President Obama's FY2013 Budget Request Leaves Global Health Goals in Doubt

GHC Senior Policy Manager Craig Moscetti breaks down the President’s global health budget numbers

President Obama released his Fiscal Year 2013 budget request yesterday, showing an essential flat-line in international affairs funding, but a $300 million cut to U.S. global health programs, a 4% decrease from levels enacted last year. Most global health issues were requested at levels 3-5% lower than FY2012 enacted levels, though several accounts received much deeper cuts, notably bilateral funding for HIV/AIDS and neglected tropical diseases. There were exceptions, including a continued emphasis to support women and girls through family planning and reproductive health, which received a modest 1.1% increase. 

A closer look at the numbers reveals potentially dramatic implications for how the U.S. approaches global health specifically and aid effectiveness generally. The President, including in the GHI, has embraced a much stronger multilateral approach to foreign affairs. Within the GHI, this means a commitment to supporting partnerships like the Global Fund and GAVI. To achieve multi-year pledge to both – which are both positive steps from an aid effectiveness perspective – the FY2013 request includes significant increases for both – the Global Fund received a 27% increase from FY2012 levels, and 12% for GAVI.

The concerning part is a possible classic instance of robbing Peter to pay Paul. In the case of the Global Fund, the offset appears to come from bilateral HIV/AIDS funding. But does this move fail to recognize the complementary elements of U.S. bilateral HIV/AIDS programs and the Global Fund? The Global Fund and GAVI are recognized as two of the most efficient and effective global health institutions, but will this type of significant resource shift effect the balance between Global Fund and PEPFAR in the field?

In stepping back, however, the largest concern is with progression towards stated goals of the GHI, particularly the funding goal. Despite assurances that the President’s budget request supports a comprehensive approach to global health, funding for the Global Health Initiative is severely lagging behind its stated funding goal of $63 billion between FY2009 and FY2013. This year’s request still leaves a $20 billion gap for the GHI heading into its final year. Many in the global health community support the Administration’s strong embrace of efficiency and innovation, but will the huge funding gap prove too great to overcome for the Administration to achieve its stated global health goals?