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Strategic Objective
Strengthen America’s Efforts to Combat Global Health Challenges
Strategic Objective
Overview
U.S. efforts to improve global health advance our broader development goals and national security interests, and are a concrete expression of our humanitarian values. The State Department and USAID use diplomacy and foreign assistance programs to address U.S. government goals of creating an AIDS-free generation, ending preventable child and maternal deaths, and reducing the threat of infectious diseases. The U.S. government partners with multilateral institutions, donor nations, and other organizations to encourage and empower developing countries to build strong, sustainable health care systems. Expanding health care capacity abroad is essential to long-term development. Health is the largest component of U.S. development assistance.
U.S. investments that result in healthier people make for stronger, more prosperous, and more stable countries; they enhance international security and trade; and they ensure a safer, more resilient America. Despite successes in addressing health challenges in recent decades, in some places progress remains far too slow. Much remains to be done to strengthen health systems in developing countries and address HIV/AIDS, tuberculosis, malaria, and maternal and child mortality. In 2012, 6.6 million children under the age of five died, many from preventable causes. Infectious, life-threatening diseases such as pneumonia, diarrhea, and malaria are exacerbated by malnutrition and poor access to health services. Infectious disease outbreaks, whether naturally caused, intentionally produced, or accidentally released, remain among the foremost dangers to human health and the global economy. Many countries have limited capacity to prevent, detect, and rapidly respond to these threats.
Strategies for Achieving the Objective
The U.S. government has more than 10 years of experience in helping countries to rapidly expand HIV prevention, treatment, and care services through the President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR's current strategy, PEPFAR 3.0 - Controlling the Epidemic: Delivering on the Promise of an AIDS-Free Generation, showcases PEPFAR’s design to support the Joint United Nations Programme on HIV/AIDS (UNAIDS)ambitious 90-90-90 global goals: 90 percent of all people living with HIV will know their HIV status; 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90 percent of all people receiving antiretroviral therapy will have viral suppression by 2020. This new focus requires a shift in business practices, pivoting to a data-driven approach that strategically targets geographical areas and populations where we can achieve the most impact for our investments. The PEPFAR 3.0 strategy makes clear that the United States' commitment to this goal will remain strong, comprehensive, and driven by science. Importantly, this framework emphasizes impact, efficiency, sustainability, partnership, and human rights as core agendas to create an AIDS-free generation.
In 2012, the U.S. government joined more than 175 countries and 400 civil society and faith organizations in pledging to end preventable child deaths worldwide by 2035, as part of the Call to Action for Child Survival. The Call to Action joins related efforts that have set ambitious goals to end preventable maternal and newborn deaths, increase access to voluntary family planning, and accelerate improvements in malaria, nutrition, and water and sanitation. These renewed efforts have spurred strategic shifts in maternal and child health programming including: increasing efforts in those countries with the largest share of under-five deaths, focusing on reaching the most underserved populations, targeting the drivers of mortality through innovation and scalable interventions, and creating mutual accountability at all levels.
The Ebola outbreak in West Africa is a jarring reminder of the need for a greater capability in all countries to rapidly detect and respond to new or re-emerging public health threats that “spill over” in humans from animal populations. The Global Health Security agenda is an effort between the U.S. government, other nations, international organizations and public and private stakeholders, to accelerate progress toward a world safe and secure from infectious disease threats and to promote global health security as an international security priority. The State Department, along with other U.S. government agencies, contributes to global health security by strengthening policies related to dual-use research of concern.
The U.S. government will use its influence in multilateral and bilateral arenas to focus attention on accelerating achievement of U.S. global health objectives and the UN Millennium Development Goals. Continued diplomatic leadership on global health in the UN Post-2015 Development Agenda will remain a U.S. priority. Supported by the State Department and USAID, our diplomats and development professionals will promote country-owned health systems and encourage shared responsibility for financing health systems with partner governments, other donors, non-governmental organizations, and the private sector. Although U.S. positions on health in the Post-2015 Development Agenda have yet to be finalized, they will likely include a focus on creating an AIDS-free generation and ending preventable child and maternal deaths. The U.S. government is also considering incorporating new areas such as non-communicable diseases and a multi-sectoral focus on health system strengthening in the Post-2015 development goals.
Many external factors affect U.S. government efforts on country ownership and shared responsibility. A successful transition to country ownership depends on political stewardship by partner governments and the administrative and technical capabilities of numerous public and private institutions. Fiscal pressures on traditional donor countries will likely continue to negatively affect their ability to support multilateral initiatives. Steady economic growth in many regions, and particularly in Africa, will create opportunities for countries to direct more domestic resources toward their health sectors.
The U.S. government, through the Senator Paul Simon Water for the Poor Act of 2005 and newly-signed Senator Paul Simon Water for the Poor Act of 2014, is committed to using its foreign assistance resources to help people and countries have reliable and sustainable access to an acceptable quantity and quality of water to meet their needs. USAID supports increased access to reliable and sustainable water supply and sanitation through funding for infrastructure development and through institutional and capacity development, strengthening of community-based systems, facilitation of private supply of products and services, improved management and governance, and mobilization of additional financing.
