(SBU) Applying Comments on the Draft Strategy of the

UNCLAS SECTION 01 OF 26 HANOI 001370 SENSITIVE SIPDIS STATE PASS TO OGAC AMEMBASSIES PASS TO PEPFAR COORDINATORS, ESTH, CDC DIRECTORS, HEALTH ATTACHES, AND AID HEALTH OFFICERS HHS/OSSI/DSI PASS TO HHS/OGHA JMONAHAN, MABDOO, ACUMMINGS, CMCCLEAN),NIH/FIC RGLASS, SAMHSA USAID FOR ANE CJENNINGS, AND GH GSTEELE, RCLAY BANGKOK FOR USAID/RDM/A OCARDUNER, MSATIN, ATHWIN CDC FOR COGH SBLOUT AND GAP, DTBE, MALARIA E.O. 12958: N/A TAGS: TBIO SOCI EAID KWMN KHIV VM SUBJECT: (SBU) Applying Comments on the Draft Strategy of the President's Global Health Initiative REF: A. STATE 125761; B. HANOI 278 HANOI 00001370 002 OF 026 SENSITIVE BUT UNCLASSIFIED REF A. STATE 125761; B. HANOI 278 HANOI 00001370 003 OF 026 ¶1. (U) Summary. Embassy Hanoi??????s inter-agency health team believes that the President??????s Global Health Initiative (PGHI) principles will advance our health diplomacy efforts in Vietnam, particularly PGHI??????s emphasis on health systems strengthening HANOI 00001370 004 OF 026 (HSS). Greater international coordination is needed around several disease-specific global partnerships that are increasingly targeting health systems strengthening, without any clear plan or policy for how to bring it together at the country level. Country selection for HANOI 00001370 005 OF 026 PGHI participation should be based on established criteria with field input. Harmonization of programmatic monitoring and evaluation is one of the biggest challenges, and planners should address how sectors outside of health affect PGHI success. With as much advance HANOI 00001370 006 OF 026 notice as possible, Post will need to work to ensure that government of Vietnam (GVN) understands the effect of PGHI on existing programs and what new resources are available, ahead of international announcements. Tuberculosis is a critical public health issue in HANOI 00001370 007 OF 026 Vietnam and globally, which requires more emphasis. End Summary. ¶2. (SBU) Analysis and improved coordination of current programs under existing USG initiatives as well as coordination among broader HANOI 00001370 008 OF 026 non-USG initiatives related to health is critical, looking for opportunities to build and strengthen partnerships (REF A). Despite the fact that the USG is a major donor to Global Alliance for Vaccines and Immunizations, ??????GAVI?????? has no obligation to 
HANOI 00001370 009 OF 026 report what it is doing in Vietnam to the U.S. Mission. In follow-up to the recent GAVI Partners?????? Forum in Hanoi, the Western Pacific Regional Office of the World Health Organization (WHO) hosted a meeting on HSS in Manila, at the end of November. Hanoi??????s local HANOI 00001370 010 OF 026 WHO HIV technical officer attended and reported to Embassy staff on the importance of the meeting for overall coordination of HSS, and noted prominent participation by WHO, World Bank, and Global Fund, but not from USG. HANOI 00001370 011 OF 026 ¶3. (SBU) Post strongly supports greater attention to HSS, but in our experience over the last two years, it is easier said than done. The World Health Organization??????s definition of six key areas provides HANOI 00001370 012 OF 026 some focus, but the definition of HSS and how to do still needs further clarification. At the end of the day, the challenge in Vietnam will be to develop focused strategies that make critical differences and ensure sustainability. With various disease-specific HANOI 00001370 013 OF 026 global health initiatives increasingly contributing directly to HSS, increased coordination internationally among both USG and other global initiatives is essential. The research base (especially operations research) and technical knowhow, especially with respect HANOI 00001370 014 OF 026 to measuring progress, to pull this off is lacking. ¶4. (SBU) Existing indicators should be the starting point, but previous attempts at harmonization have been challenging. One HANOI 00001370 015 OF 026 example driven by headquarters, establishing a monitoring and evaluation framework for influenza work, resulted in two different schemes, one by CDC and one by AID, which made it difficult for our multiagency health team to participate effectively in GVN??????s HANOI 00001370 016 OF 026 alignment of monitoring and evaluation across programs and donors. PGHI should also empower USG to seek better monitoring of funding and accountability within countries. HANOI 00001370 017 OF 026 ¶5. (U) In the emerging economy of Vietnam, caught up in the throes of health sector reform, there is a strong need to recognize the importance of non-health sector factors and contributions to ensure health gains. For example, education and social services, which HANOI 00001370 018 OF 026 often have better access to affected communities than health providers, are often neglected as a fundamental part of any health development strategy. Further, one-size does not fit all. For example, Vietnam still has a localized HIV/AIDS epidemic, whereby HANOI 00001370 019 OF 026 persons who inject drugs are the core most-at-risk population driving transmission. Our PEPFAR strategy is necessarily different than a country with a generalized epidemic. PGHI should allow the field to drive health initiative planning, including by allowing for greater HANOI 00001370 020 OF 026 input when USG prepares government-wide interventions in international forums. ¶6. (SBU) Tuberculosis is a tremendous problem in Vietnam (REF B), HANOI 00001370 021 OF 026 arguably more so than HIV. In-country coordination for tuberculosis and HIV work, both within our PEPFAR framework and broader donor coordination circles, with the government has at times been challenging, despite the fact that tuberculosis and HIV are very HANOI 00001370 022 OF 026 closely linked epidemiologically. Such coordination challenges will be magnified when trying to bring together broader public health issues. HANOI 00001370 023 OF 026 ¶7. (SBU) International announcements on the substance of the PGHI must be synchronized with communications strategies at the country level to the host government. Failure to do so will lead to confusion. This is especially important in a country such as Vietnam HANOI 00001370 024 OF 026 where 75 percent of USG resources are applied to health and disability development work and government-to-government cooperation. Moreover, PGHI timelines and duration are important. If we are to change or add programs, we cannot expect immediate results. This is HANOI 00001370 025 OF 026 particularly true for initiatives that target capacity building at provincial, district, and local levels. ¶8. (SBU) Minimize Considered HANOI 00001370 026 OF 026 MINIMIZE CONSIDERED Michalak