Bono Made Bill Frist Cry, too! – 2008 Elections and Child Survival

In homage to a paper I wrote on the Jubilee 2000 campaign, a colleague of mine sent me this article in the Times about Bill Frist, the former Tennessee Senator and ex Repub majority leader, who is leading a new initiative to seek more U.S. funding for child survival. Frist, as you know, is a trained medical doctor and has long been interested in global public health. He and Jesse Helms were champions of greater U.S. action on AIDS. Frist had a pretty good reputation on these issues until he squandered his political capital by demagoguing on Terri Schiavo. But I digress….

The other interesting part of the story is how the Gates Foundation is financing a major effort in 2008 to put these issues on the agenda and how activists are seeking to broaden global public health advocacy to focus on child survival. The Gates Foundation gave $22mn to the One Campaign, with Frist and former North Dakota Senator Tom Daschle on board as the co-chairs of the One Vote ’08 initiative.

Quoted in the piece is Charles MacCormack, head of Save the Children, who said: “The children and mothers who die are in huts beyond the end of pathways with no direct access to political or media leaders,” Mr. MacCormack said. “We need people who can walk into prime ministers’ and presidents’ offices.

MacCormack was a participant in a recent conference I went to in Aspen, Colorado. It was the so-called Brookings Blum Roundtable on new actors in development. Given the opulence and lifestyle of Aspen, it was something of a surreal experience to give this paper with people like George Soros and Al Gore as participants. Nonetheless, it was great to see such an influential body concerned about developing countries, even if people had quite different views on what should be done. See here an Economist profile on two African businessmen, Mo Ibrahim and Sam Jonah, who participated in the conference. There was heavy if not exclusive emphasis on Africa, and these guys represented a new face of African commerce, very optimistic about the possibilities for Western investors.Thinking back to advocacy efforts to get the candidates thinking about global public health and other issues, I think activists have been savvy to focus on child survival. I mean who can be against that? Here is what they want…

Having left the Senate only in January, Mr. Frist is not yet allowed to lobby members of Congress to support the Global Child Survival Act, a bill introduced this year that would sharply increase spending on the problem. But the One Campaign has mobilized. More than 150,000 of its supporters have written letters to members of Congress, encouraging them to vote for the bill, which has sponsors from both parties.

The measure proposes increasing the budget of the United States Agency for International Development for child and maternal health to $600 million next year and $1.6 billion by 2011, from $356 million this year.

The amounts being considered in the appropriations process are much lower. The Bush administration proposed $345 million. The House version of the bill countered with $374 million, while the Senate bill offered $450 million.

In the paper I presented in Aspen, I was not as nearly sanguine about the possibilities for sustained increases in funding for development. I worry that there is not nearly enough investment in health systems and governance and that activists have been so focused on the quantity of aid that there has not been sufficient discussion of its quality.

Development advocates need to think about whether just getting more money for aid and for AIDS should be their main focus. Donors have embarked upon a multi-billion dollar open-ended commitment to anti-retroviral therapy for AIDS sufferers. Unless countries both come to prevent HIV and build broader health systems, the experiment could run aground if local capacity remains lacking and if donor money ever runs dry. There is a recognition that project-based development is broken, and donors have not had great success improving governance in weak and failing states. The Millennium Challenge Account has been an experiment in this direction, but it has not been sufficiently funded, despite strong advocacy by groups like DATA. The U.S. and other governments do not have adequate tools in their toolkit for institution-building. The main U.S. development agency, USAID, is under-funded, perceived in some quarters to be ineffective, and increasingly has had its mandate taken away by other institutions.

I think the new child survival initiative is good, but I hope the money also supports health systems and not just us saving children now at the expense of developing countries be able to save their own children in the future.

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