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Dr. Ariel Pablos-MendezAssistant AdministratorBureau for Global Health, USAID
Goal Overview
USAID with its partners in the U.S. Government and the global community are committed to the goal of ending preventable child and maternal deaths. While many challenges remain, today, more than ever, we are equipped with the tools and knowledge to reach this goal. The health of mothers and children around the world is linked to improvements in maternal health, which inherently affect child health. Over the past two decades, there has been a nearly 50 percent reduction in maternal deaths, from 543,000 in 1990 to 287,000 in 2010. Meanwhile, the annual number of under-five deaths declined from 12.6 million in 1990 to 6.6 million in 2012. While under-five mortality is declining faster now than in the past two decades, with the annual rate of reduction more than tripling in 2005-2012 compared to the rate in 1990-1995, 18,000 children still die every day. The U.S. cannot act alone and in order to meet the Millennium Development Goal Four (Reduce Child Mortality) target by its agreed date of 2015, an additional 3.5 million children's lives above the current trend rate will need to be saved between 2013 and 2015.
Strategies
The June 2012 Child Survival Call to Action was a high-level forum convened by the governments of Ethiopia, India, and the United States, in collaboration with UNICEF, that challenged the world to reduce child mortality to 20 or fewer child deaths per 1,000 live births in every country by 2035.Reaching this historic target will save an additional 45 million children’s lives by 2035.USAID used the momentum of the Child Survival Call to Action and its follow on initiative, A Promise Renewed, to increase its focus on five countries that collectively account for one-half of global child deaths: Ethiopia, the Democratic Republic of the Congo, India, Nigeria, and Pakistan.These governments are already sharpening plans and accelerating efforts to reduce maternal and child mortality; for example, Nigeria has committed $500 million over four years to support frontline health workers and improve rural health facilities and Pakistan is developing a scorecard that will track progress at the federal and provincial level.
USAID programs have contributed to accelerated maternal mortality declines in 24 maternal and child health priority countries at an average rate of five percent per year, faster than the global average.Attendance at birth by a skilled provider has increased from 26.9 percent to 50.0 percent between 1990 and 2012, increasing access for women to life-saving interventions in some of the world’s most challenging environments.
USAID’s strategy to accelerate reduction in preventable maternal deaths includes the promotion of respectful care and high-impact interventions for the major causes of death, especially postpartum hemorrhage and preeclampsia/eclampsia, strengthening health systems, and changing family and community behaviors to access maternity care.USAID programs take into account and address cultural and financial factors that limit utilization of life-saving care.Programs pay special attention to strengthening care during labor, delivery, and the first vital 24 hours postpartum, a particularly vulnerable time for women and their infants.Increasingly, USAID programs are incorporating new approaches and technologies, including mobile phones, to speed progress and are improving measurement of pregnancy outcomes.
As part of efforts to scale-up integrated care for children, USAID promotes low-cost, evidence-based interventions to reduce pneumonia and diarrhea mortality.By the end of 2012, through partnership with the GAVI Alliance, the pneumococcal conjugate vaccine has been introduced in 24 countries and rotavirus vaccine in 12 countries.Many more countries are approved for and working to introduce pneumococcal and rotavirus vaccines by 2015.Other interventions to protect against pneumonia and diarrhea include exclusive breastfeeding and vitamin A supplementation, practices such as proper hand washing with soap, and improving the quality of drinking water and access to adequate sanitation.
In an effort to multiply the effect of key interventions, USAID continues to improve the treatment of pneumonia and diarrhea diseases by expanding the number and quality of frontline health workers who can treat pneumonia and diarrhea.With USAID support, health workers are integrating treatment and case management of these diseases into their daily work through appropriate use of antibiotics, oral rehydration salts (ORS), and zinc. Integrated community case management (iCCM) of childhood illness is one strategy to reduce morbidity and mortality in the under-five population by providing the delivery of high-quality services through community health workers to underserved and hard-to-reach populations.Many countries are still in the early stages of their iCCM programs, while a few countries have begun to implement the approach on a national scale.In three countries where USAID supported integrated iCCM for pneumonia, diarrhea and malaria in 2012, more than 45,000 children under five with pneumonia were treated by trained facility or community health workers.
Most of the interventions needed to reduce child deaths are inexpensive and straightforward – provide children with bednets, vaccines, and oral rehydration solution and zinc; promote healthy nutrition during pregnancy; have mothers give birth with someone experienced by their side; support exclusive breastfeeding; use voluntary family planning to ensure healthy timing and spacing of pregnancies; and help a newborn baby breathe following birth. USAID’s long-term investments in these and other key interventions have been paying dividends towards promoting child survival.
