The Obama Administration has released its plan to achieve the Millennium Development Goals by 2015. The Administration has recognized the crucial nature of the MDGs and the developmental, strategic and economic importance each of that these goals mean.
The Administration has also recognized the tremendous progress to date, but points to the vast amount of work left to be done. “Enormous progress has been made so far toward meeting the MDGs, and we must recognize, celebrate, and support these achievements. Above all, credit belongs to the citizens and governments of countries that have prioritized development and invested in their people. These achievements are also testimony to the power of successful development partnerships.
But much more remains to be done. If we are to meet the ambitious objectives we have set, historic leaps in human development will be needed. For this reason, we must be even more determined, strategic, and focused on results as we chart the path to 2015.”
The Administration focuses on four key areas; Leveraging innovation, Sustainability, tracking outcomes and practicing mutual accountability.
The Malaria Policy Center applauds the Administration’s focus on the MDGs and looks forward to seeing the results we can produce in the future.
In Mozambique, PMI has supported the launch of new treatment guidelines for malaria, as well as the engagement of religious leaders in partnerships for development against malaria.
In 2007 the Ministry of Health of Mozambique announced its intention to adopt artemether-lumafantrine (AL) as the first-line treatment for uncomplicated malaria. PMI supported this initiative through its implementation in 2009, including technical assistance, forecasting of drug requirements to implement the new policy, and procuring most of the AL needed. In 2009 PMI procured more than 3.9 million ACT treatments for Mozambique. Finally, PMI provided logistical support to provincial and district health authorities to support massive new clinical staff training efforts, as well as printed much of the material used to train these clinicians. With PMI’s support, more than 16,000 health workers were trained in case management with ACTs. PMI will continue to monitor the new policy to ensure that it is being implemented appropriately at the community level.
In addition PMI, through the U.S. Agency for International Development, engages religious leaders to facilitate greater partnership in community’s development. Religious leaders, along with their well-established networks of volunteers and community groups, have the potential to promote and sustain positive changes in social norms, attitudes, and behaviors of their communities, which can immensely effect development outcomes. Over the past few years, malaria and other global health programs have increased support to grassroots health movements within faith communities. In addition to promoting health-seeking behaviors, these programs have helped bridge cultural and religious divides.
For example, the Together Against Malaria (TAM) initiative arose in Mozambique in 2006 from the common vision of 10 faith communities to use their religious organizations to disseminate malaria control messages and commodities, the goal being to train religious leaders on key malaria control and prevention measures so they could reach the members of their communities. The TAM partners sought to maximize the vast reach and influence of religious organizations to address the health delivery gap in remote areas where government clinics and programs often do not reach, thus overcoming both geographic and religious differences.
TAM worked with the Center for Interfaith Action on Global Poverty and formed the Inter-religious Program Against Malaria (PIRCOM) to carry out TAM’s program activities, and has been supported by a three-year initial grant from PMI. To date, PIRCOM has trained more than 21,000 religious leaders from a variety of faiths on malaria prevention and treatment, who have in turn reached more than 1.5 million individuals across Mozambique with these life-saving messages. Uniting to promote malaria prevention and control in their communities, PIRCOM members have recognized the importance of their new relationships across faith lines.
The Huffington Post published an article titled “Aid Reform Within Reach: Time for the President to Lead,” which discusses the advancing possibility of fundamental aid reform, something that has not occurred since the Foreign Assistance Act of 1961, “despite various attempts and a vastly changing world.” The article urges the current administration to take a leadership role at this critical point in defining how the United States delivers its foreign assistance, so that the most value is obtained from each dollar.
Centered on the fight against global poverty, The US’s approach to development from a policy point of view is a sound one. It has prioritized international development as a national strategy and has recently designed well constructed food and health initiatives. Dr. Rajiv Shah, has also made promising changes at the United States Agency for International Development (USAID). However, the logistical side of translating policy into action has seen less progress. It is well known that multiple agencies implementing parallel or inconsistent programs is not effective and assistance programs need more transparency and accountability. It is also clear that the legislation behind our foreign assistance system “a 500-page Cold War-era statue, lacks clear goals and objectives and is bursting at the seems with outdated, overlapping, and duplicative and conflicting provisions.”
Recent progress has been generated, as seen through the President’s endorsement of “A New Approach to Development,” one of the most noteworthy declarations about US development efforts since the Foreign Assistance Act. Furthermore, House Foreign Affairs Committee Chairman Howard Berman put forth a working draft of the FAA, which, if passed would significantly reconstruct US foreign assistance.
