The Lancet examines the history of the Obama administration’s attempt to “reform the way the country delivers development assistance for health abroad” by establishing the Global Health Initiative (GHI). “Despite unusual bipartisan support in Congress and broad consensus among development practitioners about the goals of reform, it proved surprisingly difficult for the multiple entities involved in U.S. global health assistance to agree on a way forward,” the journal states, noting that GHI leadership and the three core entities of GHI — USAID, the Centers for Disease Control and Prevention (CDC) and PEPFAR — announced the closure of the GHI office and an end to the initiative’s current phase on July 3. The Lancet outlines several challenges the initiative faced, including collaboration among the three agencies, leadership, and external factors, such as “the austere budgetary climate.”

“Many observers credit [GHI] with beginning a larger conversation among development staff about sustainability, country-ownership, and outcomes-based evaluation — while acknowledging that those concepts are hardly new,” the Lancet writes, adding, “GHI also recognized the central role ambassadors play in deploying U.S. health assistance, although many have been doing so for some time.” The journal continues, “Even as the GHI office disbands, its staff say the initiative will go on: the GHI principles will persist, the core entities will continue to meet, and plans are underway for a new Office of Global Health Diplomacy at the State Department to support ambassadorial leadership in the field. … But the next administration will have to take bolder steps if it is to fulfill the goals GHI articulated, and to establish the U.S. as a true leader in global health” (Alcorn, 10/6).