VZCZCXRO8756
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DE RUEHHI #1370/01 3510852
ZNR UUUUU ZZH
R 170849Z DEC 09
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 0571
INFO ASEAN REGIONAL FORUM COLLECTIVE
ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
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UNCLAS SECTION 01 OF 26 HANOI 001370 
 
SENSITIVE 
SIPDIS 
STATE PASS TO OGAC 
AMEMBASSIES PASS TO PEPFAR COORDINATORS, ESTH, CDC DIRECTORS, HEALTH ATTACHES, 
AND AID HEALTH OFFICERS 
HHS/OSSI/DSI PASS TO HHS/OGHA JMONAHAN, MABDOO, ACUMMINGS, CMCCLEAN), NIH/FIC RGLASS, SAMHSA 
USAID FOR ANE CJENNINGS, AND GH GSTEELE, RCLAY 
BANGKOK FOR USAID/RDM/A OCARDUNER, MSATIN, ATHWIN 
CDC FOR COGH SBLOUT AND GAP, DTBE, MALARIA 
 
E.O. 12958: N/A 
TAGS: TBIO SOCI EAID KWMN KHIV VM
SUBJECT: (SBU) Applying Comments on the Draft Strategy of the 
President's Global Health Initiative 
 
REF: A. STATE 125761; B. HANOI 278 
 
 
HANOI 00001370  002 OF 026 
 
 
SENSITIVE BUT UNCLASSIFIED 
 
REF A. STATE 125761; B. HANOI 278 
 
HANOI 00001370  003 OF 026 
 
 
¶1. (U) Summary.  Embassy Hanoi??????s inter-agency health team 
believes that the President??????s Global Health Initiative (PGHI) 
principles will advance our health diplomacy efforts in Vietnam, 
particularly PGHI??????s emphasis on health systems strengthening 
 
HANOI 00001370  004 OF 026 
 
 
(HSS).  Greater international coordination is needed around several 
disease-specific global partnerships that are increasingly targeting 
health systems strengthening, without any clear plan or policy for 
how to bring it together at the country level.  Country selection for 
 
HANOI 00001370  005 OF 026 
 
 
PGHI participation should be based on established criteria with field 
input.  Harmonization of programmatic monitoring and evaluation is 
one of the biggest challenges, and planners should address how 
sectors outside of health affect PGHI success.  With as much advance 
 
HANOI 00001370  006 OF 026 
 
 
notice as possible, Post will need to work to ensure that government 
of Vietnam (GVN) understands the effect of PGHI on existing programs 
and what new resources are available, ahead of international 
announcements.  Tuberculosis is a critical public health issue in 
 
HANOI 00001370  007 OF 026 
 
 
Vietnam and globally, which requires more emphasis.  End Summary. 
 
¶2. (SBU) Analysis and improved coordination of current programs under 
existing USG initiatives as well as coordination among broader 
 
HANOI 00001370  008 OF 026 
 
 
non-USG initiatives related to health is critical, looking for 
opportunities to build and strengthen partnerships (REF A).  Despite 
the fact that the USG is a major donor to Global Alliance for 
Vaccines and Immunizations, ??????GAVI?????? has no obligation to 
 
HANOI 00001370  009 OF 026 
 
 
report what it is doing in Vietnam to the U.S. Mission.  In follow-up 
to the recent GAVI Partners?????? Forum in Hanoi, the Western Pacific 
Regional Office of the World Health Organization (WHO) hosted a 
meeting on HSS in Manila, at the end of November.  Hanoi??????s local 
 
HANOI 00001370  010 OF 026 
 
 
WHO HIV technical officer attended and reported to Embassy staff on 
the importance of the meeting for overall coordination of HSS, and 
noted prominent participation by WHO, World Bank, and Global Fund, 
but not from USG. 
 
HANOI 00001370  011 OF 026 
 
 
¶3. (SBU) Post strongly supports greater attention to HSS, but in our 
experience over the last two years, it is easier said than done.  The 
World Health Organization??????s definition of six key areas provides 
 
HANOI 00001370  012 OF 026 
 
 
some focus, but the definition of HSS and how to do still needs 
further clarification.  At the end of the day, the challenge in 
Vietnam will be to develop focused strategies that make critical 
differences and ensure sustainability.  With various disease-specific 
 
HANOI 00001370  013 OF 026 
 
 
global health initiatives increasingly contributing directly to HSS, 
increased coordination internationally among both USG and other 
global initiatives is essential.  The research base (especially 
operations research) and technical knowhow, especially with respect 
 
HANOI 00001370  014 OF 026 
 
 
to measuring progress, to pull this off is lacking. 
 
¶4. (SBU) Existing indicators should be the starting point, but 
previous attempts at harmonization have been challenging.  One 
 
HANOI 00001370  015 OF 026 
 
 
example driven by headquarters, establishing a monitoring and 
evaluation framework for influenza work, resulted in two different 
schemes, one by CDC and one by AID, which made it difficult for our 
multiagency health team to participate effectively in GVN??????s 
 
HANOI 00001370  016 OF 026 
 
 
alignment of monitoring and evaluation across programs and donors. 
PGHI should also empower USG to seek better monitoring of funding and 
accountability within countries. 
 
HANOI 00001370  017 OF 026 
 
 
¶5. (U) In the emerging economy of Vietnam, caught up in the throes of 
health sector reform, there is a strong need to recognize the 
importance of non-health sector factors and contributions to ensure 
health gains.  For example, education and social services, which 
 
HANOI 00001370  018 OF 026 
 
 
often have better access to affected communities than health 
providers, are often neglected as a fundamental part of any health 
development strategy.  Further, one-size does not fit all.  For 
example, Vietnam still has a localized HIV/AIDS epidemic, whereby 
 
HANOI 00001370  019 OF 026 
 
 
persons who inject drugs are the core most-at-risk population driving 
transmission.  Our PEPFAR strategy is necessarily different than a 
country with a generalized epidemic.  PGHI should allow the field to 
drive health initiative planning, including by allowing for greater 
 
HANOI 00001370  020 OF 026 
 
 
input when USG prepares government-wide interventions in 
international forums. 
 
¶6. (SBU) Tuberculosis is a tremendous problem in Vietnam (REF B), 
 
HANOI 00001370  021 OF 026 
 
 
arguably more so than HIV.  In-country coordination for tuberculosis 
and HIV work, both within our PEPFAR framework and broader donor 
coordination circles, with the government has at times been 
challenging, despite the fact that tuberculosis and HIV are very 
 
HANOI 00001370  022 OF 026 
 
 
closely linked epidemiologically.  Such coordination challenges will 
be magnified when trying to bring together broader public health 
issues. 
 
HANOI 00001370  023 OF 026 
 
 
¶7. (SBU) International announcements on the substance of the PGHI 
must be synchronized with communications strategies at the country 
level to the host government.  Failure to do so will lead to 
confusion.  This is especially important in a country such as Vietnam 
 
HANOI 00001370  024 OF 026 
 
 
where 75 percent of USG resources are applied to health and 
disability development work and government-to-government cooperation. 
 Moreover, PGHI timelines and duration are important.  If we are to 
change or add programs, we cannot expect immediate results.  This is 
 
HANOI 00001370  025 OF 026 
 
 
particularly true for initiatives that target capacity building at 
provincial, district, and local levels. 
 ¶8. (SBU) Minimize Considered 
 
HANOI 00001370  026 OF 026 
 
 
MINIMIZE CONSIDERED 
Michalak