Read Less...Progress Update
The Department of State and USAID have determined that performance towards this objective is making noteworthy progress.
Ending Preventable Child and Maternal Deaths (EPCMD):
The world has made remarkable strides in both public and private efforts toward saving the lives of women and children, yet maternal and child mortality remains a critical problem in developing countries. Child deaths decreased by 46 percent from 1990 to 2012, and maternal deaths decreased by 45 percent from 1990 to 2013. While these global mortality declines since 1990 are impressive, recent estimates indicate that each year more than 289,000 women still die from complications during pregnancy or childbirth and there are still 6.3 million deaths of children under five years of age – 43 percent of which are in the first month of life. Approximately three-quarters of these child and maternal deaths are preventable with currently available interventions.
Together with country partners, international organizations, and nongovernmental organizations from around the globe, the United States is working toward targets that will truly represent an end to preventable child deaths––with all countries having fewer than 20 deaths per 1,000 live births and fewer than 50 maternal deaths per 100,000 live births by 2035. The related Agency Priority Goal is to reduce under-five mortality by 4 deaths per 1,000 live births in our priority countries by the end FY 2015 (as compared to FY 2013).
Improvements in mortality outcomes are the result of increasingly effective efforts to link diverse health programs in maternal and child health, malaria, family planning’s contribution to the healthy timing and spacing of pregnancy, nutrition, HIV/AIDS, and sanitation and hygiene improvement. All of these efforts contribute to ending preventable child and maternal deaths.
The U.S. government cannot achieve these goals alone. To achieve this objective the U.S. must encourage country ownership and invest in country-led plans while continuing to challenge the global community to support this global goal. The U.S. government approach works with partner countries to address these primary drivers by building sustainable health systems that can address the full range of developing country health needs.
On June 25, 2014, USAID and the Governments of Ethiopia and India, in collaboration with United Nations Children’s Fund (UNICEF), the Bill & Melinda Gates Foundation, and other partners, came together for a high-level forum: Acting on the Call: Ending Preventable Child and Maternal Deaths, to celebrate the progress, assess the challenges that remain, and identify the steps needed to sustain momentum in the future.
To accelerate efforts toward this goal, in FY 2014, USAID is providing over $2 billion, with the bulk of the resources going toward the 24 priority countries where the majority of child and maternal deaths occur. USAID continues to work to ensure that our programs and budgets are focused on the key drivers of child and maternal deaths and to support state-of-the-art, evidence-based programs to ensure we meet our goals.
Shared Responsibility – Strengthen Results for an AIDS-Free Generation:
PEPFAR represents America’s commitment to saving lives, controlling the HIV/AIDS epidemic, and working with our partners to achieve an AIDS-free generation. Reaching the goal of an AIDS-free generation is a shared responsibility among host country governments, civil society, faith-based organizations, development partners, multilateral organizations, the private sector, and others. PEPFAR remains firmly committed to its foundational principles of making smart investments based on sound science, good public health, a human rights approach, and focusing on the accountability, transparency, and impact of our work.
At the end of FY 2014, PEPFAR supported more than 7.7 million men, women, and children worldwide on life-saving antiretroviral therapy (ART). In FY 2014, PEPFAR supported HIV testing and counseling (HTC) for more than 56.7 million people, providing a critical entry point to prevention, care and treatment. Of those receiving PEPFAR-supported HTC, more than 14.2 million were pregnant women. For the approximately 745,000 of these pregnant women who tested positive for HIV, PEPFAR provided antiretroviral medications for PMTCT. In FY 2014 alone, due to PEPFAR support, 95 percent of these babies were born HIV-free (including 240,000 that would otherwise have been infected). From FY 2013-14, more than 1.5 million HIV-positive pregnant women received these interventions to prevent mother-to-child transmission and improve maternal health. By the end of calendar year 2014, PEPFAR supported a cumulative total of 6.5 million voluntary medical male circumcisions (VMMC) for HIV prevention procedures in east and southern Africa. In FY 2014, PEPFAR also supported more than 17 million people with care and support, including 5 million orphans and vulnerable children.
To accelerate progress, PEPFAR is further increasing its efficiency and maximizing its impact. This includes driving down the cost of commodities; employing the highest yield interventions and targeting specific geographic areas, populations, and risk behaviors; utilizing site-level and expenditure analysis data to rigorously monitor program impact; expanding HIV services access while maintaining high-quality care; and strengthening coordination with other donors, particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria, to reduce duplication, leverage our collective buying power, and optimize our combined efforts.
Water and Sanitation:
USAID’s Water and Development Strategy sets the overall goal of saving lives and advancing development with the first strategic objective to improve health outcomes through improvements in water supply, sanitation, and hygiene (WASH) programs. USAID has set a target of reaching a minimum of 10 million persons with sustainable access to improved water supply and six million persons with sustainable access to improved sanitation over the period of 2013 - 2018. The Strategy has added emphasis to sustainability, safe water, and sanitation.
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Strategic Goals
Strategic Goal:
Strengthen America’s Foreign Policy Impact on Our Strategic Challenges