Progress Update
Overview
USAID, with its partners in the U.S. Government and the global community, is committed to the goal of ending preventable child and maternal deaths (EPCMD). All women deserve to give birth safely, and all children — no matter where they are born — deserve the same chance to survive and thrive. For the first time in history, there exist the tools, technologies, and approaches to end extreme poverty and its most devastating effects – including widespread hunger and preventable child death – within two decades. USAID focuses efforts on the set of 24 priority countries that account for nearly 70 percent of child deaths worldwide.
Over fiscal years (FY) 2014-2015 USAID met or exceeded all but one of its two-year targets for its six indicators for the Global Health Agency Priority Goal (APG) for EPCMD.
USAID continues to mobilize international action through evidence-based interventions to address major health challenged facing women and children. USAID priority countries experienced a decline in the absolute change in under-five mortality (U5MR) rate of 2.0 deaths per 1,000 live births in FY 2014 (meeting the target of 2.0) and 1.7 deaths per 1,000 live births in FY 2015 ( which is significant, sustained, progress though falling short of the target of 2.0). A major component of EPCMD is ensuring access to and use of family planning contraceptives. By enabling women and couples to practice healthy timing and spacing of pregnancies and providing family planning commodities, family planning could reduce maternal deaths by 30 percent and child deaths by 25 percent globally. For USAID’s quarterly indicator percent of shipments of contraceptive commodities that are on time, USAID exceeded the target six out of eight quarters, met the target once, and fell short of the target once. In FY 2014, USAID exceeded the target of 90 percent, averaging 90.75 percent over the four quarters. In FY 2015, USAID exceeded the target of 90 percent with an average of 93.5 percent.
An important component of saving the lives of women during and around childbirth is ensuring skilled health professionals attend all births. Timely management and treatment are needed to address the causes of maternal mortality, including severe bleeding, high blood pressure, and infection. USAID exceeded its targets for the percentage of births attended by a skilled doctor, nurse of midwife (SBA) by 7.5 percent in FY 2014 and 2.1 percent in FY 2015.
The Annual total percentage of children who received DPT3 (diphtheria, pertussis [whooping cough] and tetanus) by 12 months of age exceeded the target in both years, increasing from 74.5 percent in FY 2014 (with a target of 61.1 percent) to 80 percent in FY 2015 (with a target of 75.0 percent). For full protection, the series of DPT vaccine require a child to receive three doses at various time points before their first birthday. Therefore, DPT3 coverage serves as a gauge of how well countries are providing immunization coverage for their children, providing an important indicator of USAID’s priority goal of EPCMD in the 24 priority countries.
Children under five years of age are one of most vulnerable groups affected by malaria. The President’s Malaria Initiative (PMI) PMI includes 19 focus countries in Africa and one regional program in the Greater Mekong sub-region. PMI coordinates its procurement and distribution of insecticide treated nets (ITNs) with other major donors including the Global Fund, the World Bank, and UNICEF. ITNs are a proven and highly effective malaria prevention and treatment measure. For the indicator annual total number of people protected against malaria with insecticide treated nets, USAID’s malaria project surpassed its target in FY 2014 and FY 2015, protecting 89 million people against malaria in FY 2014 (target of 45 million) and 72 million in FY 2015 (target of 50 million).
Increased contraceptive use leads to decreases in unintended pregnancies and abortion rates and slows population growth over time. The indicator absolute change in modern contraceptive prevalence rate (MCPR) measures the percentage of in-union women of reproductive age (15-49 years) using, or whose partner is using, a modern method of contraception at the time of the survey. In FY 2014, USAID met its target of 1.0 percentage point increase in MCPR across the USAID-assisted 24 priority countries. In FY 2015, USAID achieved a 1.3 percentage point increase, exceeding the target of 1.0.
In addition, USAID completed all Global Health milestones, including the joint USAID, World Bank, and World Health Organization Summit. In June 2015, USAID, the World Bank and the World Health Organization (WHO) convened a global summit on Measurement and Accountability for Results in Health, bringing together decision makers and thought leaders representing governments, multilateral agencies and civil society. The Summit defined a new health measurement and accountability strategy, which articulates a shared agenda for the global health community, and resulted in the Roadmap for Health Measurement and Accountability. The Roadmap clearly outlines smart investments that can be adopted at the country level to strengthen basic measurement systems and align partners and donors around common priorities.
Explanation of Results
Ending preventable child and maternal deaths requires a health service delivery system that provides high-quality, equitable, and sustainable essential services to women, newborns, and children. USAID’s equity-focused approach prioritizes services for the poorest and the most marginalized. This approach is supported by work in health governance that equips local governments to effectively plan, manage, and finance high-quality maternal and child care services and commodities.
During FY 2014 and FY 2015, USAID’s programs across maternal, newborn, and child health; family planning; malaria; and nutrition aggressively targeted the drivers of death and disease. Successes from this approach are evidenced by USAID’s progress in meeting or exceeding six out of six indicators in FY 2014 and five out of six indicators in FY 2015.
