The PMI Turns One - How Will We Measure Success?

In a July 1 editorial, the Lancet (free registration required) praised the US President's Malaria Initiative (PMI) which was celebrating the one year anniversary of its founding. Although much quieter than its older brother, PEPFAR, the PMI has slowly and softly helped revolutionize the battle against malaria by concentrating resources to make substantial gains against the disease. However, this model is not without its critics. According to the article:

For PMI, the key measure of success must be whether or not it adds value independently of other organizations' efforts. As long as its existence does not jeopardize US financial support of the Global Fund, PMI's pledges to focus on what is needed, to ensure sustainability of achievements, and to empower countries to drive anti-malaria efforts themselves should win the initiative international support to expand and move forward. What is necessary now is for Congress to see PMI’s potential and meet President Bush's full request.

Myra comments: It is clearly true that the PMI has helped increase international attention to malaria and has transformed a notoriously under-funded and under-appreciated area of US foreign assistance for global health. However, measuring the success of this initiative should not be confined to a discussion of health outcomes and implementation strategies, although these elements are crucial. Evaluators should also look at the aid mechanism itself: is this model effective? What are the trade-offs for those countries that receive the concentrated funding and those who don't? What are the trade-offs for US global health and foreign assistance overall? Are the gains that are made cost-effective? What we need going forward is increased transparency in decision-making processes, including country selection, as well as better public knowledge about the inputs and results. We also need an understanding that this is a new and different way of doing business - a grand experiment in foreign aid - and one that needs healthy scrutiny from time to time.