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Civil Society Statement Recognizing the Role of Global Health in Development

Download PDF version of statement here.

As organizations that work around the world to ensure healthier, safer lives for all people, we join together to support sustained and strengthened U.S. commitment to global health.

Health is the backbone of strong and stable communities, which makes global health – in addition to humanitarian relief, democracy and governance, disaster assistance, agriculture development, and education – a critical component of how the United States engages with the world. By investing in global health and development, the United States helps to build healthier and more self-reliant communities, which are more economically and politically stable. U.S. leadership in global health is critical to reaching the finish line on bold global health initiatives.

Global health programs also are some of the greatest successes of U.S. foreign assistance, and have contributed to tremendous gains in health around the world, including a halving of preventable child deaths, a 60 percent decrease in deaths from malaria, and a 45 percent reduction in maternal mortality since 1990. They are also some of the most critical, putting the U.S at forefront of fighting future disease threats, building resilient health systems, and promoting global health security. Global health programs play an important role in meeting objectives across other evelopment priorities, as well, including food security and gender equality.

As the Administration considers the organization of the U.S. government, including international development and diplomacy operations, it is critical to recognize and sustain global health functions that support maternal and child health; HIV/AIDs; tuberculosis; malaria; neglected tropical diseases; family planning and reproductive health; water, sanitation, and hygiene; nutrition; noncommunicable diseases; research and development; workforce development; and global health security.

Any reorganization of U.S. foreign aid and diplomacy operations must prioritize:

Distinct and deliberate tracks for development and diplomacy. While development and diplomacy work hand-in- hand to promote our humanitarian and security interests, they offer different and unique perspectives on U.S. global engagement. U.S. global health efforts exemplify this distinction, as programs work to improve health in the most vulnerable populations worldwide, not just in those areas of strategic national interest. Accordingly, agenda-setting, priorities, and budgets for these two areas of foreign policy must remain distinct and deliberate.

Global health as a prominent and distinct feature of U.S. foreign aid and development. Global health is multi- faceted and cross-cutting – and one that is not confined to national borders, low economic or humanitarian development status, or emergency operations. For U.S. humanitarian and strategic objectives, it is just as important for global health efforts to address challenges stemming from a natural disaster as it is to target endemic health issues that may prevent a country from achieving growth and stability. It is critical that any redesign or restructuring of U.S. development and diplomacy programs maintains a prominent and distinct place for global health that recognizes and supports the diverse and cross-functional health challenges facing low- and middle-income countries.

Maintaining and supporting technical expertise in development, including global health. U.S. global health programs have a track record of success and high-impact because they are supported by strong and deep technical expertise at USAID and the State Department. To continue and build upon this legacy of success, it is vital to maintain and support technical experts for the full range of U.S. global health programs and priorities.

Global health is a critical component of U.S. development and diplomatic engagement, and must be sustained. As such, the unique attributes and value-add of global health programs must receive appropriate attention, and be included at the highest levels of strategic discussions on government organization.

We strongly urge any redesign plan to commit to continued U.S. leadership in global health and support and sustain the cross-cutting development and diplomatic initiatives that help people live longer, healthier lives.

Action Against Hunger Advocates for Youth ALIMA USA
American College of Cardiology American Heart Association American Public Health Association AVAC
CARE USA
Center for Health and Gender Equity (CHANGE) CORE Group
Elizabeth Glaser Pediatric AIDS Foundation
Elizabeth R Griffin Research Foundation
FHI 360
FIND
Frontline Health Workers Coalition
Fund for Global Health Georgia AIDS Coalition Global Health Council Global Health Strategies
Global Health Technologies Coalition
HarvestPlus
Health Systems Management Helen Keller International IMA World Health
Infectious Diseases Society of America
IntraHealth International Johns Snow, Inc. (JSI) Millennium Water Alliance MMV
Noncommunicable Disease (NCD) Roundtable
Planned Parenthood Federation of America
Population Council RESULTS Austin SPOON
TB Alliance
The American Academy of Pediatrics
The Hunger Project
Uniting to Combat Neglected Tropical Diseases
Washington Global Health Alliance
WaterAid
White Ribbon Alliance

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Strengthening Sierra Leone Health Systems: Applying Lessons from the 2014 Ebola Outbreak to Future Emergencies

This guest post was written by Laurentiu Stan (laurentiu_stan@jsi.com), MD,MPH, MBA, Chief of Party, Advancing Partners and Communities (APC) Project, Sierra Leone, JSI Research & Training Institute, Inc. John Snow, Inc., a member of Global Health Council (GHC), and the nonprofit JSI Research & Training Institute, Inc., are public health management consulting and research organizations dedicated to improving the health of individuals and communities in the US and around the globe.

