ANNEX A: Global Health Initiative

Ambitious Targets

The GHI seeks to contribute to major improvements in health outcomes - with a particular focus on women, newborns and children - through transformational advances in access to, and the quality of, health care services in resource-poor settings.

We have set out ambitious targets to inspire an intensive effort. While specific targets will be established at the country level, the GHI is expected to achieve the following aggregate goals by the time performance can be measured in 2015.

HIV/AIDS: As the largest bilateral health assistance program of the U.S. government, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) serves as the cornerstone of the Global Health Initiative. As part of the GHI, and as laid out in its Five-Year Strategy, PEPFAR will:

• Support the prevention of more than 12 million new HIV infections;
• Ensure that every partner country with a generalized HIV epidemic has both 80-percent coverage of testing for pregnant women at the national level, and 85-percent coverage of antiretroviral drug prophylaxis and treatment, as indicated, of women found to be HIV-infected;
• Double the number of at-risk babies born HIV-free, from a baseline of 240,000 babies of HIV-positive mothers born HIV-negative during the first five years of PEPFAR;
• Provide direct support for more than 4 million people on anti-retroviral treatment;
• Provide direct support for care for more than 12 million people, including 5 million orphans and vulnerable children;
• Support training and retention of more than 140,000 new health care workers to strengthen health systems; and
• Ensure that in each country with a major PEPFAR investment, the partner government leads efforts to evaluate and define needs and roles in the national response.

Tuberculosis (TB): Save approximately 1.3 million lives by reducing TB prevalence by 50 percent. This will involve treating 2.6 million new TB cases and 57,200 multi-drug resistant (MDR) cases of TB.

Malaria: Reduce the burden of malaria by 50 percent for 450 million people, representing 70 percent of the at-risk population in Africa. This effort will include the expansion of malaria efforts into Nigeria and the Democratic Republic of Congo.

Maternal Health: Save approximately 360,000 women's lives by reducing maternal mortality by 30 percent across assisted countries.

Child Health: Save approximately 3 million children's lives, including 1.5 million newborns, by reducing under five mortality rates by 35 percent across assisted countries.

Nutrition: Reduce child undernutrition by 30 percent in food-insecure countries in conjunction with the President's Global Food Security Initiative.

Family Planning and Reproductive Health: Prevent 54 million unintended pregnancies. This will be accomplished by reaching a modern contraceptive prevalence rate of 35 percent across assisted countries, reflecting a 2 percentage point increase annually, and reducing to 20 percent the number of first births by women under 18.

Neglected Tropical Diseases (NTDs): Reduce the prevalence of 7 NTDs by 50 percent among 70 percent of the affected population, contributing to: (1) the elimination of onchocerciasis in Latin America by 2016; (2) the elimination of lymphatic filariasis globally by 2017; and (3) the elimination of leprosy.

Health Systems Strengthening: The Initiative places a deliberate focus on addressing health systems barriers that constrain the delivery of health interventions. Measures to strengthen health systems and assess their efficiency and effectiveness will be developed with partner countries and donors. While specific targets will vary, depending on needs, demographics, epidemiology and structural conditions, these measures may include:

• Improved health financing strategies that reduce financial barriers to essential services, including increased government and/or private sector funding for health and reduced out-of-pocket payments for health services, where appropriate;
• Steps to reduce disparities in health outcomes by providing essential health services (e.g., skilled birth attendance and voluntary family planning), especially among underserved groups;
• Increased numbers of trained health workers and community workers appropriately deployed in the country; and
• Improved functioning of health management information and pharmaceutical management systems to reduce stock-outs.