INTRODUCTION
It is time to implement the broader United States Government (USG) global health mandate while maintaining priority for the most effective health interventions. The political and policy mandate exists to invest in a more flexible and more equitable approach. The recent Institute of Medicine (IOM) evaluation of PEPFAR applauds PEPFAR's impressive successes.1 At the same time, the IOM points out 2 major challenges for PEPFAR: (1) to better address prevention through behavior change, and (2) to shift the burden and responsibility of programming more to the affected countries. Also, the President's Global Health Initiative (GHI) acknowledges the huge and compelling global health needs beyond those of HIV, including principles that focus on women, girls, and gender equity, and on health systems strengthening. The policy mandate for a broader PEPFAR approach already exists in its Hyde–Lantos authorizing legislation2:
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Section 4(6) (A) states: “the USG should strengthen primary health care systems”
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Section 301(b)(1)(B), Title III; Subtitle A states: “It is the policy objective of the United States to strengthen the capacity to deliver primary health care in developing countries, especially in sub-Saharan Africa …”
THE NUMBERS SPEAK FOR THEMSELVES: TOO MANY CHILDREN DIE EACH YEAR
Approximately 6.9 million people die annually before their fifth birthday from preventable causes.3,4 By comparison, approximately 1.7 million people of all ages die from HIV5; about 1.4 million die from TB6; and about 655,000 die from malaria.7 Thus, approximately 3.76 million people of all ages die each year from HIV, TB, and malaria combined—about 10,300 per day—an extraordinary and important number, to be sure. Tragically, however, about …
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