America and our partners have more than doubled the number of people who get AIDS drugs. We’ll soon cut maternal mortality by a quarter. How? The answer may surprise you.
When I became Secretary of State, I asked our diplomats and development experts: “How can we do better?” I could see our strengths, including tens of thousands of public servants who get up every day thinking about how to advance America’s interests and promote our values around the world. At the same time, I could also see areas where we could be stronger partners, and where we could do more to get the most out of every hour of effort and dollar of funding. I saw it in our diplomacy, in our development efforts—and in our global health work.
America had been leading the global health fight for decades. In my husband’s administration, we began to make HIV treatment drugs more affordable, stepped up the fight against AIDS in India and Africa, and expanded investments in scientific research. Under President Bush’s leadership, we made historic commitments—on AIDS and malaria in particular—that were saving millions of lives.
The American people rightly take great pride in all these investments. Even during the worst economic downturn in a generation, the Obama Administration has been committed to maintaining and expanding them. But we recognized that to sustain the impact of our work, we needed to change the way we did business.
For example, while our agencies were providing tremendous leadership in isolation, they could still do more to collaborate effectively. Teams in PEPFAR (the President’s Emergency Plan for AIDS Relief) would work with a country to develop a plan for fighting HIV/AIDS; then, our malaria team would work separately with the same country to develop a malaria plan. Often we weren’t doing enough to coordinate our efforts with other donors or our partner countries either. And we weren’t building sustainable systems to eventually allow our partner countries to manage more of their own health needs.
The result? We were unintentionally putting a ceiling on the number of lives we could save. Not only could we become more effective and efficient, we had to. And we needed to shift from global health aid to global health investments—using our funding as a catalyst to spark self-sustaining progress.
We started by defining a set of seven principles for our work under the Global Health Initiative. Among them, we emphasized country ownership—the end state where a nation’s efforts are led, implemented, and eventually paid for by its government, communities, civil society and private sector. We elevated the role of women across all our programs, because the evidence shows that healthy women lead to healthy families and societies. And we emphasized strengthening health systems to build sustainability and to ensure that programs were working more efficiently together.
We retooled many of our programs to reflect these principles. Each of our country teams now assess how they fit within a comprehensive vision and program, based upon a health plan established by the country where we are operating. We also took several practical steps to lower costs, such as switching to generic AIDS drugs, which saved more than $380 million in 2010 alone.
And we made global health one of our diplomatic priorities—because fighting disease takes political leadership. Donors and partner countries have to make health a priority in their budgets. Their policies have to reflect a long-term commitment to improving access to care for everyone, not just a privileged few. They have to fight corruption. All of these are inherently political challenges. So I instructed our ambassadors around the world to elevate health in their discussions with presidents, prime ministers and leaders from outside government as well.
What does all this mean in practice?
Through our global health diplomacy, we’ve helped bring new partners to the table and keep old partners at the table; while we’ve committed $4 billion to the Global Fund to Fight AIDS, TB and Malaria since 2009, other donors have committed $7 billion.
We’re breaking down the walls that used to divide our teams and—even more importantly—integrating the health services that patients need. For example, we’re supporting a cadre of health workers in rural Malawi who travel door-to-door to provide a range of services, including HIV testing and counseling, nutrition evaluations, family planning, and tuberculosis screening.
We’re also seeing more low- and middle-income countries investing more in the health of their people. Earlier this year, USAID worked with India and Ethiopia to bring together 80 countries to agree on a roadmap for ending preventable childhood deaths. Together, we made concrete commitments on five specific strategies—from focusing our funding on the hardest-hit populations to spurring new research and innovation—that will accelerate our progress so that, one day, every child will get to celebrate her fifth birthday.
And our efforts to promote country ownership are paying off. PEPFAR, for example, is shifting out of emergency mode and starting to build sustainable health systems. It’s hard to overstate what a seismic shift this has been. Earlier this year I visited South Africa, where we agreed on a series of steps that put South Africa firmly in the lead of the fight against AIDS while committing both countries to expand prevention, care, and treatment to more people. By taking the lead, the South African government is ensuring that its national strategy will be sustainable and even more responsive to the specific needs of different communities. We want to see more of our partner countries take a similar leading role when they’re ready.
All this work is delivering real results. With our partners, we’re providing life-saving HIV treatment to 4.5 million people—an increase of more than 160 percent since 2008. In the same time period, the number of people receiving malaria-prevention measures is up to 58 million, an increase of 132 percent. The maternal mortality rate in our partner countries has dropped 15 percent in the past four years, and it’s on track to drop a total of 26 percent by next year.
Of course, putting these principles into practice hasn’t always been easy. There have been bumps along the way. We’ve seen more progress in some places than others. But our mission remains the same: to keep making gains together and spread them to more people in more places. So we will continue to work with our partners on country plans that maximize the impact of all our investments.
We are also elevating the critical role that global health diplomacy plays in making sure that these gains continue. The State Department is establishing a new Office of Global Health Diplomacy, led by an Ambassador-at-Large, that will bring the full force of U.S. diplomacy to advancing our global health goals. That means encouraging other donors to maintain or expand their contributions; engaging with partner countries as they work to meet their responsibilities; and coordinating with international health organizations, civil society, the private sector, faith-based organizations and foundations. The office will also support our ambassadors, giving them the information and tools they need to have a greater impact where the real health care work is actually happening.
Finally, in the spirit of the old maxim, “What gets measured gets done,” we are pilot-testing a scorecard that will allow us and our partners to assess our progress in building sustainable, country-owned health programs. We are setting goals and will check in regularly to see how we are doing. We want our progress to be transparent and want our partners to ask us hard questions. They can expect that we will do the same.
In short, America’s investments in global health are saving lives. They are making us more secure, and advancing our values. But it is a shared responsibility. Every nation—partner countries and donors alike—needs to invest in health. It’s one of the surest steps to build the safer, fairer world that we all want.