There are three steps that the President should take immediately in order to build on the recent progress that has been and overcome bureaucratic delays. First, he pursue the vision described in the G8 statement to create the country’s first Global Development Strategy to be ready for the Millennium Development Goals Summit in September in order to grasp the attention of the world. There are two issues at the center of the current debate. “Is achieving broad-based, sustainable development a goal in itself for U.S. global engagement, or is it merely a tool for diplomatic or defensive objectives? Furthermore, will development experts, rather than diplomats or soldiers, have the authority and resources to lead our foreign aid programs?”
He should also let it be known that he is prepared and willing to work with Congress on foreign aid reform without delay. Third, he must enable USAID with authority and the necessary tools to work collaboratively with the State Department and other agencies. The President must move decisively to restore US leadership to development to strengthen the efforts to end global poverty, ensure child survival, increase access to clean water and fight HIV/AIDS, tuberculosis, and malaria.
Four former USAID Administrators, J. Brian Atwood, Henrietta Holsman Fore, M. Peter McPherson and Andrew Natsios, penned a blog for the Huffington Post, arguing against cuts made to the International Affairs budget. The article is posted below.
“One would imagine that a national investment that pays dividends in the forms of greater national security, economic growth, and revitalized American values would be a wise investment in the future of our country. Yet the International Affairs budget — which funds America’s vital development and diplomacy programs — is burdened with a disproportionate share of the budget cuts now being made by Congress.
We recognize that Congress is faced with agonizing choices — and many competing priorities — on the budget front. However, cuts to the International Affairs budget will only weaken USAID and other agencies that make vital contributions to global development and our national security. This tiny fraction of the budget totals only 1.4% of federal spending, but is bearing the brunt of the cuts being made by Congress to President Obama’s budget request.
We are grateful for the emphasis the President has placed on development and foreign assistance–a tradition he continues from President Bush. And we strongly support Secretary Clinton’s call to make USAID “the premier development agency in the world.” But this goal will only be achieved when USAID’s personnel capacity is rebuilt and its funding enhanced.
USAID’s investments result in gains in diplomacy and democracy worldwide. Following the Aceh tsunami, 63 percent of Indonesians had a favorable impression of the United States, up from 28 percent. The striking positive change in a country with the largest Muslim population in the world is critical for American foreign policy.
For nearly half a century, USAID has brought people out of poverty and built thriving communities. In West Africa, USAID has partnered with businesses and governments to develop a commercial seed industry. Now more than 500,000 small-scale farmers have timely, affordable and reliable access to high-quality seeds and planting material through a network of over 800 agro-dealers in five focus countries further providing increased yields and protecting crops from drought, pests, and disease; lowering costs; and improving nutritional content.
And when tragedy strikes, USAID is always there. Following January’s devastating earthquake in Haiti, USAID led the U.S. relief effort, mobilizing resources from across the government. The percentage of Port-au-Prince residents who have access to safe drinking water is now higher than it was before the earthquake. As a result, the incidence of diarrhea has declined 12 percent compared to pre-earthquake levels.
These achievements can be multiplied but only if we provide USAID with the programmatic and personnel resources it needs. With personnel rolls on a steady decline for the last few decades, the U.S. now literally has more personnel in military bands than it has diplomats.
Some say USAID is broken, and we agree major revitalization is needed. To meet challenges around the world, we need a modernized USAID. With White House and State Department development reviews under way, we believe USAID will be fortified, securing development as the essential third pillar of our foreign policy, alongside diplomacy and defense. But reform and revitalization can only go so far without resources.
Both Democrats and Republicans agree on the imperative of focusing on international development. In April, every living former Secretary of State wrote Congress calling for an increase in the International Affairs Budget. They said, “We know from our collective experience that these strategic tools are essential to achieving our goals of protecting national security, building economic prosperity, and providing humanitarian assistance.”
Administrator Rajiv Shah has called for a new generation of “development entrepreneurs” who combine a deep knowledge of what works in the field with American entrepreneurial spirit. Individuals can transform USAID, creating innovative programs and partnerships that save lives, promote growth and multiply U.S. resources many times over. With the proper resources, USAID can realize this vision.
America needs a vibrant USAID with improved capacity to be a force for good around the globe. But USAID’s leader needs a full team to implement new initiatives. We call upon the administration to work tirelessly and fill the vacant senior leadership positions. And we call upon Congress to ensure that USAID is adequately funded and has the resources to do its important work. The time is now, the support is broad and the need is crucial. Helping to create the conditions for peace and stability is essential to our national security. It’s an investment in building a better, safer world.”
J. Brian Atwood, Henrietta Holsman Fore, M. Peter McPherson and Andrew Natsios served as USAID Administrators in previous administrations. Ms. Fore also served as the Director of Foreign Assistance. All are advisors to the U.S. Global Leadership Coalition.
