VZCZCXRO1743
RR RUEHHM
DE RUEHHI #1339/01 3440935
ZNR UUUUU ZZH
R 090935Z DEC 08
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 8822
INFO RUEHHM/AMCONSUL HO CHI MINH 5353
RUEHBK/AMEMBASSY BANGKOK 6554
RUEHGV/USMISSION GENEVA 1253
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC

UNCLAS SECTION 01 OF 03 HANOI 001339 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, OGAC 
STATE PASS TO USAID FOR ANE AND GH 
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/MABDOO) 
BANGKOK FOR RDM/A (CBOWES/MACARTHUR/MBRADY/MKLEINJAN) 
GENEVA FOR HEALTH ATTACHE 
 
E.O. 12958: N/A 
TAGS: TBIO PREL PGOV SOCI KHIV KFLU VM
SUBJECT: HANOI CORE STATEMENT ON HEALTH TOUCHES ON BROADER AID 
EFFECTIVENESS AND DEVELOPMENT POLICY ISSUES 
 
REF: A. 2006 Hanoi 2803 B. Hanoi 370 
 
THIS IS AN ACTION CABLE.  PLEASE SEE PARAGRAPH 2. 
 
 
¶1. (U) Summary.  The Government of Vietnam (GVN) and several 
development partners have drafted a Statement of Intent (SOI) to 
improve the Vietnamese health care system, through improving 
development assistance, coordinating GVN and donor efforts, and 
increasing transparency and accountability.  The GVN and these 
donors have negotiated a draft document modeled upon earlier 
international health development commitments and upon existing, 
successful partnerships among the GVN and its donor partners.  At 
this late stage in the drafting process, major, substantive edits 
may result in U.S. exclusion from the final document.  Such a result 
will have definite impacts on U.S. health policy goals in Vietnam. 
On balance, the in-country inter-agency team favors concurrence. 
End Summary. 
 
¶2. Action Request: This cable provides relevant background 
information and context for the draft SOI and explains likely 
consequences should the United States choose not to sign or require 
significant, substantive edits to the document.  We request 
inter-agency review and clearance of the draft SOI, forwarded by 
separate e-mail; provide edits and relevant justifications by 
January 10.  We will need these explanations when we negotiate the 
final draft of the document. 
 
The Negotiating Process 
----------------------- 
 
¶3. (U) The GVN and several prominent development partners, including 
the United States, recently completed drafting the SOI on "Improving 
the effectiveness of development assistance for health."  At the 
November 26, Health Partnership Group (HPG), the Ministry of Health 
(MOH) presented the "final draft" of the SOI, which the drafters 
modeled on the Paris Declaration (PD), referred to the Accra Agenda 
for Action (AAA), and built upon the Hanoi Core Statement (HCS), 
each of which has been signed by the United States.  MOH and the 
World Health Organization (WHO) have signed off on the document, 
which they expect will only receive routine, legalistic changes 
during the clearance process with various development headquarters. 
Following headquarters clearance, we expect the GVN and development 
partners to sign the document in late February.  Therefore, and 
because of the shut down of GVN and many diplomatic missions 
connected with the Tet Holiday, we will need suggested edits and 
clearances from Washington agencies by January 10 in order to review 
with the GVN and development partners and finalize the document for 
concurrence. 
 
 
The SOI 
------- 
 
¶4. (SBU) For several years, health diplomacy has formed a prominent 
part of our Mission Strategic Plan and has been a principal catalyst 
to our expanding bilateral relationship with the GVN.  Consistent 
with our health development goals, we have worked with MOH, the 
Ministry of Planning and Investment (MPI), and development partners 
on a non-binding SOI, which will encourage the MOH (and the rest of 
the GVN) to take ownership of health programs, coordinates GVN and 
donor policy goals, technical programs, and financial contributions, 
improves transparency and accountability, and provides guiding 
priorities for budgeting and spending.  This, in turn, may 
facilitate better leveraging of the substantial commitment the 
United States has made to the Vietnamese health sector, which in 
FY2008 totaled about USD 100 million (includes work in animal 
health).  The SOI follows from the HCS, which is derived from the 
PD, both of which focus on aid effectiveness.  Similarly, the 
drafters modeled the document on the highly successful Partnership 
for Avian and Human Influenza (PAHI) (ref A), which the United 
States helped craft and which has been held up around the world as a 
model for host country-donor cooperation. 
 