For the FY 2014-2015 indicators, the FY 2015 under-five mortality rate indicator was the only one that fell short of the annual target. While the decline of 1.7 was below the target of 2, it was neither unexpected nor an indication of poor performance. Rather, as USAID begins closing the gap between developing and developed country mortality rates, and making progress toward the Agency goal of ending preventable child deaths, USAID expects the absolute change to decrease from year to year.
PMI coordinates its procurement and distribution of ITNs with other major donors including the Global Fund, the World Bank, and UNICEF. PMI exceeded the projected target due to a mass universal coverage campaign that was scheduled and successfully implemented in Uganda in FY 2014 and Nigeria in FY 2015.
Challenges and Opportunities
USAID will continue to report on the six FY 2014-2015 indicators for its FY 2016-2017 Global Health APG. These indicators focus on high-impact child and maternal interventions with support for essential health system and human resource improvements. Sustainable and equitable maternal, newborn, and child health programs depend on the overall quality of the health system. USAID selected the priority countries because they have weak health systems, particularly for the delivery of primary health services. In these high-burden countries, health systems are challenged by weak overall capacity, including lack of leadership and management skills; inadequate financing and budgetary allocations; and poor supply chains and infrastructure. In addition, many of these countries have had services disrupted in recent years by disasters (e.g. earthquakes), conflict, and population displacement.
USAID continues to address bottlenecks and identify challenges that impact results, so that it can ensure family planning commodities continue to be available where needed. In the delivery of family planning commodities, preclearance, custom clearance and manufacturing delays vary from country to country and can affect the timely shipment of procurements. Overcoming these obstacles involves working closely with other USAID projects, missions, and partner country governments; the introduction of new in-country clearance agents better equipped to manage the clearance process; a change in the shipping lane assignment; and adjustment of the order lead times for procurement planning purposes.
One cannot underestimate the difficulty in achieving higher coverage of skilled birth attendants, given the significant challenges of sufficiently training and maintaining critical staff, as well as supporting health facilities and systems in adequately addressing the barriers to women seeking care. To help support continued increases in skilled birth attendant coverage, USAID will continue to work in close collaboration with host country governments to help train, deploy, and motivate skilled birth attendants, in addition to strengthening existing systems for quality management and quality improvement and reducing barriers to use of services.
Finally, while DPT3 coverage across 24 USAID-assisted countries increased in FY 2015 to 80 percent, limited increments in future year targets are due to the challenge in the 24 USAID priority countries of reaching an entirely new birth cohort with all routinely recommended vaccines each year. USAID continues to strive for high vaccination coverage, an effort that can be difficult to maintain in the presence of extreme weather events, disasters, conflict, failing health infrastructure, supply chain problems, and population displacement.
Next Steps
No Data Available
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Performance Indicators
Modern contraceptive prevalence rate
Contraceptive commodities
Under-five mortality rate
Births attended by skilled birth attendants
DPT3
People protected against malaria with insecticide treated nets
Contributing Programs & Other Factors
Contributing programs within the agency: USAID health assistance programs that address ending preventable child and maternal deaths include: 1) Malaria; 2) Maternal and Child Health; 3) Family Planning and Reproductive Health; and 4) Nutrition.
Contributing programs or partners outside the agency: The USAID Assistant Administrator for Global Health leads efforts to achieve the Global Health Agency Priority Goal. Several other USG initiatives contribute to this effort, including the President's Emergency Plan for HIV/AIDS Relief, the President's Malaria Initiative, and Feed the Future. The Department of State, the Centers for Disease Control and Prevention, the Department of Health and Human Services, the Peace Corps, and the Millennium Challenge Corporation are also key partners and contributors. USAID also works closely with host country governments, key international bilateral and multilateral partners, non-governmental organizations, and for-profit partners to achieve these goals.
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Strategic Goals
Strategic Goal:
Strengthen America’s Foreign Policy Impact on Our Strategic Challenges
Statement:
Strengthen America’s Foreign Policy Impact on Our Strategic Challenges
Strategic Objectives
Statement:
Description:
We will strengthen America’s foreign policy impact as we work independently and with our partners to build a new stability in the Middle East and North Africa. Success in this endeavor is essential to U.S. global interests and is linked to other pressing challenges and opportunities for U.S. national security: preventing Iran from acquiring a nuclear weapon remains a top priority; terrorist groups active in the region continue to seek the capability to attack our allies, interests, and homeland; the region’s strategic energy supplies are essential to support the global economy; and regional stability and Middle East peace efforts are vital for the security of Israel and our other friends in the region.
