The man who led President George W. Bush’s extraordinary international effort to combat the AIDS epidemic thinks it’s time for a new approach — a comprehensive, evidence-based approach that no longer singles out HIV/AIDS but instead treats it as one of many health needs in the developing world.
The Global Health Fund. Or maybe, World Wellness Fund.
Dr. Mark Dybul, the physician who oversaw PEPFAR (the President’s Emergency Plan for AIDS Relief), believes the international community’s response to the health problems of the developing world suffers from paternalism, turf battles and mission fragmentation. Dybul, who spoke at the University of Washington on Wednesday, said this is partly due to our tendency to focus on “disease-specific” projects based on the patronizing attitude that poor countries can only handle simple health interventions. He said it’s time to move toward a much grander vision aimed at creating a single international funding mechanism that would coordinate a comprehensive effort aimed at improving health overall.
This sounds great, except for the fact that PEPFAR was created by the Bush Administration in 2003 with a single-minded focus on fighting AIDS at about the same time the international community launched the Global Fund to Fight AIDS, Tuberculosis and Malaria GFATM. Dybul contended that this was a good and necessary thing to do at the time – set up two similarly purposed global funds – but that we are now at a stage where it makes more sense to bring all these efforts under one roof.
Good luck with that. As Dybul noted, development and international assistance is often structured to serve the donor country’s political motivations and interests. PEPFAR was redundant to the Global Fund and often criticized for some of its controversial policies — supporting abstinence-only sex education programs and often funding U.S. charitable organizations rather than providing the funds directly to developing country governments or domestic non-profits. Congressional re-authorization of PEPFAR in 2008 made it a $48 billion, five-year assistance program that now includes tuberculosis and malaria. Hmmm, that sounds like another fund I know.
Dybul is probably correct that it would be more efficient and successful for the international community to combine resources and work together to improve the overall health of poor countries. But it sounds odd coming from a man who led a program that, though laudable and perhaps the most significant (positive) thing done by Bush while in office, was also an example of the problem he now seeks to solve.