Bush Heads to Africa, Scene of Successes on Health Policy

"His administration is really the first one to put the AIDS global pandemic on the policy map," said Josh Ruxin, a Columbia University professor who runs health programs in Rwanda. "There was a lot of talk in the Clinton administration, but there wasn't so much doing. It was the Bush administration that got out of talking about millions for AIDS and instead talking about billions."

The president last year proposed doubling the program's funding to $30 billion over the next five years. But activists said that the initial investment slowly ramped up to funding of about $6 billion a year, so $30 billion over five years would simply maintain current annual spending. As a result, the Global AIDS Alliance, an advocacy group, said Bush "is now putting his legacy at risk." Congressional Democrats have proposed spending $50 billion over five years.

Bush will also highlight his $1.2 billion program to fight malaria. In Tanzania, for instance, bed nets have helped cut malaria among children on the island of Zanzibar by 95 percent in two years. Bush will also sign a new $700 million Millennium Challenge Account contract with Tanzania, the largest so far for a program he created to invest in nations that commit to reforms. Overall, singer-activist Bono said this week that "President Bush has every reason to be proud of what he and so many others have accomplished in Africa."

But other activists complain that Bush has proposed cutting funds for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and they deride what they see as a fixation on abstinence as part of U.S. programs. "PEPFAR could be a positive legacy of the Bush administration, but only if the new legislation does not repeat the mistakes and limitations of the current program," said Joseph Amon, the HIV/AIDS director at Human Rights Watch.

The Africa trip is one of eight overseas journeys that Bush has scheduled for his final year, an active agenda for a president who prefers to stay home. The president has already traveled to the Middle East once and plans to return in May. He will also attend NATO and European Union meetings this spring, fly to China for the Summer Olympics, and visit Peru and Japan for economic summits.

His legacy is already hotly debated on the campaign trail, and opponents have launched efforts to write their own history of his tenure. House Democratic Caucus Chairman Rahm Emanuel (Ill.) produced a chart comparing 2000 with 2008 to make the case that Americans under Bush make less, owe more, pay more for college and have less health care. Americans United for Change, a liberal advocacy group, has created the Bush Legacy Project, which plans to spend $8.5 million over the next year to highlight what it sees as the president's record of failures in Iraq, New Orleans and elsewhere.

Bush has been casting his record in his own terms. In the State of the Union address and in last week's speech to the Conservative Political Action Conference, he listed what he considers his accomplishments -- cutting taxes; appointing two Supreme Court justices; protecting the country after the attacks of Sept. 11, 2001; freeing Iraqis and Afghans from dictatorships; and trying to spread democracy around the world.

In his CPAC speech, Bush noted that Reagan's reputation changed from "warmonger" to winner of the Cold War. In a documentary on Fox News Channel, he reflected on Abraham Lincoln and likened the liberation of Afghanistan and Iraq to freeing the slaves. Speaking with BBC this week, he acknowledged that his legacy for many will be "Bush equals Iraq," as interviewer Matt Frei put it.

"That's what the current, you know, elite would like everybody to think about," the president said. "And that's fine. I think when history marches on, there will be a little more objective look about the totality of this administration."