Recent events have again demonstrated the need to look beyond traditional security concerns and consider the full range of issues that affect and contribute to regional stability. A new regional stability will be built on the premise that increased democracy with respect for the rights of all citizens of a country, including minorities, will benefit both the region and the United States. Regional stability must be built on a foundation of responsive and accountable governance, inclusive economic growth, and rights-respecting and capable security institutions.
The crisis in Syria embodies these complex challenges. The Asad regime has violently defied the Syrian people’s demands for reform, and the regime’s brutality has destabilized the region through its partnership with Iran and the regime’s increasing reliance upon Hizballah. Neighboring states, including Lebanon, Jordan, Turkey, and Iraq, struggle to cope with vast refugee flows, spillover violence, and, in the case of Lebanon, serious threats to political stability.
Strategies for Achieving the Objective
The United States will build regional stability by working toward a comprehensive Middle East peace; forging strong partnerships to address regional threats; supporting economic growth and prosperity; and promoting democratic governance and political reforms, among other measures.
Working towards a comprehensive Middle East Peace between Israel and the Palestinians, and Israel and its neighbors:
The United States is committed to a just, lasting, and comprehensive peace in the Middle East, central to which is a two-state solution to the Israeli-Palestinian conflict. We define comprehensive peace as peace between Israel and a future Palestinian state, as well as between Israel and its neighbors. With the resumption of Israeli-Palestinian negotiations in July 2013, Middle East peace efforts now focus on the conclusion and full implementation of a final status agreement and the realization of the 2002 Arab Peace Initiative, which promises normalization of relations between Israel and Arab League states in the context of a comprehensive peace. Should the efforts of the United States and the international community succeed in a two-state resolution to the conflict, U.S. assistance will remain critical in building Palestinian governance capacity and implementing an agreement. Comprehensive peace also will require Israel and a Palestinian state to normalize political and economic relations with the region.
The United States is building strong partnerships to address regional security threats. The United States will work with international partners to ensure that Syrian chemical weapons are removed and eliminated and that Syria complies with the Chemical Weapons Convention, UN Security Council resolutions, and Organization for the Prohibition of Chemical Weapons requirements. We will continue to deliver humanitarian assistance to affected communities inside Syria and in neighboring countries, and to work to achieve a negotiated political solution that ends the violence in Syria and begins a political transition. The United States will continue our unwavering commitment to Israel's security.
Egypt continues to face economic and political instability, while Jordan struggles to handle an influx of refugees from Syria even as it simultaneously addresses dire economic challenges, including an energy crisis.
Build strong partnerships to address regional security threats:
U.S. strategic partnerships, globally and within the region, enhance our security efforts on counterterrorism and nonproliferation. We will continue to work with the P5+1 (the United States, United Kingdom, Germany, France, Russia, and China, facilitated by the European Union), the broader international community, and international organizations like the International Atomic Energy Agency (IAEA) to ensure that Iran complies with its obligations under the Nuclear Nonproliferation Treaty (NPT), and relevant UN Security Council resolutions.
Building upon the work at the NATO Summit in Wales, Jeddah Conference, and U.N. General Assembly meetings in September 2014, we will continue to strengthen the global coalition formed to defeat the Islamic State of Iraq and the Levant (ISIL) through humanitarian and security assistance to partner countries in the region threatened by ISIL. This also includes coordinating broad efforts to counter terrorist financing the flow of foreign fighters within and through the region.
The United States seeks to achieve a comprehensive agreement that fully resolves the international community’s concerns with Iran’s nuclear program. Syria’s accession to the Chemical Weapons Convention was a major accomplishment. In cooperation with like-minded international partners, we have dismantled one of the largest remaining chemical weapons arsenals in the world and eliminated those weapons as a strategic threat to Israel. We will continue to work to achieve a negotiated solution that ends the violence in Syria and begins a political transition.
In addition, U.S. security cooperation and assistance to our partners will cover all aspects of counterterrorism, including legal frameworks and rights-respecting security approaches. We will undertake efforts to prevent and mitigate extremism, sectarian conflicts, and mass atrocities; and we will counter Iran's destabilizing activities in the region. We will also emphasize our work with states undergoing democratic transitions to assist them in establishing the capacity to provide a stable and rights-respecting domestic security environment.
The Syrian regime could resist a negotiated settlement to its current situation. Terrorist organizations may take advantage of regional instability, fragile security environments in transition countries, and ongoing conflicts to launch attacks. Governments backsliding on democratic transitions could further endanger long-term regional stability. We must continue to undermine the violent extremist narrative by encouraging states to establish democratic and accountable institutions thereby supporting our needs to advance our broader regional security priorities.
