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| >> Regional Overview >> Global Health Overview | |||||||||
THE DEVELOPMENT CHALLENGE: Investing in the health of the world's population serves U.S. national interests by contributing to global economic growth, a sustainable environment, and regional security. Recent evidence supports the linkages of good health to improvements in productivity and poverty reduction. High levels of disease can slow or even halt economic growth. Likewise, control of infectious diseases, good nutrition and stabilization of population size are essential to sustainable development; indeed, they are fundamentally interdependent. People can contribute more fully to the social and economic progress of their community and nation when they are well nourished, free from diseases, and given adequate information to make informed decisions about their own family size. Reduced population pressures also lower the risk of humanitarian crises in countries where population growth rates are highest. In addition to enhancing livelihoods of people overseas, protecting human health and nutrition in developing and transitional countries directly affects public health in the U.S. by preventing the spreads of diseases that know no borders. These concerns are articulated in the US Department of State foreign policy objectives for health and population. To that end, USAID serves as the chief implementing agency to carry out the U.S. government's mandates. The rapid spread of HIV/AIDS in many parts of sub-Saharan Africa, South and Southeast Asia, and the Caribbean presents a special development challenge. By devastating the most productive members of society, the disease drains the country's human and financial resources. In recent years, the AIDS pandemic alone stands to reverse decades of life expectancy and other health gains in sub-Saharan Africa, contributing to weakened prospects for economic growth and civil society stimulation. In 2002, this incurable virus has reached a magnitude exceeding any historical ravage from a single disease. In response, the Administration has highlighted HIV/AIDS and infectious diseases as high priority global concerns and threats to U.S. national security. In response to these challenges, USAID created the Bureau for Global Health (GH) to serve as the locus of technical leadership for USAID in health. GH is vested with primary responsibility for research contributing to overall USAID's strategic objectives in international health. It investigates and produces innovations and develops pilot projects for broad application. GH also draws on the most advanced knowledge in health technical matters and shares that knowledge with field missions, donors, and partners at all levels. BUREAU FOR GLOBAL HEALTH PROGRAM: In order to serve the USAID strategic objectives for health, GH provides leadership and technical expertise in the areas of HIV/AIDS, infectious diseases, child survival, maternal health, nutrition, and family planning. As such, GH aligns USAID resources with identified public health and development needs, and influences the global health priorities of partners and stakeholders. GH becomes the repository for state-of-the-art thinking in biomedical, social science, and operational research. It produces results that can be disseminated and replicated at USAID missions throughout the world. GH also helps ensure compliance with congressional directives and legislative intentions, and develops mechanisms for overall program evaluation and performance measurement. The expansive perspective of USAID is critical given that diseases are borderless - TB being the most recent example - and USAID works to mitigate their negative impact before they become serious global health threats. USAID programs in international health engage in the following five priority areas:
GH's programs are primarily funded through the Child Survival and Health (CSH) Fund of the Development Assistance account. Field programs for HIV/AIDS and population receive additional support from other accounts, including the Economic Support Fund, Freedom Support Act, and Assistance to Eastern Europe and Baltic States. The FY 2003 request for the Bureau for Global Health is $304.8 million (including $3.8 Development Assistance Fund for Displaced Children & Orphan Fund), down from the FY 2002 level of $326.1 million. The FY 2003 funds will be allocated as follows:
In the coming year, USAID will substantially increase the resources it devotes to HIV/AIDS programs. GH has already established a new Office of HIV/AIDS and begun to realign its programs and staffing to support its expanded efforts in this area. These expanded efforts seek to monitor the spread of HIV/AIDS in sub-Saharan Africa and other parts of the developing world and improve the quality of life of those infected and affected by the disease. GH will also continue with its commitment to reduce the incidence of TB, malaria and other major infectious diseases. More generally, USAID's efforts to improve health conditions in the developing world and stabilize population growth directly contribute to economic growth and political stability while at the same time helping to reduce environmental degradation. Improved health and nutrition are key contributors to increased economic productivity and the reduction of poverty. GH addresses USAID's priority areas through a combination of technical support to the field, research and evaluation, and global leadership. Field-Driven Program Design and Comprehensive Technical Support: GH has developed an innovative approach to program design that is rare in the development field. In contrast to typical practice, GH follows a field-driven, field-oriented