In the United States of America a woman has a 1 in 4,800 chance of dying during child birth. In sub-Saharan Africa, a woman is 200 more times likely to die during child birth where 1 one out of every 22 women giving birth dies. “The President’s Global Health initiative is designed to close that gap,” opened Dr. Rajiv Shah, 16th Administer of USAID, during his speech on Tuesday, June 29th at the Center for Strategic and International Studies. The U.S. will donate $63 billion dollars over the next six years to help partner countries achieve major advances in health.
George Bush’s legacy consists of the President’s Emergency Plan for AIDS Relief, the largest effort by any one country against a single disease in history, and the President’s Malaria Initiative, directly targeting a disease that kills 900,000 people every year, mostly young children in Africa. PMI consists of a package of proven prevention measures and has so far resulted in the distribution of 19 million insecticide treated bed nets, 40 million lifesaving antimalarial treatments, and has contributed the reduction of malaria by 50% in some countries. While these disease specific programs are responsible for much of the progress that has taken place in Africa they have left gaps that Obama’s Global Health Initiative seeks to meet in an adequate, efficient, and sustainable manner.
The Global Health Initiative is aimed at the patient as a whole, so as not to as crowd out other life saving interventions with a disease driven focus. For example, during recent years we have succeeded in saving many babies from a fate of HIV/AIDS only to allow them to die of diarrheal diseases before their fifth birthdays, as many HIV clinics have replaced the previously existing ORT distribution clinics. The Global Health Initiative recognizes the need to integrate the clinic and the community, by supporting community health systems so that patients can access many services at a single location. However, the goal is not to support health systems for their own sake but so that they work for and produce health outcomes.
Among other targets, the Global Health Initiative seeks to double the number of babies born free of HIV, halve the malaria burden, and reduce maternal mortality by 30%. It will robustly address HIV, malaria, TB, neglected tropical diseases, nutrition, hygiene, sanitation, and maternal and child health. It will prioritize the development and distribution of vaccines to prevent diseases from occurring instead of treating them later. Secondly, the GHI works to expand platforms and promote new insights to deliver services effectively through integrated methods. Next, the GHI is designed to encourage innovation, through results based financing, and entrepreneurship such as private sector participation in research and innovation in diagnostics. The GHI also challenges recipient nations to take country ownership, and reminds donors to “work in partnership, not patronage.” We do not want to build parallel health systems, but strengthen host country health systems. This requires a full global response and coordination with global partners and government ministries.
Finally, the GHI is focusing on women and girls who are most vulnerable because of gender discrimination and their reproductive roles. Investments in women and girls is well known, and their access to basic health care and knowledge of health is amplified to the family and community. Clinic hours will be adjusted so that they are more friendly to the schedules of women and girls, there will be a greater variety of commodity distribution service such as in salons, and many female health workers will be trained to bring services into the home. There will be a large emphasis on ending child marriage, and family planning, which when done appropriately, could prevent 25% of maternal deaths.
The GHI aims to bring a more entrepreneurial spirit to aid. Over the past ten to fifteen years enormous progress has been achieved in the health field. Now is the time to pivot to sustainability and not backtrack when the agenda is switched to new programs in new countries. There are high expectations for the US to play a leadership role in the development of true and transparent partnerships that not only produce health outcomes, but develop local capacity in health systems to sustain themselves.
Following a year-long process that included widespread consultation with the development community, House Foreign Affairs Committee Chairman Howard Berman (D-CA) has released a preliminary draft of the “Global Partnership Act of 2010,” which is intended to replace the nearly-fifty year old Foreign Assistance Act of 1961.
The draft states that “It is the policy of the United States to help build and sustain an international community composed of states that meet basic human needs, resolve conflicts peacefully, respect fundamental freedoms, cooperate to address issues that transcend national boundaries, use wisely the world’s limited resources in a sustainable manner, and work toward the achievement of economic well-being for all people,” showing influence from the eight Millennium Development Goals. This represents an exciting first step in the process of foreign assistance reform.
In addition, USAID Administrator Rajiv Shah, in an address at the National Press Club, outlined a series of reforms taking place at USAID and broader, government-wide initiatives that impact development. Shah announced that USAID “will pursue a development strategy that is based on focus, scale, and impact,” specifically focusing on greater returns to investments, support for local capacity building and institutions, more flexibility within USAID and a greater ability to take risks, better and more timely monitoring and evaluation, and transparency. Earlier this month, Shah announced the creation of a new Policy, Planning and Learning bureau that would restore policy capacity at the agency. Shah also promised that the Presidential Study Directive on Global Development Policy and the State-USAID Quadrennial Diplomacy and Development Review will be released to the public, commenting, “I think it’s incumbent upon us to get this reform agenda enacted and to make USAID the most effective and strategically significant development enterprise anywhere in the world.”
