R 090328Z DEC 09

FM SECSTATE WASHDC
ACTION:
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ASHGABAT, AMEMBASSY IMMEDIATE

UNCLAS STATE 125761 
 
FOR CHIEFS OF MISSION, DEPUTY CHIEFS OF MISSION AND 
HEALTH TEAM LEADS 
 
E.O.: 12958 
TAGS: EAID KHIV KWMN KOCI
SUBJECT: GLOBAL HEALTH INITIATIVE: PROMOTING GREATER AWARENESS AND 
PARTICIPATION 
 
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SUMMARY 
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¶1. SUMMARY This is an action request. See Paragraph 
¶10. Earlier this year President Obama announced the 
launch of the Global Health Initiative (GHI), a six-year, 
$63 billion interagency effort of the U.S. government to 
support partner countries in improving and expanding 
access to health services. The Presidents global health 
agenda is an ambitious one. The GHI builds on past 
successes in U.S. global health assistance by making 
significant new investments in health programs and 
leveraging the full range of U.S. assets in support of a 
long-term strategic approach to global health. The GHI 
includes a prominent global leadership role for the U.S., 
encompassing both a robust bilateral program and a 
concerted and deliberate effort to work together with the 
international community to advance common global health 
objectives. The GHI seeks to improve specific health 
outcomes through activities that are guided by the 
following principles: i)adopt a women and girl-centered 
approach to health and gender equity; ii) increase impact 
through strategic integration and coordination; iii) 
strengthen and leverage multilateral institutions; iv) 
encourage country ownership and invest in country-led 
plans; v) build sustainability through health systems 
strengthening; vi) improve metrics, monitoring and 
evaluation; and vii) promote research, development and 
innovation. The Department solicits feedback on the 
goals and principles of the Initiative, further described 
in paragraphs 7-9. END SUMMARY 
 
¶2. The Presidents launch of the GHI emphasized the 
commitment of the United States to a comprehensive global 
health strategy that continues historically strong 
support for fighting infectious diseases while expanding 
efforts to strengthen health systems, improve child and 
maternal health and family planning, and promote better 
integration and alignment of global health programs. 
More information on the Global Health Initiative can be 
found at: 
http://www.whitehouse.gov/the_press_office/St atement-bythe- 
President-on-Global-Health-Initiative/. 
 
 
-------------------------------------------- 
ENCOURAGING PARTICIPATION IN THE GHI PROCESS 
-------------------------------------------- 
 
¶3. Field-based health personnel have already begun to 
work with colleagues from State, USAID, HHS, DoD and 
other agencies in planning the GHI strategy and 
implementation. We are seeking additional input and 
suggestions to help shape and inform the Initiatives 
development. This cable solicits feedback on the 
Initiatives goals and principles described in Paragraphs 
7 - 9. Future cables will solicit feedback on the draft 
GHI strategy and on plans for implementation. 
 
¶4. The GHI builds on the successes and lessons learned 
from PEPFAR, PMI, Stop TB, Stop Polio and other global 
health programs. Inputs based on experiences with these 
programs are critical to planning the GHI. Posts are 
requested to draw on the material contained in this cable 
to inform USG staff about the goals and principles of the 
GHI. 
 
¶5. The following five working groups, under the guidance 
of a Steering Committee, have shaped and designed aspects 
of the GHI: a) Maternal and Child Health, Family Planning 
and Nutrition; b) Integration and Coordination; c) Health 
System Strengthening; d) Infectious Diseases; and e) 
Metrics, Monitoring and Evaluation, Research and 
Innovation. These working groups have already begun to 
solicit feedback from the field, and include among their 
membership field personnel. The purpose of this cable is 
to establish a broader mechanism for information and 
engagement with Posts. Post engagement, whether as 
individuals, officers or interagency teams, is essential 
to the strategy and implementation planning process. 
 
¶6. Additionally, a series of outreach meetings recently 
took place in Washington D.C. to solicit feedback from 
civil society, philanthropic organizations, multilateral 
institutions and academic and foundation leaders. The 
working groups and Steering Committee are also pursuing 
international outreach efforts in tandem with 
international health events. For example, a GHI team 
held consultative meetings and engaged in a helpful 
series of discussions with international attendees at the 
recent Global Fund Board meeting in Ethiopia. The 
Department welcomes input regarding other such 
opportunities, and Posts will be informed when in-country 
outreach meetings are planned. Posts are also invited to 
seek opportunities to discuss GHI goals and principles 
with partners and in-country colleagues. 
 
---------------------------------------- 
Approach of the Global Health Initiative 
---------------------------------------- 
 
¶7. The Global Health Initiative strategy is being 
developed through a consultative process within the U.S. 
government and with the global community and other 
stakeholders, including foundations, universities, nongovernmental 
organizations, and the private sector. It 
will include both specific targets to be reached by 2015 
and a longer term vision for the next ten years and 
beyond. Broadly stated, the goals of the Initiative are 
to improve health outcomes and access while increasing 
sustainability by improving and expanding country 
capacity to implement and manage health services. These 
goals will be achieved by better integrating U.S. 
government health programs, increasing alignment with 
country-led and defined priorities, systems and 
procedures, and engaging more deeply with the donor 
community and multilaterals to address the health needs 
of the worlds poor. 
 