Zainab Jalloh, holding her one-year-old daughter Khadijatu, at the Gbanti Community Health Post (CHP) on April 3, 2017 in Bombali District, Sierra Leone.

I’ve lived in Sierra Leone for almost two years, working to help this country’s long-battered health system recover from the Ebola outbreak that took the lives of more than 200 health professionals. Now the country has been affected by an epic landslide. Despite these tremendous setbacks, health systems and health indicators are improving.

Even before the Ebola Virus Disease (EVD) outbreak, Sierra Leone had the world’s highest maternal mortality ratio: 1630 of 100,000 live births (UNICEF, 2010). By 2015, the ratio had dropped to 1360, but Sierra Leone still held the top spot in this dismal measurement. Ebola compounded the problem because about 1 in every 4 women stopped coming to clinics for prenatal care and delivery. In fact, although almost 4,000 Sierra Leoneans died due to the EVD outbreak (between May 2014 and January 2016), during that same period more than 4,500 women died in childbirth.

The Ministry of Health and Sanitation (MOHS) focused its post-Ebola health recovery priorities on strengthening the health system’s capacity to safely detect and prevent diseases and respond to future epidemics in cooperation with its neighbors. It also recognized the need to contribute to global health security to improve health and economic opportunities.

A health facility water pump before APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

Between September 2015 and August 2017, under the umbrella of the USAID-funded and JSI-managed Advancing Partners & Communities (APC) project, I have helped implement a number of programs that are contributing to MOHS recovery objectives by improving primary care service delivery in the communities hardest hit by Ebola. APC has revitalized 305 primary care facilities, ensuring access to basic health services—with a focus on improving quality of maternal health services—for almost 2 million Sierra Leoneans, including the 3,400 registered Ebola-survivors.

A health facility water pump after APC revitalization. Photo courtesy/ JSI Research & Training Institute, Inc.

APC’s community health facility upgrades dramatically improved water and sanitation standards, installed solar power systems, provided basic equipment, and trained more than 900 health professionals and 1,500 community health workers (CHWs) on reproductive, maternal, newborn, and child health and as—importantly, given how Ebola was spread—infection prevention and control practices. Today, more than 2 million Sierra Leoneans in five districts have access to revitalized primary care and community health services in these primary care units and their catchment villages.
We know that another epidemic or emergency could come at any time, and while the Sierra Leone health system is going through significant transformations as part of the five-year recovery plan, it is better equipped now to address it.

The tragic August 14 landslide was just such an emergency—and the new systems that the U.S. government has invested in are working. The emergency coordination and resource mobilization mechanisms put in place with CDC support reacted well and fast. Mental health nurses who were trained to support Ebola survivors are providing psychosocial support to the several-thousand people who lost homes and relatives: more than 1,000 people died in the landslide. The CHWs recently trained by APC have undergone a 15-day social mobilization exercise to identify and convey messages on the prevention of cholera and other waterborne diseases to at-risk populations. With USAID and DfID support, JSI is assisting the MOHS relief efforts with emergency delivery of essential pharmaceutical and medical consumables to one area hospital and six primary care units.

This most recent tragedy has demonstrated that the country’s service delivery system has improved. One year after the outbreak ended, the MOHS data showed about a 10% positive change in uptake of facility deliveries and outpatient services in the four districts where 70% of Ebola survivors live. Now that health facilities have been revitalized, and health care workers are providing higher-quality services, we are seeing more and more Sierra Leoneans returning to their local health facilities.

There is still much to be done, of course. But Sierra Leone is on its way to a health system that meets the needs of its people—and, given the toll that Ebola took, is ready to confront the next infectious disease—be it Ebola or some other virus—with stronger, better prepared health services. And that helps us all.

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Advocacy Update ~ September 11, 2017

This post was written by Danielle Heiberg, GHC Senior Advocacy Manager.

Last week, Congress returned from August recess and got to work, tackling not only the aftermath of Hurricane Harvey and the debt ceiling, but also appropriations for Fiscal Year (FY) 2018, which begins on October 1.

The legislation to provide disaster relief funds to those affected by Hurricane Harvey, includes a short term deal to raise the debt limit through December and a continuing resolution (CR) to keep the government open until December 8. In the Senate, Senator Rand Paul (R-KY) had proposed an amendment to offset the funds needed for Hurricane Harvey relief by cutting from USAID funding. The Senate voted to table the amendment by 87-10, with the 10 no votes all cast by Republicans.

