The Lancet examines the history of the Obama administration's attempt to "reform the way the country delivers development assistance for health abroad" by establishing the Global Health Initiative (GHI). "Despite unusual bipartisan support in Congress and broad consensus among development practitioners about the goals of reform, it proved surprisingly difficult for the multiple entities involved in U.S. global health assistance to agree on a way forward," the journal states, noting that GHI leadership and the three core entities of GHI -- USAID, the Centers for Disease Control and Prevention (CDC) and PEPFAR -- announced the closure of the GHI office and an end to the initiative's current phase on July 3. The Lancet outlines several challenges the initiative faced, including collaboration among the three agencies, leadership, and external factors, such as "the austere budgetary climate."