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Diplomacy in Action

Strategic Goal 3 - Selected Strategic Priorities and Analyses

Bureau of Resource Management
April 21, 2011


HEALTH: Improve global health, including child, maternal, and reproductive health; prevent and treat infectious diseases; and increase access to better drinking water and sanitation services.

Urgent health challenges remain in the priority areas of HIV/AIDS, child mortality, maternal mortality, tuberculosis, malaria, tropical diseases, unintended pregnancy, and undernourishment. The President’s Global Health Initiative (see sidebar below) is focusing U.S. resources to help partner countries improve and sustain health outcomes through strengthened health systems.

The health systems strengthening program provides support to ensure that developing country health systems are effective, efficient, and equitable. Working health systems are vital to ensuring widespread use of effective health measures and to reaching priority groups, including the poor, women, children, urban and rural residents, and the acutely and chronically ill. A well-functioning health system delivers the right volume and distribution of client-friendly services at the community, local, and national levels and leads to improved health outcomes.

The U.S. approach is to look for constraints in quality, accessibility, and affordability to develop interventions that address gaps and bottlenecks in the system. This is achieved through a continuous process of implementing changes in policies and management arrangements. This process involves individual governments, nongovernmental organizations (NGOs), or donor agencies, and includes support for Demographic and Health Surveys that provide empirical evidence to guide the reform process.

HIV/AIDS Analysis: PEPFAR takes a comprehensive approach to HIV/AIDS prevention, treatment, and care in developing countries, working in close partnership with host-country governments and national and international partners. Antiretroviral (ARV) treatment provides direct therapeutic benefits for individuals, increasing the length and quality of their lives, and enabling many to resume normal daily activities. ARV treatments reduce viral load in patients on therapy and decrease transmission rates. The indicator of the number of people receiving HIV/AIDS treatment measures the reach of PEPFAR. The U.S. analyzes the indicator results by country to identify which countries face challenges in scaling up their programs, and which have best practices that should be replicated. PEPFAR-supported treatment has helped save and extend millions of lives and prevent children from being orphaned. Rapid scale-up of treatment programs in collaboration with partner nations enabled the United States to support treatment directly for more than 3.2 million men, women, and children living with HIV through FY 2010.

Malaria Analysis: Malaria claims more than 850,000 lives in Africa each year. Two critical President’s Malaria Initiative (PMI) interventions—insecticide-treated mosquito nets (ITN) and indoor residual spraying (IRS)—are highly effective in controlling malaria when used properly. The indicator for prevention monitors the number of people protected against malaria by one or both of these methods. It also indicates whether U.S. assistance is successfully extending the prevention measures that are necessary to reduce the number of malaria deaths. PMI shifted from targeting mainly pregnant women and children under 5 to providing 1 ITN per 2 people in malaria endemic areas, which resulted in the United States exceeding its target of 33 million people protected against malaria by 7 million in FY 2010. In addition, PMI protected 1.2 million more people with IRS than in FY 2009. In FY 2010, PMI expanded to the Democratic Republic of Congo and Nigeria. Results from these new countries will be reported in FY 2011.

Maternal and Child Health Analysis: U.S. assistance in this area aims to increase the availability and use of proven life-saving interventions that address the major killers of mothers and children. Having a skilled attendant at birth is a critical component of efforts to reduce maternal mortality. Most non-abortion-related maternal deaths happen during labor and delivery or within the first few days following delivery. In many countries, most births occur at home. Increasing the frequency of deliveries overseen by skilled birth attendants is more likely to result in prompt recognition of complications, initiation of treatment, and lives saved. The United States exceeded the FY 2010 target of 48.9 percent of deliveries overseen by skilled birth attendants, reflecting progress in countries that reported Demographic and Health Survey (DHS) results this year and continuing the positive trend.

Family Planning and Reproductive Health Analysis: The United States family planning and reproductive health program aims to expand access to high quality, voluntary family planning and reproductive health information and services in order to reduce unintended pregnancy and promote healthy reproductive behaviors. Increased use of modern contraception translates into fewer unintended pregnancies and fewer abortions. A successful family planning program can be expected to increase the modern contraceptive prevalence rate (MCPR) by one to two percentage points annually. MCPR is the percentage of in-union women of reproductive age (15-49) using, or whose partner is using, a modern method of contraception at the time of the survey. The FY 2010 result of 28.4 percent exceeded the target and continued the trend of increased contraceptive use as reported in DHS or Reproductive Health Surveys.

