Global Health Initiative: Namibia Comment

UNCLAS SECTION 01 OF 03 WINDHOEK 000484 SIPDIS STATE FOR D(L) CHBONNER O/GAC AF/S MHARRIS, PGWYN PLEASE PASS TO USAID, CDC E.O. 12958: N/A TAGS: EAID KHIV KWMN KOCI WA SUBJECT: Global Health Initiative: Namibia Comment REF: 09 STATE 125761 -------------- SUMMARY -------------- ¶1. (U) Post welcomes the opportunity to respond to reftel, "Global Health Initiative: Promoting Greater Awareness and Participation." The USG team in Namibia strongly supports GHI's seven guiding principles. Specifically, the focus on women and girls as the "gateway" to families is crucial, but it is important that men and boys remain key targets for awareness and advocacy. We welcome the emphasis on sustainability, but stress the need to integrate health programs with broader USG foreign policy initiatives, and with the host governments' financial and political leadership. GHI investments should be focused on systems (e.g., human resources, legal frameworks, finance) to improve healthcare access and equity, and to leverage the involvement of the private sector and civil society in supplementing the host governments' healthcare programs. We applaud the GHI's emphasis on integration and coordination, health systems strengthening, and metrics, which are critical issues for Namibia. End Summary. -------------- -------------- -------------- BEST PRACTICES, LESSONS LEARNED, AND OPPORTUNITIES -------------- -------------- -------------- ¶2. (U) As the largest bilateral donor in the health sector in Namibia, the USG has produced several valuable lessons: --The co-location of USG personnel within partner government ministries has greatly strengthened the quality of our collaboration with the government. --In the second five-year phase of PEPFAR we are emphasizing direct government-to-government support to key host country ministries. --Engagement with the local private sector (beyond public-private partnerships). Best practices include: 1) Private insurance schemes to include low cost HIV/AIDS coverage. 2) Inclusion of public and private sector providers in USG sponsored trainings. 3) Development of community health care systems financed and managed by a public-private trust fund. 4) Corporate social responsibility activities coordinated to maximize health impact. --Empowering communities and civil society through support to Community Coalitions/Community Advisory boards and other non-governmental frameworks. These entities have helped strengthen local involvement in decision making for health system investments and health policies. They have also increased accountability, given a voice to marginalized populations, expanded access to underserved groups and areas, and improved the ownership of health at the household level. Community-based interventions such as microfinance/microenterprise have also proved effective. --Task-shifting: PEPFAR's support for training for nurses has allowed resource-constrained countries to address human resource shortages in the clinical setting quickly, efficiently, and without sacrificing patient safety. Task-shifting at all levels of the healthcare system should be a cornerstone of GHI's human resources for health strategy. In Namibia, task-shifting has led to the creation of a "Health Extension Worker" cadre within the civil service. --Scholarships: Support for pre- and in-service training through WINDHOEK 00000484 002 OF 003 scholarships and "twinning" exchanges has been critical in helping build local capacity. GHI should also support host country governments to develop post-graduate fellowship or internship programs within existing civil service systems. --Leveraging HIV/AIDS investments. Namibia's ability to conduct tuberculosis drug resistance monitoring and molecular screening for H1N1 are direct results of PEPFAR investments in laboratory infrastructure. Investments in blood safety have improved access to screened blood and blood products, critical tools for clinicians in the management of obstetric emergencies and childhood anemia. -------------- RECOMMENDATIONS -------------- ¶3. (U) Post provides the following recommendations for consideration in the development of GHI: --Broader engagement of USG staff: To link health programs to Missions' broader foreign policy activities, Missions' political and economic officers as well as other agency representatives should be integrated into GHI Country Teams as appropriate. --Resource tracking for health should allow host governments and USG teams to understand how funds are spent, and how to set sustainability targets. National Health Accounts and sub-accounts will help ensure accountability, transparency and evidenced-based resource allocation. --Human Resource Retention: Greater emphasis to develop innovative strategies to retain trained personnel. --GHI should include male engagement and involvement. -------------- -------------- -------------- COMMENTS AND QUESTIONS ON CORE PRINCIPLES -------------- -------------- -------------- ¶4. (U) Post has the following comments and questions regarding GHI's core principles: --Women and Girl-centric approach. Male involvement strategies are critical. --Strategic Integration and Coordination. USG strategic integration and coordination is welcome and should be linked to Agencies' core competencies. --Strengthen and Leverage Multilateral Institutions. What role will PF Agreements, which take multilateral contributions into account, play in GHI? --Country ownership. Civil society and private sector involvement is critical. Post would like to contribute to discussions on strategies to engage host governments. WINDHOEK 00000484 003 OF 003 --Health Systems Strengthening (HSS). HSS strategies should focus on sustainability, quality, access and efficiency. The cable mentions the need to make "measurable improvements" in the six building blocks. Post suggests using the same HSS M&E indicators as used by the GFATM. --Metrics, M&E. Support for host country and multilateral stakeholder planning, coordination and ownership should be driven by quality evidence. --Research, Development and Innovation. Implementation of research initiatives should be streamlined. MATHIEU