On March 10, the Senate Foreign Relations Committee held a hearing, “Building on Success: New Directions in Global Health.”
Chair John Kerry (D-MA) touted the work of comprehensive HIV/AIDS legislation (P.L. 108-25) that established PEPFAR [the President’s Emergency Plan for AIDS Relief]. “Today, thanks to these programs, over 2.4 million people are receiving life-saving treatment and nearly 350,000 babies of HIV-positive mothers have been born HIV-free. That’s not enough but it does represent a remarkable achievement.” Sen. Kerry added, “The Global Health Initiative has rightly identified several core principles that should guide our thinking: A holistic approach leads us to focus on the women and girls who are at the center of each family’s health, but are too often marginalized by their economies and health systems. This includes taking on maternal mortality, which robs families of half a million young mothers every year.”
“Before the program [PEPFAR] began in 2003, only 50,000 people in all of sub-Saharan Africa were receiving life-saving anti-retroviral drugs,” said Ranking Member Richard Lugar (R-IN). “Today, ten times that many are being treated in South Africa alone.” Sen. Lugar also noted that “the U.S. government must do more to ensure that its own global health dollars are being spent effectively. Although PEPFAR has been an unqualified success, we need to continue to seek greater efficiencies in this program and other global health efforts. In particular, we should improve coordination among agencies working on international health programs. The State Department, [U.S. Agency for International Development], [National Institutes of Health], [Centers for Disease Control and Prevention], and the Defense Department all have critical expertise and capabilities that are being applied to global health. We need to ensure that these agencies are talking to one another, adopting best practices throughout our government, and avoiding duplication in activities.”
After expressing his strong support of the Global Health Initiative, Bill Clinton, former president and chair of the William J. Clinton Foundation, outlined several recommendations to further improve global health. President Clinton said that the United States needs to do more to accelerate the reduction of prices for commodities, such as drugs, lab tests, and equipment. He also lauded the creation of UNITAID a program that began as a tax on French overseas airline tickets and expanded to include more than a dozen countries that make voluntary contributions to fund global health projects in more than 90 countries and reminded the committee that this program can provide another source of global health funding worldwide. Citing the statistic that “20 percent of the problems are in Africa, but only three percent of the medical personnel are,” President Clinton also recommended lowering non-commodity costs by better managing the training of nurses and health professionals, and urged support for “moving from dependency aid to empowerment aid.”
Among his other recommendations, President Clinton added, “Prevention is really still the key. If you look at the Caribbean where we started our AIDS work, [in] the last two years there have been zero mother-to-child transmissions in the Bahamas, the wealthiest country in the Caribbean, which had a substantial AIDS problem when we started. Zero. But we’re still reaching nowhere near the number of pregnant women who are HIV-positive with the medication that is 98 percent-plus effective.” He noted that vaccinations and clean water also are critical prevention strategies. Finally, the president urged the committee to examine ways to “reduce the overhead of foreign assistance programs.” He indicated that many of the restrictions Congress places on foreign aid dollars reduce the amount of aid available to spend in the recipient countries.
Bill Gates, co-chair of the Bill and Melinda Gates Foundation, discussed the Gates Foundation’s “Family Health” efforts, saying, “We know that healthy mothers mean healthier children. More than 500,000 mothers die each year in childbirth, most of preventable causes. When a mother dies, she leaves behind a newborn and usually several older children who have lost their primary caretaker. A mother’s death destabilizes the family, causing a chain reaction that affects everything from her surviving children’s health to their prospects for education and ultimately breaking the cycle of extreme poverty…Investments in family health are highly cost effective, especially when we make it easier for women and children to access information and multiple health services in an integrated setting. Up to 72 percent of deaths in the first month of life could be prevented through delivery of packages of proven interventions during pregnancy, childbirth and the postnatal period, in households, communities, and in primary care and referral level facilities in low and middle income countries. Some of the interventions are scientifically innovative; others have existed for decades but have never before been applied systematically and to scale. Some key interventions that could be taken to scale include: Fortifying foods with key vitamins and minerals like zinc and iodine, one of the most cost-effective interventions as it can reach individuals for fewer than 25 cents per person per year…Promoting breastfeeding, starting immediately after birth and continuing as the sole food for the first six months of life, then transitioning to feeding appropriate foods in addition to breast milk, to boost a child’s immunity, prevent the uptake of pathogens and ensure healthy nutrition…Promoting a comprehensive package of interventions for mothers and newborns, including: discouraging a mother from washing a baby right after she is born, which can induce hypothermia and introduce an abrasion, and then an infection, through the skin; encouraging ‘kangaroo mother care,’ which allows a baby to benefit from his mother’s warmth until she is strong enough to maintain her own body temperature, while also promoting breastfeeding and prevention of infection; and providing two very inexpensive drugs to prevent postpartum bleeding so a mother doesn’t hemorrhage during childbirth…[and] Training community-based health workers and skilled birth attendants who can help ensure that women in the most rural and remote areas receive prenatal care, accurate information about best practices in newborn care, assistance in delivering their babies safely and hygienically, and advice on care seeking for illness.”
On the issue of family planning, Mr. Gates said, “Another powerful and cost-effective intervention that could have a dramatic effect on everything from maternal and child health to HIV prevention is providing access to voluntary family planning. An estimated 215 million women would like to determine the number and spacing of their children but lack sufficient access to family planning. Integrating family planning into other services would cost $1.20 per year per capita and could have a dramatic effect on lives saved. A recent study by the Guttmacher Institute found that combining maternal and neonatal health interventions with access to family planning services could cut maternal deaths by 70 percent saving the lives of 390,000 mothers every year. Incorporating family planning services into programs aimed at preventing mother-to-child-transmission of HIV (PMTCT) would prevent twice the number of child HIV infections and three times the number of child deaths than PMTCT programs alone. In fact, between 1999 and 2006, access to family planning services helped prevent more than 10 times the number of HIV-infected pediatric cases in sub-Saharan Africa than did the provision of antiretroviral drugs to pregnant mothers. I know that for some lawmakers, family planning is a controversial issue. The question of whether and how the U.S. should help increase access to voluntary family planning for those who seek it remains difficult for many lawmakers. As you wrestle with this question, I urge you to remember that voluntary family planning is a proven and cost-effective way to save lives.”
Also with regard to family planning, Sen. Jeanne Shaheen, (D-NH), a member of the Commission on Smart Global Health Policy, asked how Congress could “move the debate beyond this topic being controversial to being another way to accomplish what we need, to deliver health care to people around the world.” President Clinton responded by saying, “As Bill [Gates] said, they can do a better job as mothers, earn income for the family and that changes everything for them. See it, see how it works in real people’s lives. I think that would change things.” Mr. Gates added that birth spacing of two years between children dramatically reduces the chances of maternal complications.