The Senate Appropriations Committee also took up the State and Foreign Operations (SFOPs) and Labor, Health and Human Services, and Education (Labor-H) appropriations bills, which funds programs at NIH and CDC. Similar to the House, the Senate rejected President Trump’s budget that recommended drastic cuts to much of global health programs, and foreign assistance in general. The Committee recommended mostly flat funding for global health programs at USAID and the State Department, and recommended increased funding to TB and flat funding for Malaria by using unobligated funds from the Ebola Emergency Response fund. In the Labor-H bill, the Committee recommended increased funding for the Fogarty International Center (which was zeroed out in the President’s budget); increased funding for NIAID; and decreased funding for the Global Public Health Protection and Global Disease Detection in the Center for Global Health at CDC. See full funding chart below.

Of particular note in the SFOPs bill, was an amendment passed by the full committee to allocate “not less than” $585 million for bilateral family planning/reproductive health programs; repeals the Mexico City Policy (or Global Gag Rule); and mandates a U.S. contribute to UNFPA of $37.5 million. The amendment, introduced by Senator Jeanne Sheehan (D-NH), passed mostly along party lines, but with Senator Joe Manchin (D-WV) voting no, and Senators Lisa Murkowski (R-AK) and Susan Collins (R-ME) voting yes. As the House was voting on the floor on their version of the SFOPs bill, which contains language diametrically opposite to this amendment, the language will most likely be stripped out during final negotiations between the two chambers.

Also of significance is the strong language that the Committee inserted in the SFOPs report to blunt some of the actions taken by the Trump administration, especially in regards to the administration’s “redesign,” or reorganization plans, and the fear that the administration may simply not spend appropriated funds. The SFOPs report included language that the Committee feels that the President’s proposed International Affairs budget does not reflect “our increased attention to public safety and national security [that] sends a clear message to the world – a message of American strength and resolve.” The Committee also stressed that “diplomacy and development remain cost effective national security tools.”

In regards to reorganization, the Committee cited that their questions remain “largely unanswered” and is “concerned that the administration has a predetermined outcome for the reorganization or redesign.” The Committee included language that any reorganization plan is “subject to prior consultation and regular notification procedures.”

The Committee also included language reminding the administration of the Budget and Impoundment Control Act of 1974, which limits “the authority of the administration to reduce or withhold funding provided in law by action or inaction.”

Meanwhile, on the other side of Capitol Hill, the House began work on a minibus (or an “octobus” as some called it), to deal with the remaining eight appropriations bills, which includes SFOPs and Labor-H. The House voted on a number of amendments to the bill, but did not get to amendments for SFOPs until late Thursday. Of particular note, an amendment from Congressman Eliot Engel (D-NY) to increase funding to TB failed. An amendment in Labor-H offered by Congresswoman Claudia Tenney (R-NY) would cut $14 million from CDC global health to increase funding for community block grants is expected to be voted on this week. The House has an additional 400 amendments to vote on, before final passage of the minibus.

With the CR in place until early December, Congress has a few months to work out final numbers and language. However, it will be crunch time to pass the final FY18 bills and negotiate a new debt ceiling, coupled with a desire to return home for the holidays.

Appropriations Budget Table (as of September 2017)

* House: Includes $250 million from remaining Ebola response funds; Senate: Includes $100 million from remaining Ebola response funds
** Includes $20 million from remaining Ebola response funds;
*** Funding from remaining Ebola response funds; An additional $130 million reserve fund is also made available for “programs to prevent, prepare for, and respond to unanticipated and emerging health threats only if the Secretary of State determines and reports to the Committee that it is in the national interest to respond to such threats”
**** The International Organizations and Programs (IO&Ps) is zeroed out. The House recommended funding for UNICEF in the Global Health Programs account.

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The Reach Act: Investing in Maternal and Child Health

This post was written by Melissa Chacko, Policy Associate at Global Health Council.

Over the past few decades great strides have been made in maternal and child health: since 1990, the deaths of mothers and children under age 5 worldwide have been cut by more than half. The decrease in maternal and child mortality rates is a product of simple evidence-based solutions and inexpensive interventions. However, there is still a significant amount of work to do to ensure that no woman or child dies from a preventable death in our generation. Nearly 300,000 women continue to die annually due to complications during pregnancy or childbirth and 99% of these maternal deaths occur in the developing world. Access to quality care is essential for women and children as they are an integral part to building strong and prosperous communities. To reach the overarching goal of ending preventable deaths may seem idealistic, but it is achievable if we maximize the return on U.S. investments in maternal and child health programs.

In 2014, an advisory panel analyzed USAID’s Maternal and Child Health program, and found areas of improvement that would maximize the progress of the program. Since then, the program has undergone the process of implementing reform and exploring innovative financing tools to bring new resources to the field. However, with these measurements and expansion, also comes a need for greater coordination and accountability.