Promote economic growth, job creation, open markets, and energy security:
The United States will address economic marginalization through the promotion of economic growth, job creation, open markets, and energy security. Economic growth and inclusive prosperity fueled by private sector development, increased investment, and inclusive employment are fundamental to regional stability and to counter the terrorist narrative. The free flow of energy resources to the global economy is critical to promoting economic prosperity. Sound regulatory, economic, education, and health policies are needed for enduring private sector expansion and stable employment. Achieving these goals requires coordination with partners to design and implement reforms. We will need to partner with governments and the private sector in the region as they develop economic incentives, protect critical infrastructure, and achieve local backing for reforms. We will support implementation of projects that increase access to finance for small and medium enterprises. We will encourage sound fiscal and economic policies and improved regulation to attract private investment and spur growth. We also will support development of improved regulatory and rules-based markets to attract foreign investors to the region, including U.S. businesses.
Setbacks to the global economic recovery, particularly in European markets, could have negative effects in the region. Regional conflicts, security deterioration, and increased acts of terrorism would deter investment, undermine growth, and threaten energy supplies. The influx of Syrian refugees into neighboring countries could have a crippling effect on the respective country’s financial stability. We will work to sustain the positive synergies and mutual reinforcement between security, democratic political reforms, and economic growth.
Promote improved, democratic governance, empowered and effective civil society, and respect for the rule of law and human rights:
The United States will continue to support democratic governance, civil society, and respect for the rule of law and human rights. Responsive, inclusive, and accountable governance serves as the strongest foundation for long-term regional stability. Governments and societies that are more inclusive, equitable, and representative are better positioned to address challenges and to partner with the United States. We will, therefore, promote government institutions that are democratic, responsive to citizens, respect minority rights, and deliver public services transparently and equitably; legislatures that represent constituent interests; and expanded opportunities for meaningful political participation by all citizens. Many civil society groups in the region lack capacity. We will support the development of civil society that is effective, empowered, and able to interact constructively with government. And we will work to strengthen and improve legal systems and weak government institutions in the region, expand access to justice, promote greater respect for human rights, and empower women, minorities, and other marginalized groups.
Factors beyond the U.S. government's control may affect our efforts in the region. The Syrian regime could resist a negotiated settlement to the conflict. Terrorist organizations may take advantage of regional instability, fragile security environments in transition countries, and ongoing conflicts to launch attacks. Governments rejecting or backsliding on reform could further endanger long-term regional stability. Other factors that may affect our efforts include setbacks to the global economic recovery, particularly in European markets, that could have negative effects in the region. Regional conflicts, security deterioration, and increased acts of terrorism could deter investment, undermine growth, and threaten energy supplies. The influx of Syrian refugees into neighboring countries also places added financial costs and demands on the infrastructure in hosting communities, as well as on social services, such as education and health care.
Countries in the region face serious challenges, including stagnant growth and lack of economic opportunity; internal and cross-border conflicts and associated refugee flows; resource scarcity; religious and ethnic tension and discrimination; and a demographic youth bulge. We are convinced that responsive and accountable governments are more capable of addressing those challenges, and are committed to use our engagement, influence, and assistance to help address them.
Statement:
Description:
The United States “rebalance” to the Asia-Pacific reflects the recognition that the future security and prosperity of our nation will be significantly defined by events and developments in that region. The United States must enhance and deepen its strategic engagement and leadership role to influence and benefit from a rising Asia-Pacific. At a time when the region is building a more mature security and economic architecture to promote stability and prosperity, sustained, active U.S. engagement is essential. U.S. leadership will help strengthen that architecture and pay dividends for our security and prosperity well into this century. The U.S. goal in the Asia-Pacific is to establish a stable security environment, an open and transparent economic environment, and a political environment that respects universal rights and freedoms. Our efforts will yield benefits for the region and increase the economic prosperity and security of the United States.
Maintaining peace and security across the Asia-Pacific is central to global progress, whether through halting North Korea’s proliferation activities, defending freedom of navigation and managing growing tensions over territorial disputes, or ensuring transparency in the region’s military activities. Supporting trade liberalization and economic development in the region stands at the center of American economic and strategic interests, and is a key U.S. priority. U.S. economic vitality depends, in part, on the extent to which our private sector can access the opportunities offered by the Asia-Pacific’s growing consumer base. Open markets in the region provide the United States unprecedented opportunities for commercial engagement and expansion of trade and investment ties. Adherence to our nation’s values – in particular, our steadfast support for democracy and human rights – greatly enhances our credibility, stature, and authority. Strengthening and deepening people-to-people ties across the region underpins the goals of the rebalance.
While the Asia-Pacific is widely recognized as a region of economic dynamism, it is also home to 29 percent of the world’s poor and the site of 60 percent of the globe’s natural disasters. Many countries in the region face challenges associated with weak institutions, inadequate rule of law, and rising inequality. The United States seeks to help our partners in the region ensure that, as economies grow, the benefits of this growth are shared by those who are most in need.
