Byliner: U.S. Helps Build Health Care Systems in Developing World

05 December 2001

Byliner: U.S. Helps Build Health Care Systems in Developing World

DAS for Health links diplomacy and disease-fighting strategy

(This byliner was originally published in the December 2001 Global Issues Electronic Journal "Health Systems for HIV/AIDS and Other Diseases." No republication restrictions.)

Diplomacy Is Central to Building Public Health Infrastructure

By Jack C. Chow, M.D.
(The author is Deputy Assistant Secretary for International Health and Science, U.S. Department of State.)

The campaign to save human lives from the global HIV/AIDS pandemic is more compelling than ever before: with 40 million people living with the virus and nearly 3 million dying from the disease in the past year, the world community is awakening to the need to confront the pandemic through tangible, effective action.

It is well recognized by public health professionals that an integrated approach to prevention, treatment, and supportive care is critical to mitigating the disease's impact on individual lives and to averting the pandemic in vulnerable regions and communities. Central to that approach is establishing the capacity in both heavily affected and at-risk countries to deliver care and provide essential services. This entails having sufficient numbers of trained professionals, hospitals, clinics, laboratories, research facilities, and equipment. Linkages among these resources are also essential to provide operational effectiveness, sustainability, and overall coordination. The complexity of confronting an epidemic of the size and impact of HIV/AIDS increasingly requires health data and surveillance systems, logistical know-how, and management capabilities.

The U.S. government is the leading provider of direct assistance to developing countries in building health system capability. Several U.S. agencies, including the Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH), support the in-country training of doctors, researchers, epidemiologists, and health professionals, and provide technical assistance on establishing and maintaining systems.

In the area of international health, the role of the Department of State is to advance U.S. objectives and interests in establishing a healthier world community through diplomacy. In recognition of the growing challenge in spurring action against HIV/AIDS and other major diseases, the department has created the new Office of International Health Affairs (IHA) within the Bureau of Oceans, International Environmental, and Scientific Affairs. This new office, building upon the previous Office of Emerging Infectious Diseases, is the State Department's focal point for global health affairs, linking and coordinating actions by governments, nongovernmental organizations (NGOs), private companies, and health communities.

IHA supports three overarching goals towards fighting the AIDS pandemic: mobilizing resources, galvanizing national leaders towards effective action, and garnering citizen support for destigmatization and for national health investments.

Mobilizing Resources

Resources are vital in building public health infrastructure and providing essential services to people living with HIV/AIDS. The State Department is now leading negotiations that would create a new Global Fund to Fight AIDS, Tuberculosis, and Malaria. This new fund would attract, manage, and disburse additional resources through a new public-private partnership that would make a sustainable and significant contribution to the reduction of infections, illness, and death caused by these three diseases. It is anticipated that partnerships formed in countries at risk of, or heavily impacted by, AIDS and the two other diseases would receive funding to enhance access to prevention, treatment, and care; boost training of health professionals; and build community-based programs. These partnerships, composed of governments, NGOs, and private sector entities, would target gaps in their public health systems, intervene to close them, and establish lasting systems.

In recognition of the importance of averting the HIV/AIDS pandemic in a large, strategic region such as Asia, IHA, through the OES Initiatives program, awarded a grant to the University of Washington that will help establish a "network of networks" in regional disease surveillance against HIV/AIDS in Asia. This grant was announced during President Bush's October 2001 visit to the Asia Pacific Economic Cooperation (APEC) forum in China.

Galvanizing National Leaders

The State Department actively seeks to establish HIV/AIDS and global health issues at the forefront of contemporary diplomacy. State has assured the inclusion of health in key diplomatic venues such as the U.S.-European Union and G-8 summits, and actively participated in meetings of the U.N. General Assembly's Special Session on HIV/AIDS, APEC, the Association of South-East Asian Nations (ASEAN), the Southern African Development Community, and several others.

By making a persuasive case to national governments and social leaders that the fight against HIV/AIDS is in their national interest, the State Department spurs the commitment by those leaders to take effective action and make compelling choices in support of their national health policies. No member of the global community can afford, either in terms of human suffering or economic costs, to fail to recognize or to forestall the impending devastation that has already begun to ravage national economies, stability and security, and social infrastructure. Political commitment at the highest level of government, as well as throughout a nation's societal institutions, makes the crucial difference in stemming the epidemic.

The role of our diplomatic posts has been and will continue to be vital in the campaign against HIV/AIDS. With over 250 diplomatic and consular posts around the world, staffed with excellent and dedicated foreign service officers in political, economic, and science counselor roles, health attaches provided by the Department of Health and Human Services, and USAID field professionals, the State Department is uniquely situated to convey the importance of health to the world community. The State Department has sponsored major chiefs-of-mission conferences in Africa, one in Zimbabwe and another in Kenya, focused on HIV/AIDS, and will be planning additional conferences in the near future in regions where the epidemic is poised to accelerate.

Garnering Public Support

No national or international policies against the pandemic can succeed without the direct support of citizens. A well-informed citizenry is the first line of defense against the spread of the disease. Citizens must know the steps they can take to lower their risk of getting infected or spreading the infection. They must know what resources are needed to create and maintain public health infrastructure. They must understand how to dispel the fear and prejudices surrounding HIV/AIDS.

The State Department recognizes the importance of listening and speaking to citizens around the world about what needs to be done to support public health needs. In my role as the Deputy Assistant Secretary for International Health and Science, I have met and spoken to many individuals and groups concerned about global health issues. Overcoming nascent and well-established problems in global health requires a dialogue with people who have new and compelling ideas. I have been hearing many excellent suggestions and proposals on how the United States and the world community can work together. I, along with the staff of the IHA office and the State Department, will continue to reach out to the people of the United States and the international community to hear their comments, criticism, and ideas.

The lasting need for strong public health infrastructure both domestically and internationally serves to confront HIV/AIDS as well as other debilitating diseases. As the challenge grows in complexity and intensity, it is more and more evident that diplomacy will be essential in assembling the resources, political support, and citizen recognition needed to make a tangible, sustainable impact. The State Department, as the lead U.S. foreign affairs agency, will play an increasingly important role in spurring action on an unprecedented scale and scope.

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