U.S. foreign assistance is typically not a hot topic for debate in the political arena. But Americans should be proud of their genorisity because it translates into things of beauty on the ground in Africa. And Senegal should be proud of the strides it has made against malaria and other diseases.
During my stay here in Senegal, I was able to visit three health huts that have been funded by USAID and The President’s Malaria Initiative (PMI). Across Senegal, there are around 9000 health huts that are staffed by people from the local community. Each health hut serves a varying number of people, but the ones I visited serve around 1200 local Senegalese.
These health huts provide maternal and newborn child health services, malaria diagnosis and treatment as well as clean water solutions. Each of these areas are immensely critical.
The health huts are not much more than two of three rooms, but hidden in these small buildings are amazing story of success and ultimately, genorisity, both by the local people and the United States.
While visiting these huts I noticed hand written charts hanging on the walls. These were in French and I asked what they were tracking. “Malaria rates.” was the answer. In 2009, they were seeing dozens of cases and before that there were even more.
But in 2010, over the past four months, each of these huts showed zero malaria cases. This reduction occurred after a bednet distribution campaign and the public awareness campaign “Xeex Sibbiru.”
This is what its all about. Americans are giving to people they have never met and will most likely never know and in Senegal, local individuals are volunteering their time, for free, to staff these huts and provide health services to their neighbors Even when there are several other pressing concerns on a volunteer health workers time, they still work to serve their community.
Ultimately, its a tale of compassion. Compassion for those in need and compassion for ones neighbor. Together the compassion of the American people and the Senegalese people is writing a story that includes the end of malaria in Senegal.
I’ve been working for Malaria No More for just over a year and a half and have loved the cause every step of the way. For me, investing in the fight against malaria just makes sense. Theres been demonstrated return on investment, economic benefits and lives saved. Quite simply, the statistics made a powerful case to me. Perhaps most compelling, we can end malaria deaths by 2015, there is a light at the end of the tunnel.
There is, however, a difference between knowing and seeing.
I have been blessed with the opportunity to travel to Dakar, Senegal and I’ve just been amazed by everything I see. The people are extraordinarily friendly (especially to someone who doesn’t speak any French or Wolof) and Dakar is a gorgeous city, situated right on the water. Dakar is also one of the most fitness oriented cities I have ever seen, every day hundreds and perhaps thousands of people gather on the beach to run, workout and stay in shape.
Beyond my wonder at this new, incredible place, is the shadow of malaria.
During my time in Senegal, I saw two women being treated intravenously to defeat their malaria infection. Both women were adults and should survive with their treatment, but the energy had just been sucked right out of them before my eyes.
Despite being familiar with malaria issues, when I stepped off of the plane, I didnt feel any more vulnerable to a crippling disease, nor did any sort of warning constantly come to my mind. But the evidence was there for me to see.
But despite the tenacious nature of malaria, success in Senegal has been wide spread. Last year the government began a distribution of 2 million bednets for children under 5. Youssou N’Dour launched his Xeex Sibbiru Song Contest campaign in order to raise awareness about malaria and the results are amazing to behold.
I saw health huts, rapid diagnostic tests, bednets and drug treatments that becoming more and more widely available. All of these treatments and the support of organizations like USAID, The President’s Malaria Initiative and the Global Fund are rolling that shadow back. Morning is coming in Senegal, as long as we keep up our support.
The World Bank’s Board of Executive Directors has approved US$63.66 million to create a unique regional network of 25 public health laboratories across Kenya, Tanzania, Uganda and Rwanda. The network will operate across country borders, improving access to diagnostic services to vulnerable populations in cross border areas and making optimal use of internet and mobile communications to improve public health.
World Bank Vice President for Africa Obiageli Ezekwesili states: “At a time when the global economic crisis has undermined Africa’s recent economic achievements, regional integration is an essential strategy for restoring medium-term growth, unlocking economies of scale, and sharpening competitiveness in Africa…Laboratories are currently the weakest link in the region’s public health defenses, seriously hindering each country’s ability to confirm and respond in a coordinated manner to disease outbreaks. By bolstering diagnostic and surveillance capacities, the new multi-country laboratory network will help to identify potentially devastating disease outbreaks at an early stage, enabling countries to act quickly to prevent the rapid spread of diseases across borders. Communicating outbreak-related information across national borders in real time is more important than ever before, as labor mobility is likely to increase shortly with the establishment of the East African Community common market and with growing global travel.”
The East Africa Public Health Laboratory Network simultaneously addresses a key weakness in health systems and a critical gap in the continental responses to disease outbreaks, expanding access to services to vulnerable groups.
“With this approach, which will continue throughout the project’s implementation, much can be done to strengthen health systems in a sustainable and coordinated manner,” says Eva Jarawan, Sector Manager in Health, Nutrition and Population for Africa at the World Bank.