Strategies for Achieving the Objective
The United States has strong and historic strategic ties and trade linkages with the Asia-Pacific, which is home to the world’s fastest growing economies. Treaty alliances with Australia, Japan, the Philippines, the Republic of Korea, and Thailand form the cornerstone of our strategic position in the Asia-Pacific. To meet transnational threats of terrorism, violent extremism, cybercrime, and nuclear, chemical, and biological proliferation, the United States supports Asia-Pacific partners as they adopt internationally recognized legal and policy frameworks, and build their capacity to deter and mitigate these pressing threats. In cooperation with the Department of Defense and other national security agencies, our diplomats and programs help maintain peace and security across the Asia-Pacific through efforts to achieve verifiable denuclearization of the Korean Peninsula, halt North Korea's proliferation activities, maintain freedom of navigation, discourage aggressive acts, and promote increased transparency in military activities.
The United States’ comprehensive economic agenda for the region combines expansion of trade and investment with greater regional economic integration. U.S. trade and investment ties with the Asia-Pacific region underpin the nation's prosperity and influence across the region. The United States is promoting development of a rules-based regional economic and trade framework that provides an open and fair commercial environment. Concluding the Trans-Pacific Partnership (TPP) agreement, the centerpiece of our economic strategy in the region, is the most important step we can take to advance prosperity in the Asia-Pacific. The TPP, with 12 members uniting Asia and the Western Hemisphere across the Pacific Rim, will foster economic growth and facilitate regional economic integration as membership expands. In collaboration with other U.S. government agencies and the private sector, the Department will also build on past successes within the Asia-Pacific Economic Cooperation (APEC) forum to foster trade and investment liberalization and strengthen regional economic integration, including initiatives on climate change and environmental protection, disaster resiliency, and health security. The Department of State is conducting sustained diplomatic efforts to reduce greenhouse gas emissions among Asia’s biggest economies. We will increase U.S. development assistance to foster trade ties, entrepreneurial activity, cleaner and more secure energy, food security, and economic empowerment of women in the region. Continued U.S. support for Taiwan maintains peace and stability in the Taiwan Strait, underpins economic and commercial relations with our 10th largest trading partner, and reinforces U.S. support for democracy and human rights.
The United States is modernizing its treaty alliances to provide the flexibility to effectively respond to traditional and non-traditional security challenges. The United States seeks to strengthen partner capabilities and policies to address shared challenges and to bolster a rules-based order that operates in accordance with international laws, norms, and standards. Strengthened partnerships with Burma, Indonesia, Malaysia, and Vietnam contribute to regional stability and prosperity. A cooperative partnership with China will strengthen U.S. national security, promote trade and economic growth, and help address transnational challenges. The United States’ engagement with Burma supports and encourages its political and economic reforms and national reconciliation. Mongolia, New Zealand, and Pacific Island countries are important partners through their contributions to peacekeeping activities, UN votes, and efforts that align with our international economic and security priorities. People-to-people activities, including continued outreach to international exchange alumni, play a critical role in building support within these countries for sustained partnerships with the United States.
The United States engages regional institutions and groupings such as the Association of Southeast Asian Nations (ASEAN), the ASEAN Regional Forum, East Asia Summit, APEC, Lower Mekong Initiative (LMI), and the Pacific Islands Forum to reinforce our bilateral relationships and advance our economic, political, and security interests with regional allies and partners. U.S. engagement with these bodies helps them establish and implement rules and norms consistent with the international norms that promote peace and stability, spur greater economic growth, and enable the region to respond more effectively to security threats and manage crises.
Across the Asia-Pacific, the United States is promoting democratic practices and improved governance, quality health and education, food security, strengthened disaster preparedness/emergency response, and improved environmental stewardship. Democratic development will contribute to greater civilian security, stability, and prosperity and stronger ties throughout the region. Strong democratic institutions and responsive governments provide the framework that paves the way for solid economic growth, improved health outcomes, greater food security, quality education, strengthened emergency response, adaptability to climate change, and stronger livelihoods overall.
Statement:
Description:
Despite the worldwide reduction of deaths from armed conflict since the end of the Cold War, more than 1.5 billion people live in fragile or conflict-affected states or countries trapped in cycles of violence. Fragility and conflict impede development and undermine U.S. interests worldwide. When states in crisis cannot control their territory, protect their people, or support economic growth, the resulting instability disrupts the people’s well-being and fosters environments ripe for violent extremists, armed factions, weapons proliferation, and crime. Fragile countries are especially vulnerable to shocks, such as natural disasters and economic crises, and their spillover effects. Complex emergencies may arise that put demands on scarce humanitarian assistance resources.