and field-based approach to developing and testing new technologies and methodologies. This is especially important in the rapidly changing health field. The approach generally includes the following steps: (1) need or problem identification (to which field missions contribute); (2) product and program development; (3) field testing, validation, and refinement; (4) field marketing and scale up; and (5) institutionalization at the field mission level. This approach has a long history of success and has been instrumental in diffusing technologies and innovations from north to south and from south to south. GH supports its state-of-the-art design activities with comprehensive technical support that maximizes the chances for programmatic success. To this end, GH manages activities that incorporate and adapt experience and knowledge gained worldwide to support and complement mission health programs. Missions expect GH to provide them with state-of-the-art tools and technologies to apply to local problems, helping them to "push the technical envelope" and encouraging cost-effective approaches to programming. GH's support includes research, policy development, information, services, training, commodities, and evaluation. Timely and Authoritative Research: GH is a leading sponsor of biomedical, operations, and behavioral research. GH promotes the development, testing and dissemination of new tools, technologies and approaches to combat critical health problems, strengthens program effectiveness, and surmounts policy constraints. GH has played a key role in developing new, cost-effective technologies such as oral rehydration salts, simple disease diagnosis, new contraceptive and birthing methods, and the use of vitamin A to enhance child survival. USAID supported studies that proved the linkage between provision of voluntary, confidential HIV counseling and testing and behavior change for at-risk population. In addition, GH has taken the lead in the development of indicators and methods to evaluate programmatic success and monitor trends in the health sector. Other donors and international agencies rely heavily on this work for policy development and program planning. Global Leadership and High-Impact Partnerships: USAID is a recognized leader worldwide in health and exercises its leadership through the technical expertise of a multi-disciplinary staff. GH's global leadership focuses on fostering technical innovation, promoting policy dialogue and encouraging increased mobilization of resources for health activities. This leadership helps achieve USAID agency-wide results by increasing the opportunities for, and likelihood of, successful health programs and by encouraging the wider global community of countries, donors and non-governmental organizations to adopt new technologies and approaches and pursue USAID priorities and goals. Recent USAID's success stories in Technical Support, Research, and Global Leadership:
Plans to build upon these successes in FY 2003 are included in the Progress Data Sheet. ONGOING PROGRAMS FOR WHICH NO FY2002 & FY2003 FUNDING IS RQUESTED: No programs will be deleted. However, given necessity for development choice, assistance for child survival and maternal health, vulnerable children, and infectious disease will decrease. OTHER PROGRAM ELEMENTS: In addition to providing overall field technical support, 63 field missions address at least one of the five health priority areas in their programs through the GH field support mechanism. Approximately one third of the country-level health and population sector funds flow back to GH to utilize centrally-managed instruments for programming and implementation. USAID also coordinates its population, health and nutrition programs with the Departments of Health and Human Services, Agriculture, State and Treasury, as well as with the Centers for Disease Control and Prevention, the White House and other bilateral and multilateral agencies, and non-governmental agencies. Increasingly, USAID is working with the private and commercial sector - industry and foundations - to take advantage of technical and financial synergies in facing the challenge to improve global health. OTHER DONORS: USAID has exceptional relationships with key multilateral (e.g. U.N. Children Fund, U.N. Population Fund, Joint U.N. Program on HIV/AIDS, World Health Organization) and bilateral agencies (e.g. United Kingdom, Japan, Germany, Canada), private foundations (Gates, Packard, Hewlett), as well as with the public and non-profit sectors. USAID also plays a lead role in the development of The Global Fund to Fight HIV/AIDS, TB and Malaria, an entity dedicated to mobilize resources in the fight against the world's major infectious diseases. USAID brings its trademark technical expertise to these partnerships. Leveraging this contribution along with significant financial resources, the U.S. government has marked impact on health policy and programs at both the global and country levels. USAID and the major partners in the health sector focus on the most pressing global health issues, including the HIV/AIDS pandemic, infectious diseases, child survival and maternal health and reproductive health. Despite having a different strategic approach toward development compared to United Nations Agencies and most other bilateral donors, which emphasize poverty alleviation over sustainable development, USAID has been able to achieve fruitful collaborations with partners to bring about health improvements for the world's population. The following examples highlight the successful partnerships that have been forged with various organizations:
Program Data Sheets
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