. 16, 2012. (AP Photo/Charles Dharapak)

Global health has been absent from the debates so far. It needs to make an appearance in the third at final debate, because we're about to sacrifice the opportunity to make a difference for women in the name of politics.

The United States doesn't think about global health the way it did four years ago. Today, there is an understanding that clinics, hospitals, and health programs cannot address one health issue without tackling others. There is a greater appreciation for communities defining their own health needs and solutions. There is a recognition that the barriers to services that women and girls face are grounded in inequality and must be confronted vigorously in order to improve global health. This reframing of the U.S. approach to global health is a game changer. Unfortunately, this frame may lose definition or vanish over the next four years, and that's not something we can afford.

In July, news circulated quickly that the Global Health Initiative (GHI) office at the Department of State was closing and a new Office of Global Health Diplomacy would take its place. The agency heads that oversee U.S. global health programs -- Raj Shah, USAID; Eric Goosby, OGAC; Thomas Frieden, CDC -- joined in a statement with Lois Quam, executive director of the GHI, declaring that the three agencies will be responsible for ensuring that the GHI principles are implemented in the field to achieve global health goals.

A focus on the GHI principles--especially principles of health sector integration, equal rights for women and girls, country ownership, and health systems strengthening--is indeed necessary to ensure US global health programs are effective. The principles are the most important piece of GHI, and what has given global health advocates optimism since it was launched in 2009.

Now on the heels of a global family planning summit, the International AIDS Conference, and a UN report on commodities to save women's lives, there is hope for increased investments in family planning, more tools available to prevent and treat HIV, and increased political commitment to prevent maternal deaths. The GHI principles are more important than ever. We're armed with science and evidence, now we have to address the social drivers of maternal mortality and HIV -- gender inequality, weak health systems, poverty, and discrimination -- to ensure the science has a chance to show us what it can do. That's where the principles come in.

Although progress has been made in GHI's implementation, as our studies based on interviews in Guatemala and Ethiopia have shown, the full vision of a comprehensive approach to global health through GHI principles has not yet come to fruition. Yet the principles clearly resonate with government officials, individuals and organizations overseas we've met and worked with who are dedicated to building healthier communities where rights are guaranteed.

Their enthusiasm contrasts sharply with some who have already accepted the death of GHI. But to call something dead in Washington can be a self-fulfilling prophecy, and does no good for women, men and youth in countries that would benefit from efficient and effective programs funded by the U.S. government.

While the administration claims that it is holding on to these principles, it is in fact putting the principles at risk by shuttering the GHI. In the final months of this administration's first term, what will be done to ensure the principles stick? Who will be held accountable (and how) to making sure this new vision of our global health strategy is actually carried out?

Right now, it appears no one is accountable and there is legitimate concern that the promise of a comprehensive approach to global health may be lost.

The administration raised expectations by announcing something so bold and so important. And the first try didn't entirely work. But this second try is doomed before it begins unless leaders come up with a new and lasting vision to make sure we do not go backwards. If administration officials truly believe that these principles are the best way to save lives, they need to show they're willing to give a real second effort -- and not by occasionally referring to the principles while going back to business as usual. No matter what happens in November, we still expect the administration to keep the vision and promulgate the principles in the field. But the question will need to be answered, who is accountable for keeping GHI's promise alive?