The U.S. government leads the international community in responding to crises, conflicts, and natural disasters. An estimated 45 million people worldwide, primarily women and children, have been uprooted from their homes due to conflict and persecution. Each year, natural disasters displace tens of millions more and climate change is increasing the frequency and intensity of events such as hurricanes and drought. U.S. humanitarian assistance aims to save lives, alleviate suffering, and minimize the costs of conflict, crises, disasters, and displacement. This requires that the United States respond urgently to emergencies, and make concerted efforts to address hunger, resolve protracted humanitarian situations, and build the capacity to prevent and mitigate the effects of conflict and disasters.
Most natural disasters such as drought or floods cannot be prevented. However, the U.S. government aims to enhance the resilience of countries so that they can respond and recover as quickly as possible. Strengthening resilience enables our humanitarian assistance to start the rebuilding and transition to long-term political, economic, and social investments that will consolidate and protect future development gains.
Strategies for Achieving the Objective
The United States will convene stakeholders, marginalize spoilers, and catalyze local efforts aimed at preventing and responding to crisis and conflict. U.S. diplomacy will support peace and reconciliation efforts at the national, regional, and local levels; and it will encourage parties to negotiate solutions, to manage peaceful transitions, and to hold accountable perpetrators of mass atrocities. To strengthen fragile states, U.S. diplomacy and development will promote inclusive economic growth, job creation, and the sound policies needed for sustainable private sector expansion and stable employment. The U.S. will direct resources to support local initiatives and to build the capacity of civil society actors so they can successfully advocate for peaceful change. The U.S. National Action Plan on Women, Peace, and Security (NAP) demonstrates that integrating women and gender considerations into peacebuilding processes promotes democratic governance and long-term stability. As such, we will strengthen women's rights, leadership, and substantive participation in peace processes, conflict prevention, peacebuilding, transitional processes, and decision-making institutions in conflict-affected settings. Finally, we will multiply the impact of our efforts by engaging the UN and partner governments, and will strengthen partnerships with the private sector and experts outside of government.
The United States will expand and improve U.S. government activities that lead to effective strategies, policies, diplomacy, and development programs that avoid negative impacts ("Do no harm") on conflict dynamics, and create the potential to manage and mitigate sources of violent conflict. The United States will promote learning agendas, and share lessons learned and best practices. And through interagency collaboration, policy development, enhanced professional training, and evaluation, the United States will institutionalize a gender-sensitive approach to our diplomatic and development activities in conflict-affected environments.
UN peacekeeping operations represent the international collective will to promote peace and reconciliation. The United States will continue as the largest financial contributor to UN peacekeeping operations. The United States will use its contributions to promote effective operations, including strengthening mandates to address the needs and vulnerabilities of women and children in conflict and post-conflict zones. The United States will also continue to support regional and sub-regional organizations and their member states as they seek to provide a cost-effective regional capacity for conflict management and crisis response.
The U.S. government will support country transitions out of fragility and political instability by fostering more inclusive, responsive, accountable, and democratic institutions. The United States will support and strengthen institutions, especially those relating to safety and justice, to manage and mitigate sources of violent conflict, including gender-based violence. The United States will support civil society actors that advocate and work toward greater civilian security.
The U.S. government will advocate policies and norms that prevent violence and protect vulnerable populations. The United States will press to strengthen norms concerning the protection of civilians, to prevent, mitigate, and redress mass atrocities, to prevent and respond to gender-based violence, and to empower women's participation in political transitions and peace processes.
The U.S. government will provide needs-based humanitarian assistance through flexible and timely funding for persons affected by crises, conflicts, and natural disasters. Through collaboration with other donors and host countries, the United States will find solutions to displacement, promote disaster risk reduction and climate
change adaptation, and will foster resilience. In line with the NAP, the United States will respond to the needs of women and children in conflict-affected disasters and crises, including by providing safe, equitable access to humanitarian assistance.
The U.S. government will promote rapid and well-planned humanitarian responses through support to the United Nations, Red Cross organizations, and Non-governmental organizations; mobilize and partner with other donors and host governments; and engage the international humanitarian community to maximize the effectiveness of humanitarian aid.
Factors beyond U.S. government control that may affect our efforts include shocks to the global economic system; political, social, or economic instability; long-standing ethnic, religious or other societal group tensions; sovereignty issues that lead governments to restrict humanitarian operations within their borders; reluctance of foreign partners to share information, regulations on protection of national security information, and privacy concerns; and natural disasters and extreme weather. Factors the United States seeks to influence include endemic or institutionalized corruption; inadequate or nonexistent control of borders and sovereign territory; actors (state and non-state) with violent and/or destabilizing agendas; weak or dysfunctional national, regional, or local civil and military institutions; mismatches between the span of transnational criminal activity and the applicability of national laws and enforcement systems; partners' resources, capabilities, quality of their laws, and strength of their judicial/legal institutions; insufficient institutional capacity for economic development, environmental regulation and oversight; persistent gender inequality and gender-based violence; and allies and/or partners' views on the need to act on security issues.
