Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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Nils Daulaire predicts the future of US global health programmes


Aids Alliance

Dr Nils Daulaire – until recently president and CEO of the Global Health Council – visited the Alliance secretariat in Brighton on 5 March.

The former senior advisor to the American government gave staff an insight into the global health priorities of Congress and the Obama administration, and shared his forecast of likely developments.

“Nils not only knows US policy very well but has through the Global Health Council contributed to shaping it,” said Alliance Executive Director Alvaro Bermejo, introducing Dr Daulaire’s presentation. “There is nobody better to explain where it's at, where it's going, how we can best engage and what it means for us.”

Dr Daulaire particularly highlighted the US government’s increased commitment to maternal and child health and family planning programmes. In this year’s budget, these programmes have been allocated increases of $50 million and $88 million respectively. He predicted a greater emphasis on sexual and reproductive health and rights, including the rights of women and freedom of choice.

While still rhetorical, there also seems to be a significant policy shift towards HIV prevention and harm reduction programmes. The geographic focus of the AIDS response is likely to remain on the most affected areas in sub-Saharan Africa.

America’s budget for global health this year is $7.1 billion – up nearly 10% from last year – of which $5.5 billion is for HIV/AIDS. Dr Daulaire explained that the AIDS budget includes more funding for operational research and evaluation, particularly of treatment programmes, which have undergone rapid expansion.

The Global Fund to Fight AIDS, TB and Malaria will receive $900 million in 2009. This increased commitment, which comes with continued scrutiny of impact, hints at stronger cooperation between the new administration and the Global Fund. Nevertheless, there remains cross party support for the US government to provide no more than one third of all contributions to the Fund.

Despite the economic downturn, Dr Daulaire expects the budget for global health to keep growing over the next three years. President Obama has proposed more money for 2010, which again will likely benefit maternal and child health and family planning programmes. Funding for the HIV response will probably stay much the same.

What will change is how the US government structures its foreign assistance. However, with many important political appointments yet to be made, Dr Daulaire agreed it was too early to predict how the Alliance and other US-supported organisations will be affected.