VZCZCXRO7292
PP RUEHROV
DE RUEHDS #2943/01 3500441
ZNR UUUUU ZZH
P 160441Z DEC 09
FM AMEMBASSY ADDIS ABABA
TO RUEHC/SECSTATE WASHDC PRIORITY 7171
INFO RUCNIAD/IGAD COLLECTIVE PRIORITY
RUEPADJ/CJTF HOA PRIORITY
RUEATRS/DEPT OF TREASURY WASHINGTON DC

UNCLAS SECTION 01 OF 02 ADDIS ABABA 002943 
 
 
SIPDIS 
 
DEPARTMENT FOR AF/SPG AND AF/RSA 
LONDON, PARIS, ROME FOR AFRICA WATCHER 
 
E.O. 12958: N/A 
TAGS: KHIV EAID ET KOCI KWMN
SUBJECT: GLOBAL HEALTH INITATIVE: PROMOTING GREATER AWARENESS AND 
PARTICIPATION 
 
Reference: State 00/125761 
 
¶1.  The U.S. Mission to Ethiopia wishes to provide the following 
comments in response to State cable 00125761 regarding the goals and 
principles of the President's Global Health Initiative (GHI).  The 
broad goals around improving overall health outcomes and increasing 
country capacity to improve prospects for sustainability are on 
target and welcome.  They provide an opportunity to tailor the GHI 
to meet the country-specific burden of disease. Host governments, 
multilateral, and bilateral partners will appreciate such 
flexibility, which will improve their motivation to work with the 
GHI. 
 
¶2.  The approaches to achieving these broad goals (integrating USG 
health programs, increasing country alignment, and deeper engagement 
with other stakeholders) are also sound. We would like to emphasize 
that strategic integration and coordination takes place at both the 
intra-sectoral and inter-sectoral levels.  Intra-sectoral approaches 
provide opportunities for holistic health programs. 
Inter-sectorally, health programs should link to programs in 
business development, environment, alternative livelihoods, 
agriculture, democracy and governance, emergency relief and 
education to ensure that health issues are taken into account and 
health messages promoted. 
 
¶3.  The women and girl-centered approach is of course valid and the 
addressing of male norms under GHI is much appreciated.  However, 
women and girl-centered programs must do much more than simply 
target women as beneficiaries for services but rather focus on 
women's status in the community, their education levels, their 
ability to earn and control income, and their ability to 
successfully negotiate health outcomes for themselves, their 
children and their communities.  Women and girl-centered programming 
must focus on the household and community levels, where most key 
decisions regarding child and maternal health are made, while 
continuing efforts to address key policy issues at higher levels. 
 
 
 
¶4.  The four specific areas of GHI, are also appropriate.  However, 
in order for these goals to generate traction at the country or 
global level, they need to be quantified with clear and realistic 
objectives and targets. Additionally the issue of balance is 
applicable  across all other GHI programs. For example, while 
agreeing that HIV prevention needs to improve, we still need to 
maintain balance with care, treatment and support programs. 
 
¶5.  The U.S. Mission to Ethiopia fully supports the seven proposed 
GHI principles.  As per para 3, we look forward to providing our 
views on how these principles may best be applied in the follow-up 
cables  on GHI's strategy and plans for implementation. In the time 
allocated for a response to this cable, we have not been able to 
fully provide information on  best practices, lessons learned and 
opportunities. Ethiopia has rich experience to share in these and we 
will communicate these as soon as possible. 
 
¶6.  The USG team and the Government of Ethiopia are well positioned 
and highly motivated to initiate implementation of the GHI.  Many of 
the policies, plans and platforms for service delivery, donor 
coordination, systems strengthening and building country ownership 
are already in place.  In all of these platforms, the USG is fully 
involved and in a position to provide strong leadership in pursuit 
of the goals and principles of GHI. 
 
¶7.  The strong emphasis on country leadership, program integration 
and improved coordination among existing agencies and programs is 
most welcome. The question around interagency coordination is of 
course "how"? To be most effective, integration needs to be across 
agencies and involve their respective partners, as appropriate. 
 
¶8.  Central support for providing guidance on an appropriate 
division of labor in the field, taking comparative advantages of 
agencies into account, is essential both at this stage of PEPFAR and 
for moving forward with GHI. We have seen PEPFAR accomplish a great 
deal over the past six years, but at a high transaction cost when it 
comes to interagency relationships. Multiple factors may have 
contributed to this, including modeling in the field the way 
agencies relate to one another at headquarters, competition for 
budget and credit going to agencies, differing agency cultures, lack 
of clarity on division of labor, and lack of headquarters and 
in-country leadership with managing the historical change that 
PEPFAR introduced to achieve targets through interagency 
coordination.  However, the lack of a clear division of labor 
between USG agencies within PEPFAR has clearly reduced the overall 
effectiveness and efficiency of the USG program for HIV/AIDS 
support. 
 
ADDIS ABAB 00002943  002 OF 002 
 
 
 
¶9.  Key to effective and efficient programming is a clear division 
of labor in tandem with excellent coordination. There are several 
ways in which to divide responsibilities, including by  programmatic 
area (HIV prevention, HIV care/treatment, neglected tropical 
diseases, TB, malaria, family planning, maternal health, child 
survival etc), health system component (supply chain, laboratory, 
strategic information, human resources, infrastructure, financing 
etc), and programmatic partnerships (private sector, public sector, 
uniformed services, community, etc.).  We believe that a management 
model whereby an agency is assigned responsibility for a specific 
area, component, population and/or partnership and is provided with 
the authority and resources for implementation, on behalf of and 
with the collaboration of all USG agencies, will ensure that GHI 
produces better results at a lower cost. 
 
¶10.  The primary lesson learned from Ethiopia, and critical for the 
eventual success of the GHI, is that clear lines of authority and an 
appropriate division of labor between US agencies, based on each 
agency's comparative strengths, needs to be established from the 
beginning. In this way, USG agencies operating in Ethiopia will be 
able to more effectively collaborate and implement GHI, improve 
health status in a lasting way, and thus serve both the interests of 
the people of Ethiopia and the US taxpayer. 
 
¶11.  In summary, the U.S. Mission to Ethiopia welcomes the 
opportunity to work with all relevant agencies in designing and 
implementing the GHI, and believes that in Ethiopia existing 
platforms across the areas covered by GHI are extremely 
well-positioned to support the Initiative.  We look forward to the 
opportunity to respond to the forthcoming cables on the draft GHI 
strategy and plans for implementation. 
 
MUSHINGI