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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?

said Amianda. Her first two children – both girls – died before they were 18 months old. Amianda thought it was because of ‘chira,’ a kind of witchcraft or curse. She said chira had also killed her husband’s first wife.

“At that time I did not know I was HIV positive, only that my children were dying,” she said.

During her third pregnancy Amianda was offered an HIV test as part of her antenatal checkups. She discovered she was HIV positive and despite the initial shock was relieved to have an answer. “Although I was positive, there was care and drugs for people with HIV and, at last, I knew why my children were dying.”

Amianda is on anti-retroviral drugs, supplied by the Ministry of Health and dispersed at Siaya District Hospital. She recently took part in a CDC/KEMRI program run out of the new annex at Siaya to test the efficacy of mefloquine, an anti-malarial, on pregnant mothers.

“From the study I am able to handle malaria thanks to the bed net as well as the drugs,” said Amianda. “Also I have gotten a lot of health education. For example [I have learned] to breastfeed exclusively for the first six months rather than using mixed feeding. Now my child is not getting sick, in fact she is so big and I am so happy!” she said, squeezing Gift’s pudgy arms.

These stories — a woman who enters a drug trial and learns about breastfeeding; a young patient who gets fast, effective malaria diagnosis and treatment because of a new vaccine trial; including questions about maternal health in the next round of CDC’s regular household survey of disease — encapsulate the approach of GHI which seeks to treat the patient as a whole, not just as the expression of a set of symptoms relating to a single disease.

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Taken at face value when it was announced, Obama's GHI seemed to dwarf the signature global-health policy of his predecessor, George W. Bush, whose President’s Emergency Plan for AIDS Relief (PEPFAR) promised $15 billion over five years (underscoring the program’s success, in 2008 Congress authorized a further $48 billion for PEPFAR).

But while Obama’s topline figure for GHI was impressive, it was also misleading for two reasons. First, whereas PEPFAR’s money was new, GHI’s is mostly repackaged. Second, the precarious states of the world and the U.S. economy mean that the announced funding is in any case unlikely to be realized. Compounding GHI’s problems is political gridlock between Democrats and Republicans in Washington.

Yet in Kenya, officials are finding ways to put the principles of GHI into action without any extra money. “GHI in Kenya is more than anything else about repackaging and reprioritizing,” said Lee Brudvig, deputy chief of mission at the U.S. embassy in Nairobi.

“For many years, many of the elements of what is now GHI have been in place,” said Brudvig. “So it’s taking what we’re already doing [and] mapping it out more effectively… We need to eliminate duplication in our own agencies and fill the gaps through reprioritization of existing money,” said Brudvig.

Stephen Morrison, Director of the Global Health Center at Washington-based think tank the Center for Strategic and International Studies (CSIS), which has published two recent papers on GHI in Kenya, agrees with Brudvig and describes the country as “the boiler room” of the emerging GHI.

“[The Kenya team] were ahead of the game in their thinking and their operational plans,” said Morrison. It is here, Morrison says, that one should look to see how GHI can work in other countries.

The recently completed Kenya GHI strategy calls for a focus on reducing maternal, neonatal and child mortality, and reducing illness and death from neglected tropical diseases.

“When you ask what’s different after GHI, I would say it’s the focus on a broader range of health conditions that affect moms and children,” explained Lynn Adrian, Director of the Office of Population and Health at USAID in Nairobi.

“We were very focussed on HIV, which is still a very big component of our program, but GHI has allowed us to step back and ask, ‘What are the full range of health challenges in this country?’” she said.

GHI also seeks to strengthen Kenya’s own national-health system, integrate available services

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