¶8. In addition to these broad goals, the Presidents 
announcement last May identified four specific areas on 
which the Global Health Initiative will focus: 
--Prevent millions of new HIV infections; 
--Reduce mortality of mothers and children under five, 
saving millions of lives; 
--Avert millions of unintended pregnancies; and 
--Eliminate some neglected tropical diseases. 
 
-------------------------------------------- 
Principles of the Global Health Initiative 
-------------------------------------------- 
 
¶9. The United States believes that the principles 
summarized below should guide the GHIs comprehensive 
approach to global health. It is expected that a focus 
on these principles will enable U.S. global health 
programs to contribute to a greater impact on health 
outcomes by making them more effective, efficient and 
sustainable. The USG intends to engage the global health 
community on these principles and to apply them to all 
USG global health programs, as appropriate, irrespective 
of funding levels. 
 
¶A. Adopt a Women and Girl-Centered Approach to Health 
and Gender Equity 
Evidence has repeatedly shown that women are the gateway 
to healthy families and key to achieving long-term 
development goals. Central to the GHI are long-term, 
systemic changes in the way health programs respond to 
and incorporate the needs, perspectives and abilities of 
women and girls, as well as funding increases in programs 
that are geared towards women and girls, including 
maternal and child health, family planning, and 
nutrition. A woman-centered approach takes into account 
the realities of womens and girls lives as shaped by 
gender norms, service availability, and larger structural 
factors. Working with men and boys will be important to 
achieving these goals. 
 
¶B. Increase Impact through Strategic Integration and 
Coordination 
The U.S. government has achieved significant success with 
disease- and issue-specific initiatives and programs. 
Under the GHI these efforts will be planned, programmed 
and implemented in a more holistic manner, taking into 
account the multiple health and development needs faced 
by governments and people. The GHI will foster 
integration where effective and efficient. It will also 
improve coordination among existing USG health agencies 
and programs, as well as with other USG development 
programs outside of health (e.g., food security, basic 
education, etc.) and with public and private donors and 
partners. 
 
¶C. Strengthen and Leverage Key Multilateral Institutions 
The GHI recognizes the critical role multilateral 
institutions and strategic global partners play in 
achieving health outcomes. The United States will expand 
its engagement with key multilateral institutions and 
global health partnerships to develop a comprehensive 
approach to defining and achieving health outcomes, 
maximizing and coordinating investments, and evaluating 
programs and ensuring accountability. 
 
¶D. Encourage Country Ownership and Invest in Country-led 
Plans 
 
The United States will partner with each countrys 
government, civil society and private sector to ensure 
that countries are at the center of development, 
implementation, management, decision-making and 
leadership of programs. GHI programs and activities will 
support country-led health and development plans. In 
countries without existing plans, the GHI will work with 
governments and other partners to develop strategies 
targeting each countrys specific needs. Working with 
other donors and multilateral organizations, the GHI will 
encourage country ownership and will develop long-term 
partner country capacity to provide essential health 
services, with particular attention to the poor and 
underserved, and with overall guidance and management of 
the health system provided by the country government. 
The GHI will mobilize complementary resources from the 
private sector to achieve the goals of the GHI. 
 
¶E. Build Sustainability through Health System 
Strengthening 
There has been substantial global progress in reducing 
under-five mortality; addressing the burden of HIV/AIDS, 
TB and malaria; and reducing the unmet need for family 
planning. Further progress on health impact requires a 
focus on sustainability. The United States recognizes 
that achieving sustainable health impact requires country 
commitment to health systems that extend access, increase 
equity and ensure quality health services. To this end, 
the GHI will help countries make measurable improvements 
in the six building blocks of health systems: service 
delivery; health workforce; information; medical 
products, vaccines and technologies; financing; and 
leadership and governance. The GHI will also support 
improvements in partner government capacity to plan, 
manage, and finance their health systems, key factors 
related to sustainability. 
 
¶F. Improve Metrics, Monitoring and Evaluation 
Programs must be continually and effectively monitored 
and evaluated to ensure accountability and measurable 
results. The GHI will identify or, when necessary, 
develop indicators, data sources and measurement 
techniques to assess outcomes and progress related to the 
GHI and its principles and to link that progress to 
higher-level health goals. The GHI will also work with 
multilateral partners to harmonize indicators and will 
review processes to reduce reporting burdens on countries 
and field teams. 
 
¶G. Promote Research, Development and Innovation 
Research and innovation under the GHI will directly 
address important questions that are immediately relevant 
to both the GHI and partner country goals and objectives. 
The GHI will strengthen institutional capacity and 
expertise in research and innovation to support country 
ownership and sustainability and to promote data use, 
analysis and evidence-based decision-making. 
 
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ACTION REQUEST 
-------------- 
 
¶10. Posts are requested to draw on the material 
contained in this cable to inform USG staff about the 
goals and principles of the Global Health Initiative. 
Posts should send comments on these goals and principles 
and, to the extent available, examples of best practices, 
lessons learned, and opportunities relevant to the GHI. 
These comments and inputs should be directed to Chris 
Bonner [BonnerCH@state.gov] by December 15. 
CLINTON