Statement:
Description:
Today, the United States faces diverse and complex security challenges. Hostile nation states, violent extremists, transnational organized crime, unaccountable or abusive governance, weak rule of law, and inter- and intra-state conflict all affect civilian security, international stability and prosperity, and directly threaten U.S. interests and foreign policy objectives. To meet these challenges, we must secure the world’s most dangerous weapons and material; prevent the rise of criminal and insurgent groups; mitigate the effects of transnational crime; dismantle al-Qa’ida, its affiliates and adherents, and other terrorist organizations and deny them new recruits; strengthen rule of law globally; counter threats posed in cyberspace; reaffirm and support the balance between individual rights and collective security; and empower women to play an equal role in solving global security problems.
Many of today’s threats cannot be solved by a single state, making U.S. global leadership and multilateral cooperation ever more crucial. This objective encompasses our efforts to counter violent extremism and build the counterterrorism capacities of partner nations’ law enforcement entities, and promote regional peace and security through our diplomatic engagement and security assistance to partner nations.
Strategies for Achieving the Objective
In order to overcome these global security challenges, the Department of State and USAID will advance the Security Sector Assistance Presidential Policy Directive (PPD-23), helping partner countries build and sustain the capacity and effectiveness of institutions to provide security, safety, and justice for their people, and to contribute to efforts that address common security challenges. The Department and USAID efforts include pursuit of arms control and nonproliferation; reduction of transnational organized crime and strengthening rule of law (ROL); countering the drivers of recruitment and radicalization to violence; and securing cyberspace. The Department and USAID will cooperate with other federal agencies and international coalitions; foreign governments and their security and justice services, and multilateral organizations. Our strategy also entails cooperation with state and local partners and civil society.
The Department and USAID will balance assistance appropriately, supporting governments when interests converge and political will is present, when governments are accountable to their people and are committed to partnering with civil society for change, and as a check on abuse. To counter violent extremism, the United States will focus on the drivers of violent extremism.
Statement:
Description:
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.
Agency Priority Goals
Statement:
Support the global effort to end preventable child and maternal deaths. By September 30, 2015, U.S. assistance to end preventable child and maternal deaths will contribute to reductions in under-five mortality in 24 maternal and child health U.S. Government-priority countries by 4 deaths per 1,000 live births as compared to a 2013 baseline.
Description:
USAID with its partners in the U.S. Government and the global community are committed to the goal of ending preventable child and maternal deaths. While many challenges remain, today, more than ever, we are equipped with the tools and knowledge to reach this goal. The health of mothers and children around the world is linked to improvements in maternal health, which inherently affect child health. Over the past two decades, there has been a nearly 50 percent reduction in maternal deaths, from 543,000 in 1990 to 287,000 in 2010. Meanwhile, the annual number of under-five deaths declined from 12.6 million in 1990 to 6.6 million in 2012. While under-five mortality is declining faster now than in the past two decades, with the annual rate of reduction more than tripling in 2005-2012 compared to the rate in 1990-1995, 18,000 children still die every day. The U.S. cannot act alone and in order to meet the Millennium Development Goal Four (Reduce Child Mortality) target by its agreed date of 2015, an additional 3.5 million children's lives above the current trend rate will need to be saved between 2013 and 2015.
Strategic Objectives
Strategic Objective:
Strengthen America’s Efforts to Combat Global Health Challenges
Statement:
Description:
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.
Agency Priority Goals
Statement: Support the global effort to end preventable child and maternal deaths. By September 30, 2015, U.S. assistance to end preventable child and maternal deaths will contribute to reductions in under-five mortality in 24 maternal and child health U.S. Government-priority countries by 4 deaths per 1,000 live births as compared to a 2013 baseline.
Description: USAID with its partners in the U.S. Government and the global community are committed to the goal of ending preventable child and maternal deaths. While many challenges remain, today, more than ever, we are equipped with the tools and knowledge to reach this goal. The health of mothers and children around the world is linked to improvements in maternal health, which inherently affect child health. Over the past two decades, there has been a nearly 50 percent reduction in maternal deaths, from 543,000 in 1990 to 287,000 in 2010. Meanwhile, the annual number of under-five deaths declined from 12.6 million in 1990 to 6.6 million in 2012. While under-five mortality is declining faster now than in the past two decades, with the annual rate of reduction more than tripling in 2005-2012 compared to the rate in 1990-1995, 18,000 children still die every day. The U.S. cannot act alone and in order to meet the Millennium Development Goal Four (Reduce Child Mortality) target by its agreed date of 2015, an additional 3.5 million children's lives above the current trend rate will need to be saved between 2013 and 2015.
