(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


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SENSITIVE BUT UNCLASSIFIED

REF A. STATE 125761; B. HANOI 278

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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

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(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

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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

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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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alignment of monitoring and evaluation across programs and donors.
PGHI should also empower USG to seek better monitoring of funding and
accountability within countries.

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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

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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

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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

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input when USG prepares government-wide interventions in
international forums.


6. (SBU) Tuberculosis is a tremendous problem in Vietnam (REF B),

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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

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closely linked epidemiologically. Such coordination challenges will
be magnified when trying to bring together broader public health
issues.

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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

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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

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particularly true for initiatives that target capacity building at
provincial, district, and local levels.

8. (SBU) Minimize Considered

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MINIMIZE CONSIDERED
Michalak