The Reach Every Mother and Child Act (S.1730) would create that accountability and coordination, as well as codify the reforms, all of which will keep USAID on track to reach its goal of reducing preventable child and maternal deaths and maximizing impact. In early August, Senators Susan Collins (R-ME) and Chris Coons (D-DE) led a bipartisan group of 10 Senators in reintroducing the Reach Every Mother and Child Act.

The Reach Act:

1) Requires a coordinated U.S. government strategy for contributing to reducing preventable child and maternal deaths;
2) Establishes rigorous reporting requirements to improve transparency, accountability, efficiency, and oversight of maternal and child health programs;
3) Ensures USAID focuses on the scale-up of highest impact, evidence-based interventions to maximize the return on existing U.S. investments;
4) Establishes the position of Child and Maternal Survival Coordinator at USAID to reduce duplication of efforts and ensure that resources are being used to maximum impact; and
5) Helps USAID explore and implement innovative financing tools, such as pay for success contracting, to leverage additional public and private resources, complementing existing U.S. assistance.

A similar version of the legislation was introduced in Congress last session (S.1911 and H.R. 3706) and received strong bipartisan support in both chambers.

In almost every field of health, women and children are the most vulnerable in areas that lack essential healthcare resources and systems. We can change this narrative by passing the Reach Act. The lasting impact of this legislation will be seen through the thousands of women and children who will live longer and healthier lives, due to access to quality care. With the Senate back in session, outreach for Senate cosponsors on the Reach Every Mother and Child Act is in full swing. It is important to rally support on this issue and vocalize the importance of bipartisan support on the Reach Act.

We encourage you to contact your Senators to voice your support for the Reach Act. You can find contact information for the Senate here.

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2017 Triangle Global Health Annual Conference

This guest post was written by Emily Kiser (emilykiser@triangleglobalhealth.org), Program Coordinator at Triangle Global Health ConsortiumThe Triangle Global Health Consortium is a non-profit member organization representing institutions and individuals from the pharmaceutical and biotechnology industry, the international health development NGO community, the faith community, and academia. The Consortium’s mission is to establish North Carolina as an international center for research, training, education, advocacy and business dedicated to improving the health of the world’s communities. To learn more, visit www.triangleglobalhealth.org.

The Triangle Global Health Consortium warmly invites you to attend the 2017 Triangle Global Health Annual Conference to share, learn, and build relationships within North Carolina’s rich global health community! The conference will be held September 28 on the North Carolina State University campus in Raleigh, NC. Conference registration is now open, and early bird rates are available through September 7. The day will feature global health leaders, compelling speakers, exciting breakout sessions, and plenty of time to network!

North Carolina is a leader in global health, housing more than 220 organizations, companies, and academic institutions that work in more than 185 countries to improve the health of people around the world. Global health work supports over 26,000 jobs in North Carolina, and in 2015, the global health sector in North Carolina contributed about $3.7 billion in gross state product. Our conference sessions will highlight many areas of global health work taking place in our state and their far-reaching impacts.

We are thrilled to present keynote addresses from three incredible speakers who will discuss the impacts of global health work, both here at home and around the world. Keynotes include:

Health, Peace, & Prosperity, All Within Reach

Pape Gaye, MBA
President & CEO of IntraHealth International

 

Global Health, the US Government, and our Future

Michael H. Merson, MD
Wolfgang Joklik Professor of Global Health, Vice President and Vice Provost for Global Affairs at Duke University, founding director of the Duke Global Health Institute

 

Women Leaders in Global Health: Say it with Stats and Stories

Nandini Oomman, PhD
Independent consultant in global health & development and founding curator for the Women’s Storytelling Salon

 

The day will also feature two plenary panel discussions which will illustrate the economic and security impacts of global health work. Panelists will discuss the many ways in which global health work contributes to development, diplomacy, and defense and the improvements that are generated in arenas far beyond health alone.

We will also offer the opportunity to select from a variety of breakout sessions which reflect the vast diversity of global health work taking place in North Carolina. We are excited to present:

1) Building Multi-Sectoral Coalitions
2) Can we translate the multilateral strategies for cervical cancer prevention to address other global health disparities?
3) Creating and Managing Specialized and Remote Health Worker Training using Referenceable Replays
4) Food and Nutrition Security in a Climate-Changed World: Health, Socioeconomic, and Environmental Inputs and Impacts
5) Impacts of Global Environmental Health Efforts: Perspectives from Federal Agencies
6) Innovation Challenges and Co-creation for Digital Health: Hands on Training
7) Story-Gathering for Social Impact
8) The global pandemic of substandard and falsified medicines

We hope you will join us to learn, share, create, and connect in Raleigh, NC on September 28!

​For more information on conference programming, speakers, sponsors, and more, visit www.triangleglobalhealth.org/annual-conference.

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