Difficult to Amend the Document 
------------------------------- 
 
¶5. (SBU) Given the lengthy negotiation process already undertaken 
and the document's consistency with previously agreed upon 
international and bilateral agreements, we believe that MOH, MPI, 
and donor partners would not accept edits to the agreement that they 
 
HANOI 00001339  002 OF 003 
 
 
do not view as consistent with the intent of PD and the reference to 
AAA.  At this point, WHO, MOH and other development partners have 
reached consensus and anticipate only legalistic changes with 
headquarters clearance.  The draft provided to Washington for review 
reflected the culmination of a seven month process and extensive 
(and finally successful) efforts to mediate inter-ministerial 
disagreements between MOH and the MPI.  At the same time, Mission 
appreciates the inter-agency complexities and multi-lateral USG 
policy concerns on aid effectiveness raised by this document. 
 
¶6. (SBU) The draft SOI reflects a carefully crafted compromise that 
balances the desire of MOH and most international donors to bolster 
GVN commitment to the health sector with MPI wishes to focus on 
specific actions.  The compromise, largely brokered by the WHO, 
re-structured the document away from a pure advocacy document 
(consistent with the intent of the PD) by using formatting similar 
to the AAA.  The final version is designed to increase and improve 
GVN health efforts.  Throughout the drafting process, we encountered 
no evidence of undue influence by the European Commission or other 
like-minded parties.  AAA language and format was inserted by the 
MPI to settle an inter-Ministerial debate with MOH over the balance 
between advocacy and action.  In the Vietnam context, we do not feel 
that reference to AAA can be extracted, nor does the current version 
of the SOI imply any specific commitments beyond PD and AAA. 
 
Benefits to Concurrence 
----------------------- 
 
¶7. (SBU) The USG plays the principal role in bilateral health 
development and technical assistance to Vietnam.  Beyond PEPFAR and 
influenza, the United States has cooperative work to build 
Vietnamese capacity in disabilities, tuberculosis, epidemiological 
training, good clinical practice, good aquaculture practice, human 
vaccine development, among others.  On a broader level, the GVN and 
other donors view the United States as a leader in overall health 
development, including our participation in the Health Partnership 
Group (Ref B), the related Joint Annual Health Review (an open, 
transparent U.S. Institute of Medicine-like in-depth analysis of 
specific health sector issues), the development of this SOI.  These 
efforts have established substantial good will and fostered 
credibility, which we have been able to use to advance U.S. policy 
goals and to ensure that the development of Vietnam's health sector 
remains consistent with U.S. views.  For example, despite MOH and 
donor inertia, we were able to negotiate a broadening of this SOI to 
formally include other ministries and partnerships (including civil 
society) -- a concrete and strategic gain for our current 
investments in health, namely HIV and influenza. 
 
Risks To Not Signing Now 
------------------------ 
 
¶8. (SBU) Failure to concur with the current draft of the SOI will 
have consequences for U.S. health interventions in Vietnam and to 
our overall assistance program, in particular our strategy to pursue 
a more comprehensive approach to health systems strengthening and to 
improve the sustainability of U.S.-supported programs.  Lack of 
action may decrease the substantial good will we have developed with 
our Vietnamese health partners, while also isolating us from other 
international donors and will make it more difficult to play a 
leading role in coordinating health policy. 
 
¶9. (SBU) More specifically, the SOI is tied to the re-establishment 
and terms of reference for the HPG.  This is the umbrella forum for 
all health-related partnerships. Originally a place to exchange 
information for the purposes of coordination, it has become a forum 
for policy development, using outside input from donors.  While we 
anticipate that we could still participate in the HPG, our voice 
could be diminished and it would be awkward if we were the only 
country not formally part of the health alliance, founded on HCS and 
the follow-on SOI.  [Note: Japan is likely the only other country 
that might have policy-related issues with the SOI; however, we have 
no evidence this is the case, and current conversations indicate 
that they intend to approve the document.]  Further, there are other 
minor likely practical coordination challenges that will most 
certainly arise, such as being left off of various lists and 
meetings, which without increased diligence on our part, could 
result in decreased recognition of USG contributions in health, 
including in media reports. 
 
¶10. (SBU) We do not think the process will come to a standstill if 
we do not concur with the SOI.  If, in fact there is concern that we 
 
HANOI 00001339  003 OF 003 
 
 
are somehow giving undue acceptance or weight to the AAA, we find it 
hard to draw that conclusion from the documents.  In any case, this 
is not the kind of document that is going to influence global 
agreements or global assistance behavior.  Indeed, the document 
provides explicitly for project and program funding in addition to 
budgetary and sectoral support as modalities for providing support. 
 
MICHALAK