July 8, 2009
Good afternoon. It is a privilege to be here with you today as part of the celebration of InterAction’s 25th anniversary. I’d like to thank Sam Worthington and Charlie MacCormack for inviting me here to speak today.
And I’d also like to thank all of you, the dedicated development experts who over these decades have worked tirelessly to better the lives of people around the world. Your work has permanently changed the landscape of global health and development, and has saved and improved so many lives.
Until very recently – I’ve been Coordinator for just about 3 weeks now – I too was representing a civil society perspective, and I’m very aware of the many challenges that you face working in countries and communities around the world.
But even though I’m fairly new on the job, I wanted to join you today to highlight the importance that health and development plays in our government’s foreign policy objectives.
And I want to convey, on behalf of the U.S. Government, that we appreciate the work of the many organizations represented here today, as well as local organizations in the countries where we work. I look forward to getting to know you and your work better in my new role.
The fight against HIV/AIDS is a central part of the global health and development agenda. In my remarks today, I’d like to share just a few thoughts on the broad health and development agenda for the new Administration, as well as highlight some of my priorities for PEPFAR.
Investing in health care is a critical component of smart power. Better health leads to improved safety, security, and prosperity for countries. Our efforts to fight the global AIDS epidemic reflect America’s leadership as a positive force for progress.
At the State Department, and throughout the Administration, there is a growing sense of the importance that health and development programs play in achieving our foreign policy objectives.
When I first visited the countries in Africa so devastated by AIDS over 10 years ago, I felt like I had been transported back in time to America before the advent of antiretroviral drugs, before hope, and when AIDS meant certain death.
I recall my frustration standing in hospital wards in Rwanda, South Africa, Zambia, Uganda, Burundi, and Cote d’Ivoire knowing that these deaths were, indeed, preventable. And I know that many of you share this frustration – which is why you are working to change the conditions that exist in far too many regions of our world.
As you are well aware, our government has spent many years responding, often at high cost, to situations of conflict that result from the cycle of poverty and disease. And from my perspective as a physician, I have seen the ways in which HIV, in particular, has been both a cause and consequence of poverty.
In that light, PEPFAR’s accomplishments over the last five years can only be characterized as enormous. But, while much has been done, there is still even more ground to cover.
Secretary Clinton has signaled her intention to elevate development as an equal pillar of our foreign policy, alongside diplomacy and defense.
Expanding opportunity and prosperity to more people – especially women – in more places around the world is clearly the right thing to do. But it’s also the smart thing to do. A more prosperous and secure world also translates into increased prosperity and security for our nation.
As we continue our critical work to address the humanitarian crises that emerge in regions with conflict, we need to make the investments necessary to prevent such crises from occurring in the future.
This Administration is doing so by ramping up efforts to fight poverty, food insecurity, and disease, with the goal of creating sustainability and durability, and giving countries and communities the tools necessary to continue long-term development progress.
Earlier this year, the President announced his Global Health Initiative. This initiative was designed to continue our country’s leadership on global health priorities like HIV, tuberculosis and malaria, and also expand our focus on maternal and child health, family planning, and neglected tropical diseases.
Through this initiative, we now have the opportunity to save the lives of more women, children and families in the developing world, advancing our core humanitarian values at the same time we’re enhancing political and economic stability.
An important component of this initiative is integration – not only integration of health care services, but increased integration of efforts among interagency partners. We need to reach beyond the boundaries of individual departments and bureaus to reach the common humanitarian goals of the U.S. government. We need to do so in close collaboration with our multilateral partners, and with civil society and the NGOs that many of you represent.
Most critically, we need to ensure that our efforts are conducted in true partnership with the countries in which we work, so that our efforts are coordinated and responsive. And to more fully ensure that these efforts are sustained.
The most effective and durable response to HIV and other diseases is one tailored to the specific situation in each country. Governments carry the long term responsibility of responding to their respective epidemics. Interventions must be integrated into each country’s overall health planning and grounded in local capacity. Our role must emphasize support of in-country efforts – more technical assistance, more collegial strategizing on country-identified problems.
Let me give you an example of how we’re working to put this principle into practice. PEPFAR is working with host country governments to develop Partnership Frameworks – five-year joint strategic frameworks designed to fully align PEPFAR HIV/AIDS assistance with national strategies.
Partnership Frameworks are an important strategy in streamlining efforts and looking for efficiencies in designing a national response to HIV. They will provide an essential opportunity to hold countries and partners – including ourselves – accountable for their contributions and results.
But in order for countries to contribute to HIV and other health programs, we must work on developing country capacity to plan, manage programs, finance, and deliver critical health services.
A critical goal of the Global Health Initiative is to engage in health systems strengthening. By using HIV treatment as a platform, PEPFAR support has strengthened and extended health systems in many areas including human resources, infrastructure, informatics, commodities logistics, and laboratory services.
Continued and intensified investment in strengthening health care systems, including the health workforce, will be crucial to scaling up proven interventions and adding to sustainability of PEPFAR and other health and development programs.
Building health systems to adequately respond to HIV/AIDS means systems that can better respond to other health issues. These can become a focal point for the convergence of other development activities focused on broader health concerns, including women and children’s health, people with disabilities, economic stability, gender equality and education.
Before I close, I would be remiss if I didn’t take this opportunity to highlight some of my priorities for PEPFAR. Some of them – increasing country ownership, transitioning to a durable program, and building capacity of health systems – are ones that I’ve already touched upon while discussing some of the larger U.S. government goals around development.
But I also want to stress the importance of identifying and expanding what we know works, and working to address our gaps in knowledge and practice, especially in the area of prevention.
It is imperative to identify effective interventions from the lab, clinical trials, and the field and take them to scale, reaching far greater portions of at-risk and infected populations with quality, effective service delivery. Basing decisions on concrete outcomes – medical, social and behavioral – has and will continue to uncover solutions to the challenges we encounter.
We cannot shy away from having difficult discussions around issues like HIV prevention. Globally, sexual transmission remains the primary driver of the epidemic. The scientific and implementing communities - including many of the organizations here today – continue to work tirelessly to identify evidence-based, effective and cost-effective behavioral, structural and biomedical interventions.
Our work must reflect real life – transient jobs, forced mobility, lack of economic opportunity, and the barrier of stigma in all its manifestations.
In addition, we must place a special emphasis on women and girls to address gender inequities, economic dependency, gender-based violence, lack of educational opportunity and access and linkages to broader health care.
PEPFAR has been an effective catalyst for change and the world is looking to us to continue our leadership – working closely with our global partners and partner governments, we can help reclaim the lives of millions of people who will otherwise be lost to the infection.
The history of PEPFAR has demonstrated what can happen when we dare to think big.
My mission is to ensure that PEPFAR continues to be a visionary program, a program that continues to exceed our expectations of what can and should be provided to people in resource-limited settings.
I believe that the example set by PEPFAR can help to guide our overall development vision, in order to allow us to develop and achieve ambitious goals.
Thank you very much for the opportunity to join you today, and for your partnership in the future.
And now, with the caveat that I am only a few days into my transition from infectious disease specialist to a broader development coordination position, I would be happy to address your questions.
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