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President Obama's ambitious Global Health Initiative — announced to a receptive international community in 2009 — is faltering as budget constraints and shaky implementation limit the impact of the multibillion-dollar program.

In Kenya, a glimpse into GHI's future

GHI's strategy isn't new to Kenya, but will it help?

SIAYA, Kenya — The only hospital here lies a short way off the only tarmac highway — a collection of single-story buildings spread out amongst the trees and carefully trimmed lawns. Waiting patients chatter, small babies cry.

Just behind this well-kept but gently aging hospital is a slick, new building attached by a covered walkway.

Opened earlier this year, the building is a clinical research center of the Centers for Disease Control and Prevention (CDC), a US government agency that works with the Kenya Medical Research Institute (KEMRI) to find vaccines, cures and treatments for the tropical and other diseases – HIV/AIDS, malaria, typhoid, tuberculosis, cholera – that are endemic in this part of the world.

The building and the work that goes on in it, in the adjacent hospital and in the surrounding community, represents the future of US engagement with health problems worldwide, a new kind of cut-price integration as envisioned in President Obama’s Global Health Initiative (GHI).

GHI was announced in May 2009 with a little fanfare and a big figure: $63 billion over six years to be spent on improving the health and saving the lives of the world’s poorest and most vulnerable people. Now, amid budget constraints in Washington, analysts predict that this number is likely to be to significantly reduced to no more than $52 billion for GHI over the six years.

In the urban and rural clinics of Kenya, where US government agencies CDC, USAID, Peace Corps, Department of Defence and PEPFAR are working, GHI has not meant much change.

“A lot of what GHI [is] all about was not new to Kenya,” said Katherine Perry, Kenya’s PEPFAR coordinator and GHI planning lead.

That’s because, unlike other countries, Kenya was already doing the things GHI aimed to do before the initiative was announced, using huge sums of HIV/AIDS money to treat broader health issues.

Because Kenya has employed GHI’s more holistic strategy for global health since before it was codified into policy, observers believe Kenya can stand as a model for everything GHI intends to accomplish. It offers a glimpse into the future of the Obama administration’s ambitious initiative. But lingering questions remain. Most pointedly, whether Kenya can find a way to build upon the solid base the country already has.

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The Siaya research center's computer lab, full of brand new high-tech machines, seem incongruous with the rural setting — close to Lake Victoria in the western corner of Kenya. Right now, the focus is on testing a potential malaria vaccine – GlaxoSmithKline Biologicals’ RTS,S.

The lab tests blood cultures and cerebrospinal fluid. Its technicians are qualified in malaria microscopy and microbiology. Results from the vaccine trial are sent directly to GSK via the Internet-connected computers upstairs.

This kind of clinical trial is core to CDC activities but has knock-on benefits for the rest of the hospital and its patients.

“The facilities were upgraded as a result of the clinical trial,” said Dr. Frank Odhiambo, who works with KEMRI/CDC in western Kenya. “All 32 beds in the pediatric ward have nets, and there is malaria microscopy available for all the kids.”

The new equipment is not just for test subjects but every sick child who is admitted to the hospital. “Nowadays you can’t tell a study subject from an ordinary patient,” added Mary Owidhi, a health worker at the hospital.

In the nearby city of Kisumu, there is also a CDC clinical-research center, but it was built some years ago. While this center, like the one in Siaya, is located within the hospital grounds, it is separated from the rest of the facilities by a wire fence. It is in the hospital but not really part of it, and so stands as a metaphor for the changing approach of U.S. agencies working in Kenya.

“Here in Siaya, the research center includes general patient support. It includes a male circumcision room run by the Ministry of Health. The facilities are there for all patients. It is really an extension, an annex, of the existing hospital,” said Odhiambo.

Joyce Amianda, a 36-year-old nursery school teacher and mother, lives a short distance from the hospital with her husband and two daughters. Amianda is HIV positive. Gift, her chubby-faced six-month-old, is HIV negative.

“I have given birth four times but I only have two children,”

http://www.globalpost.com/dispatch/news/health/110916/kenya-ghi-future-pepfar-aids