Scott Weathers

What can the Reach Act do for Global Health?

For a primer on the Reach Every Mother and Child Act, see 

 on our blog. Here, Scott explains the Maternal and Child Survival Coordinator position and argues that it has the most potential for impact at USAID.

Everybody knows our representatives don’t accomplish much. But they’ve actually reached a few pretty big milestones recently: just last month, four major pieces of global health and development legislation passed through the House Foreign Affairs Committee. The 

 (or Reach Act), not included in those four, is another piece of particularly high-impact legislation that is quickly garnering bipartisan support.

The most important reform in the Reach Act is probably the Maternal and Child Survival Coordinator position (Coordinator, for short). The Coordinator position is designed to give authority to an existing employee within 

 to coordinate spending across agencies, set budget priorities, and take other actions that would maximize the effectiveness of US spending on global health.

Ariel Pablos-Mendez, the current Coordinator, has begun implementing an evidence-based strategy to end preventable newborn, child, and maternal deaths called 

 prioritizes the most effective interventions and has already dramatically increased the impact of U.S. global health investments. In order to fully implement the strategy, however, the Coordinator position would need to be institutionalized past the current USAID administration and even into future U.S. presidencies.

The idea for the Coordinator position follows the advice of the Blue Ribbon Panel, commissioned by USAID’s previous Administrator Raj Shah, 

 with Rear Admiral Timothy Ziemer acting as U.S. Global Malaria Coordinator, which is where the idea for a Coordinator position at USAID came from. Although PMI is far from the President’s Emergency Plan for AIDS Relief (PEPFAR) in terms of media attention and overall funding, PMI’s effectiveness 

A good amount of PMI’s success has come from Ziemer’s leadership, but 

the broader lesson for global health is that well-defined initiatives can be achieved when a single person is given the ability to coordinate and focus decision-making, especially across agencies

 is the framework for how USAID can help end preventable newborn and maternal deaths by 2035, but enacting this vision requires a leadership structure like PMI’s.

Some of the benefits of this kind of leadership structure are hard to quantify in terms of impact - think smoother reporting requirements, better coordination, etc. Other benefits, however, are quite tangible: with a coordinator in place, USAID would have a much easier time prioritizing the high-impact interventions in 

. Although we can’t exactly predict the degree to which future coordinators would fund specific interventions, we do know that spending priorities will move up the cost-effectiveness ladder considerably.

One last detail to follow on the Reach Act - arguably the most important - is how the Senate and House will negotiate differences in how they think the coordinator position should function. Lauren Post at the Center for Global Development has an 

 explaining the current differences, namely that the House version would give the coordinator more authority to coordinate across agencies - exactly what U.S. funding for global health needs.

Reaching for Greater Impact Through US Legislation

The United States Senate is currently considering 

, a bill that USAID argues could save the lives of 15 million children and 500,000 mothers – Effective Altruists should take note.

At its core, the Reach Act would create a Maternal and Child Health Survival Coordinator position at USAID, who would prioritize spending on the most cost-effective, evidence-based interventions. The Reach Act builds on 

, a report commissioned to identify the most high-impact interventions in maternal and child health.

 gives a benchmark for the impact scaling up maternal mortality interventions could have through 2020.

Raj Shah, the previous administrator at USAID, instituted a number of reforms that has allowed USAID to save more lives. This legislation is about codifying and institutionalizing those reforms through future administrations.

An important distinction that Effective Altruists will notice is that this legislation (at least in the short run) will save lives primarily by prioritizing the best interventions, rather than summoning up new resources for global health. This means that the true number of lives saved by the Reach Act will be the difference between the impact of the interventions USAID funded before and after the reforms are enacted.

USAID does not specify which interventions will be de-prioritized, possibly because this involves upsetting constituencies within USAID. It’s impossible to tell exactly how many lives this legislation could save because this number hinges on decisions that future Maternal and Child Survival Coordinators will make.

USAID’s priorities affect billions of dollars of aid every year.

However it is very clear that USAID’s intentions under Raj Shah align nearly perfectly with EA values. The interventions USAID has prioritized are highly cost-effective – vaccinations, micronutrient supplementation, breastfeeding, and other priority interventions 

 feature prominently in Acting on the Call. Under Raj Shah, USAID has made allocation decisions to prioritize funding within 24 focus countries that have 70% of global maternal and child deaths and scaled up evidence-based and cost-effective interventions.

Ultimately, the Reach Act will also elevate the profile of global health and create favorable conditions that could deliver more overall funding for cost-effective interventions. This will happen through 3 major reforms: the Reach Act will 1) create an inter-agency working group to produce a “whole of government” 10-year plan for ending maternal and child deaths by 2035, 2) obligate the White House to report to Congress on this plan, and 3) establish a public-private partnership to generate more financial resources.

In India, USAID’s focus on several interventions could save tens of thousands of lives.

It is also likely that USAID will be able to demonstrate much greater impact through Reach Act reforms, making the case for increased funding much easier. Together, these reforms would 

generate resources and create accountability mechanisms

 for political actors that are not currently using their power to improve global health as much as they could.

Effective Altruists bemoan the lack of opportunities to effectively do good in the world beyond cost-effective charitable giving. Let’s be clear: giving to GWWC-recommended charities represents the clearest and easiest way to improve the world for individuals in the developed world. But supporting the Reach Act offers the potential to improve millions of lives and refine US efforts to save lives in the developing world.

Scott Weathers

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What can the Reach Act do for Global Health?

Reaching for Greater Impact Through US Legislation