GLOBAL HEALTH INITATIVE: PROMOTING GREATER AWARENESS AND

UNCLAS SECTION 01 OF 02 ADDIS ABABA 002943 SIPDIS DEPARTMENT FOR AF/SPG AND AF/RSA LONDON, PARIS, ROME FOR AFRICA WATCHER E.O. 12958: N/A TAGS: KHIV EAID ET KOCI KWMN SUBJECT: GLOBAL HEALTH INITATIVE: PROMOTING GREATER AWARENESS AND PARTICIPATION Reference: State 00/125761 ¶1. The U.S. Mission to Ethiopia wishes to provide the following comments in response to State cable 00125761 regarding the goals and principles of the President's Global Health Initiative (GHI). The broad goals around improving overall health outcomes and increasing country capacity to improve prospects for sustainability are on target and welcome. They provide an opportunity to tailor the GHI to meet the country-specific burden of disease. Host governments, multilateral, and bilateral partners will appreciate such flexibility, which will improve their motivation to work with the GHI. ¶2. The approaches to achieving these broad goals (integrating USG health programs, increasing country alignment, and deeper engagement with other stakeholders) are also sound. We would like to emphasize that strategic integration and coordination takes place at both the intra-sectoral and inter-sectoral levels. Intra-sectoral approaches provide opportunities for holistic health programs. Inter-sectorally, health programs should link to programs in business development, environment, alternative livelihoods, agriculture, democracy and governance, emergency relief and education to ensure that health issues are taken into account and health messages promoted. ¶3. The women and girl-centered approach is of course valid and the addressing of male norms under GHI is much appreciated. However, women and girl-centered programs must do much more than simply target women as beneficiaries for services but rather focus on women's status in the community, their education levels, their ability to earn and control income, and their ability to successfully negotiate health outcomes for themselves, their children and their communities. Women and girl-centered programming must focus on the household and community levels, where most key decisions regarding child and maternal health are made, while continuing efforts to address key policy issues at higher levels. ¶4. The four specific areas of GHI, are also appropriate. However, in order for these goals to generate traction at the country or global level, they need to be quantified with clear and realistic objectives and targets. Additionally the issue of balance is applicable across all other GHI programs. For example, while agreeing that HIV prevention needs to improve, we still need to maintain balance with care, treatment and support programs. ¶5. The U.S. Mission to Ethiopia fully supports the seven proposed GHI principles. As per para 3, we look forward to providing our views on how these principles may best be applied in the follow-up cables on GHI's strategy and plans for implementation. In the time allocated for a response to this cable, we have not been able to fully provide information on best practices, lessons learned and opportunities. Ethiopia has rich experience to share in these and we will communicate these as soon as possible. ¶6. The USG team and the Government of Ethiopia are well positioned and highly motivated to initiate implementation of the GHI. Many of the policies, plans and platforms for service delivery, donor coordination, systems strengthening and building country ownership are already in place. In all of these platforms, the USG is fully involved and in a position to provide strong leadership in pursuit of the goals and principles of GHI. ¶7. The strong emphasis on country leadership, program integration and improved coordination among existing agencies and programs is most welcome. The question around interagency coordination is of course "how"? To be most effective, integration needs to be across agencies and involve their respective partners, as appropriate. ¶8. Central support for providing guidance on an appropriate division of labor in the field, taking comparative advantages of agencies into account, is essential both at this stage of PEPFAR and for moving forward with GHI. We have seen PEPFAR accomplish a great deal over the past six years, but at a high transaction cost when it comes to interagency relationships. Multiple factors may have contributed to this, including modeling in the field the way agencies relate to one another at headquarters, competition for budget and credit going to agencies, differing agency cultures, lack of clarity on division of labor, and lack of headquarters and in-country leadership with managing the historical change that PEPFAR introduced to achieve targets through interagency coordination. However, the lack of a clear division of labor between USG agencies within PEPFAR has clearly reduced the overall effectiveness and efficiency of the USG program for HIV/AIDS support. ADDIS ABAB 00002943 002 OF 002 ¶9. Key to effective and efficient programming is a clear division of labor in tandem with excellent coordination. There are several ways in which to divide responsibilities, including by programmatic area (HIV prevention, HIV care/treatment, neglected tropical diseases, TB, malaria, family planning, maternal health, child survival etc),health system component (supply chain, laboratory, strategic information, human resources, infrastructure, financing etc),and programmatic partnerships (private sector, public sector, uniformed services, community, etc.). We believe that a management model whereby an agency is assigned responsibility for a specific area, component, population and/or partnership and is provided with the authority and resources for implementation, on behalf of and with the collaboration of all USG agencies, will ensure that GHI produces better results at a lower cost. ¶10. The primary lesson learned from Ethiopia, and critical for the eventual success of the GHI, is that clear lines of authority and an appropriate division of labor between US agencies, based on each agency's comparative strengths, needs to be established from the beginning. In this way, USG agencies operating in Ethiopia will be able to more effectively collaborate and implement GHI, improve health status in a lasting way, and thus serve both the interests of the people of Ethiopia and the US taxpayer. ¶11. In summary, the U.S. Mission to Ethiopia welcomes the opportunity to work with all relevant agencies in designing and implementing the GHI, and believes that in Ethiopia existing platforms across the areas covered by GHI are extremely well-positioned to support the Initiative. We look forward to the opportunity to respond to the forthcoming cables on the draft GHI strategy and plans for implementation. MUSHINGI