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The U.S. Global Health Initiative (GHI) represents the Obama administration’s new strategy for international development assistance in health. With a pledge of $63 billion over six years, GHI aims to fund PEPFAR and a set of broader global health issues (e.g., maternal and child health, nutrition, and neglected tropical diseases). GHI is also being framed as “smart power” whereby health would serve as a critical tool for U.S. foreign policy.

However, as the U.S. enters a period of severe budgetary restraint and as domestic crises rise to the fore, the promise of global health reform could become illusory. The lack of coordination and coherence in the U.S. global health architecture, as well as the broader U.S. foreign assistance system, require fundamental changes in the U.S. approach to global health going forward. This article analyzes current weaknesses in the GHI strategy and makes four key suggestions for the transformation of the U.S. global health enterprise under GHI. These suggestions include: (1) the devotion of resources that are predictable, sustainable, and scalable to needs; (2) the development of a true “whole of government” approach; (3) greater collaboration with international partners for success; and (4) the encouragement of host country ownership.


Publication Citation

304 JAMA 789-790 (2010)