WASHINGTON, DC —In mid-June 2010, the Obama administration named its first eight Global Health Initiative focus countries. It called them the “GHI Plus” countries and gave them special designation and attention, promising that they would “receive additional technical and management resources to quickly implement GHI’s approach.”

GlobalPost’s Special Report Healing the World and this blog have been dedicated to assessing the eight “GHI Plus” countries with on-the-ground reporting and have found many challenges ahead for the Obama administration as it seeks to implement the ambitious initiative over the last year.

Now the GHI 8 has become the GHI 29. 

The administration quietly conducted a second round of selections, naming 21 countries and reviewing detailed plans from each on main strategies and goals, according to US officials. By the end of this year, that list is expected to grow again to include a third round of an additional 13 countries. And GlobalPost will continue its reporting on GHI as it broadens its reach and its scope.

Unlike the US President’s Emergency Plan for AIDS Relief – or PEPFAR, the ambitious US global AIDS program, which remained focused on 15 countries for several years -- GHI’s plan from the start was to spread its principles of better integration of programs and expanding into new health areas as quickly as possible.

“We didn’t want to start too big on round one, and we wanted to have the teams to think through what they wanted to do,” said Katherine “Kemy” Monahan, GHI’s deputy executive director said in an interview with GlobalPost. 

“Originally, we picked countries that had a number of things going for them in global health – whether it was their size, or record of achievement, or a specific committed interest from the countries. They were the shining stars of the US GHI initiative.”

Monahan continued: “It’s not to say that the second round is not full of star performers as well. But the second round will really learn from the experiences of the countries in the first round, and make sense of what works and what doesn’t.”

More from GlobalPost: GHI: A Rough Beginning.  

The expansion of GHI principles to these 21 countries, though, doesn’t include a larger pool of funding.

GHI, like all federally funded programs, is in the midst of a federal government budget crunch. A House bill has cut $700 million from the administration’s request for GHI, lowering proposed spending to $7.1 billion in fiscal year 2012.

Ann Starrs, co-founder and president of Family Care International and a member of the GHI Initiative Coalition, a group of NGOs that closely track developments in the program, said in an interview that expanding GHI to more countries made sense.

“Since GHI is a set of principles, it’s a good thing because these principles should cut across US programs for global health,” she said. “The principles should apply to all countries.”

GHI’s top three listed principles, according to its website, are to “focus on women, girls and gender equality; encourage country ownership and invest in country-led plans; and build sustainability through health systems strengthening.”

Starrs also said that the administration needs to show Congress that GHI programs were moving ahead, and she believed making the second round of selected countries helped support that goal.

“This is important in terms of the question of how GHI is perceived, and that there is a sense of making some progress,” she said. “Using that perspective, expanding to 29 countries is going to help.”

The original eight “GHI Plus” countries are Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda. 

The 21 countries in the second round are Burundi, Democratic Republic of Congo, Georgia, Indonesia, Lesotho, Liberia, Sierra Leone, Tanzania, Ukraine, Vietnam, Botswana, Cambodia, Mozambique, Benin, South Africa, Namibia, Nigeria, Senegal, Dominican Republic, Philippines, and Swaziland. Some information on the eight of the countries can be found here.

More from Globalpost: A survey of 8 countries

Among the new emphasis in US support for health care: Tanzania will expand its services now used to prevention transmission of HIV from mother to child to include more services for mothers, especially adolescents; Vietnam will do more to combat tuberculosis; Mozambique will work on retaining health workers; Georgia will strengthen management and delivery of health services; and Indonesia will get expert help at district levels in reforming health systems, including assistance in purchasing drugs and supplies.

Other new initiatives: Cambodia will improve its services for reproductive health by tying together family planning and HIV and other sexually transmitted diseases; Liberia will receive assistance in strengthening the way it delivers health care; and Burundi will receive help in coordinating donor priorities and in a “gender assessment” document that explores gender issues in some communities.

Monahan, who started her job just two months ago, visited one of the 21 countries, Nigeria, last month for the launch of its GHI program. She called Nigeria’s plan “one of the best strategies we have.”

“The strategy does not focus on just the US government role, and not just the role of the federal government of Nigeria, but the role of many other players in the country, such as NGOs or community service organizations, or local governments.”

Nigeria’s GHI plan has a large focus on primary health care. She said that the Nigerian government has pledged to spend more money, committing in legislation to spend 2 percent of the national budget on primary health care. The US effort, she said, will include expanding HIV/AIDS services “to reach the entire family affected by HIV. 

“It has such potential,” she said. “It is striking how they are creating these one-stop shops, in which mothers can receive ante-natal care, treatment for HIV, treatment for TB and malaria, and have other mothers from the community can mentor them. It ties everything together.”

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