Water and Sanitation Analysis: Access to reliable and economically sustainable water supply is a key component of a country’s ability to attain health, security, and prosperity for its population. Access is achieved through diverse approaches, including both direct support for small- and large-scale infrastructure development and indirect support through institutional development for community-based systems, private sector engagement, and financing to ensure long-term sustainability. Targets for this indicator fluctuate based on the number and scope of activities planned for a given year. The United States fell short of the FY 2010 target of 5.6 million people with first time access to improved drinking water supplies, with the bulk of the shortfall attributed to Pakistan, West Bank and Gaza, and the Africa regional program. Trend information varies because after first-time access to improved drinking water is attained, results are captured using other indicators. For example, Pakistan’s focus shifted from increasing access to increasing the availability of water. In West Bank and Gaza, the focus shifted to improving access to sanitation facilities. The Africa Regional program encountered delays in launching a Global Development Alliance between Coca-Cola and USAID intended to support water-related programs in 19 countries. However, there were notable successes at the country level; for example, Kenya exceeded its target by 252 percent as a result of a water treatment project that expanded women’s access to water.

BASIC EDUCATION: Provide equitable access to quality basic education that includes literacy, numeracy, and other basic skills for youth and adults.

Analysis: In the basic education sector, the United States assesses its performance based on the primary net enrollment rate (NER) for a sample of countries receiving basic education funds. NER monitors students from the official primary school-age group. The rate is expressed as a percentage of the total primary school-age population. U.S. assistance supports an increase in NER through a variety of activities designed to improve the quality of teaching and learning, which help to reduce barriers to student attendance and promote effective classroom practices. High NERs lead to increases in school completion rates and higher educational attainment within the overall population. Countries with an educated population are more likely to experience improvements in health and economic growth. Since FY 2002, NERs have improved steadily in countries receiving U.S. assistance. In FY 2010, the United States exceeded its target of 80 percent NER with significant increases in Ethiopia, Ghana, and Mali.

Global Health Initiative

Photo showing a peer educator talking with Kenyan youth about HIV/AIDS prevention.

A peer educator talks with Kenyan youth about HIV/AIDS prevention. IYF

The President’s Global Health Initiative (GHI), announced in May 2009, is focusing U.S. resources on helping partner countries improve health outcomes through strengthened health systems, with a particular focus on bolstering the health of women, newborns, and children by combating infectious diseases and providing quality health services. The GHI serves as a whole-of-government effort to coordinate U.S. Government global health programs and create greater country-level capacity to manage and operate programs. GHI aims to maximize the sustainable health impact the United States achieves for every dollar invested.

GHI will deliver based on core values drawn from the principles of effective development partnerships, announced by President Obama in L’Aquila, Italy.

  • Implement a woman- and girl-centered approach
  • Increase impact through strategic coordination and integration
  • Strengthen and leverage key multilateral organizations, global health partnerships, and private sector engagement
  • Encourage country ownership and invest in country-led plans
  • Build sustainability through strengthened health systems
  • Improve metrics, monitoring, and evaluation
  • Promote research and innovation

The GHI has identified specific goals and targets to be achieved over the course of the initiative, including preventing 12 million new HIV infections and providing care to more than 12 million people living with HIV/AIDS, reducing child undernutrition by 30 percent across assisted food-insecure countries in conjunction with the President’s Feed the Future Initiative, and reducing the burden of malaria by 50 percent for 450 million people under the President’s Malaria Initiative.

While the GHI program will apply everywhere U.S. Government global health dollars are at work, GHI launched an intensified effort in a subset of 8 GHI Plus countries, to be joined by up to 12 more, providing significant opportunities for impact, evaluation, and partnership with local governments. These countries will receive additional technical, management, and financial resources to accelerate the implementation of GHI’s innovative approach.

See USAID’s website for further information on the Global Health Initiative.


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