Abstract
BackgroundGlobal health programs, as supported by organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR), stand to make significant contributions to international medical outcomes. Traditional systems of monitoring and evaluation, however, fail to capture downstream, indirect, or collateral advantages (and threats) of intervention selection, design, and implementation from broader donor perspectives, including those of the diplomatic and foreign policy communities, which these programs also generate. This paper describes the development a new métier under which assessment systems designed to consider the diplomatic value of global health initiatives are described and applied based on previously-identified “Top Ten” criteria.MethodsThe “Kevany Riposte” and the “K-Score” were conceptualized based on a retrospective and collective assessment of the author’s participation in the design, implementation and delivery of a range of global health interventions related to the HIV/AIDS epidemic. Responses and associated scores reframe intervention worth or value in terms of global health diplomacy criteria such as “adaptability”, “interdependence”, “training,” and “neutrality”. Response options ranged from “highly advantageous” to “significant potential threat”.ResultsGlobal health initiatives under review were found to generate significant advantages from the diplomatic perspective. These included (1) intervention visibility and associations with donor altruism and prestige, (2) development of international non-health collaborations and partnerships, (3) adaptability and responsiveness of service delivery to local needs, and (4) advancement of broader strategic goals of the international community. Corresponding threats included (1) an absence of formal training of project staff on broader political and international relations roles and responsibilities, (2) challenges to recipient cultural and religious practices, (3) intervention-related environmental concerns, and (4) a lack of prima facie consideration of intervention diplomatic and foreign policy consequences.ConclusionsGlobal health interventions stand to generate significant diplomatic advantages for donor and recipient countries and organizations when appropriately selected, designed, targeted, and delivered. Conversely, in the absence of the application of standards such as those developed under the Kevany Riposte, threats to diplomacy and international relations may occur. With the application of related systems to other global health programmes and settings, comparative results on the relative worth of alternate approaches from the diplomatic perspective may be generated to better inform political, strategic, and global health policy and programmatic decisions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12992-015-0108-x) contains supplementary material, which is available to authorized users.
Highlights
Global health programs, as supported by organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR), stand to make significant contributions to international medical outcomes
In the United Kingdom, foreign assistance forms an integral component of foreign affairs [7] under the stated goal of “policy coherence” [8]. But convergently, both the United Nations and international military forces have displayed an increased propensity to combine conflict resolution and humanitarian activities [9], whilst the World Bank has recommended that international development focus on security issues beyond primary programmatic goals [10]. These trends are of increasing importance to the design, delivery and evaluation of global health intervention programs under initiatives such as the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) [11] in the context of the recent creation of the Office of Global Health Diplomacy [12] and related programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (“The Global Fund”) [13]
Amongst other features, technical assistance to strengthen prevention programming; community support mechanisms; referral systems; and other behavioral and community-based health promotion and educational initiatives [28]. Within this broader operational context, HIV Counseling & Testing (HCT) based around “wellness days”, “community mobilization”, and “post-test support services”, amongst other forms of service delivery, are provided in community venues in order to increase, for example, numbers of persons tested for HIV/AIDS provided with personalized support and guidance regarding behavioral risk-reduction, as well as raising community awareness and engagement
Summary
As supported by organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR), stand to make significant contributions to international medical outcomes. Traditional systems of monitoring and evaluation, fail to capture downstream, indirect, or collateral advantages (and threats) of intervention selection, design, and implementation from broader donor perspectives, including those of the diplomatic and foreign policy communities, which these programs generate. This paper describes the development a new métier under which assessment systems designed to consider the diplomatic value of global health initiatives are described and applied based on previously-identified “Top Ten” criteria
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