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Cablegate: Hanoi Core Statement On Health Touches On Broader Aid

VZCZCXRO1743
RR RUEHHM
DE RUEHHI #1339/01 3440935
ZNR UUUUU ZZH
R 090935Z DEC 08
FM AMEMBASSY HANOI
TO RUEHC/SECSTATE WASHDC 8822
INFO RUEHHM/AMCONSUL HO CHI MINH 5353
RUEHBK/AMEMBASSY BANGKOK 6554
RUEHGV/USMISSION GENEVA 1253
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHINGTON DC

UNCLAS SECTION 01 OF 03 HANOI 001339

SENSITIVE
SIPDIS

STATE FOR EAP/MLS, EAP/EP, INR, OES/STC, OES/IHA, OGAC
STATE PASS TO USAID FOR ANE AND GH
HHS/OSSI/DSI PASS TO OGHA (WSTIEGER/LVALDEZ/MABDOO)
BANGKOK FOR RDM/A (CBOWES/MACARTHUR/MBRADY/MKLEINJAN)
GENEVA FOR HEALTH ATTACHE

E.O. 12958: N/A
TAGS: TBIO PREL PGOV SOCI KHIV KFLU VM
SUBJECT: HANOI CORE STATEMENT ON HEALTH TOUCHES ON BROADER AID
EFFECTIVENESS AND DEVELOPMENT POLICY ISSUES

REF: A. 2006 Hanoi 2803 B. Hanoi 370

THIS IS AN ACTION CABLE. PLEASE SEE PARAGRAPH 2.


1. (U) Summary. The Government of Vietnam (GVN) and several
development partners have drafted a Statement of Intent (SOI) to
improve the Vietnamese health care system, through improving
development assistance, coordinating GVN and donor efforts, and
increasing transparency and accountability. The GVN and these
donors have negotiated a draft document modeled upon earlier
international health development commitments and upon existing,
successful partnerships among the GVN and its donor partners. At
this late stage in the drafting process, major, substantive edits
may result in U.S. exclusion from the final document. Such a result
will have definite impacts on U.S. health policy goals in Vietnam.
On balance, the in-country inter-agency team favors concurrence.
End Summary.

2. Action Request: This cable provides relevant background
information and context for the draft SOI and explains likely
consequences should the United States choose not to sign or require
significant, substantive edits to the document. We request
inter-agency review and clearance of the draft SOI, forwarded by
separate e-mail; provide edits and relevant justifications by
January 10. We will need these explanations when we negotiate the
final draft of the document.

The Negotiating Process
-----------------------

3. (U) The GVN and several prominent development partners, including
the United States, recently completed drafting the SOI on "Improving
the effectiveness of development assistance for health." At the
November 26, Health Partnership Group (HPG), the Ministry of Health
(MOH) presented the "final draft" of the SOI, which the drafters
modeled on the Paris Declaration (PD), referred to the Accra Agenda
for Action (AAA), and built upon the Hanoi Core Statement (HCS),
each of which has been signed by the United States. MOH and the
World Health Organization (WHO) have signed off on the document,
which they expect will only receive routine, legalistic changes
during the clearance process with various development headquarters.
Following headquarters clearance, we expect the GVN and development
partners to sign the document in late February. Therefore, and
because of the shut down of GVN and many diplomatic missions
connected with the Tet Holiday, we will need suggested edits and
clearances from Washington agencies by January 10 in order to review
with the GVN and development partners and finalize the document for
concurrence.


The SOI
-------

4. (SBU) For several years, health diplomacy has formed a prominent
part of our Mission Strategic Plan and has been a principal catalyst
to our expanding bilateral relationship with the GVN. Consistent
with our health development goals, we have worked with MOH, the
Ministry of Planning and Investment (MPI), and development partners
on a non-binding SOI, which will encourage the MOH (and the rest of
the GVN) to take ownership of health programs, coordinates GVN and
donor policy goals, technical programs, and financial contributions,
improves transparency and accountability, and provides guiding
priorities for budgeting and spending. This, in turn, may
facilitate better leveraging of the substantial commitment the
United States has made to the Vietnamese health sector, which in
FY2008 totaled about USD 100 million (includes work in animal
health). The SOI follows from the HCS, which is derived from the
PD, both of which focus on aid effectiveness. Similarly, the
drafters modeled the document on the highly successful Partnership
for Avian and Human Influenza (PAHI) (ref A), which the United
States helped craft and which has been held up around the world as a
model for host country-donor cooperation.

Difficult to Amend the Document
-------------------------------

5. (SBU) Given the lengthy negotiation process already undertaken
and the document's consistency with previously agreed upon
international and bilateral agreements, we believe that MOH, MPI,
and donor partners would not accept edits to the agreement that they

HANOI 00001339 002 OF 003


do not view as consistent with the intent of PD and the reference to
AAA. At this point, WHO, MOH and other development partners have
reached consensus and anticipate only legalistic changes with
headquarters clearance. The draft provided to Washington for review
reflected the culmination of a seven month process and extensive
(and finally successful) efforts to mediate inter-ministerial
disagreements between MOH and the MPI. At the same time, Mission
appreciates the inter-agency complexities and multi-lateral USG
policy concerns on aid effectiveness raised by this document.

6. (SBU) The draft SOI reflects a carefully crafted compromise that
balances the desire of MOH and most international donors to bolster
GVN commitment to the health sector with MPI wishes to focus on
specific actions. The compromise, largely brokered by the WHO,
re-structured the document away from a pure advocacy document
(consistent with the intent of the PD) by using formatting similar
to the AAA. The final version is designed to increase and improve
GVN health efforts. Throughout the drafting process, we encountered
no evidence of undue influence by the European Commission or other
like-minded parties. AAA language and format was inserted by the
MPI to settle an inter-Ministerial debate with MOH over the balance
between advocacy and action. In the Vietnam context, we do not feel
that reference to AAA can be extracted, nor does the current version
of the SOI imply any specific commitments beyond PD and AAA.

Benefits to Concurrence
-----------------------

7. (SBU) The USG plays the principal role in bilateral health
development and technical assistance to Vietnam. Beyond PEPFAR and
influenza, the United States has cooperative work to build
Vietnamese capacity in disabilities, tuberculosis, epidemiological
training, good clinical practice, good aquaculture practice, human
vaccine development, among others. On a broader level, the GVN and
other donors view the United States as a leader in overall health
development, including our participation in the Health Partnership
Group (Ref B), the related Joint Annual Health Review (an open,
transparent U.S. Institute of Medicine-like in-depth analysis of
specific health sector issues), the development of this SOI. These
efforts have established substantial good will and fostered
credibility, which we have been able to use to advance U.S. policy
goals and to ensure that the development of Vietnam's health sector
remains consistent with U.S. views. For example, despite MOH and
donor inertia, we were able to negotiate a broadening of this SOI to
formally include other ministries and partnerships (including civil
society) -- a concrete and strategic gain for our current
investments in health, namely HIV and influenza.

Risks To Not Signing Now
------------------------

8. (SBU) Failure to concur with the current draft of the SOI will
have consequences for U.S. health interventions in Vietnam and to
our overall assistance program, in particular our strategy to pursue
a more comprehensive approach to health systems strengthening and to
improve the sustainability of U.S.-supported programs. Lack of
action may decrease the substantial good will we have developed with
our Vietnamese health partners, while also isolating us from other
international donors and will make it more difficult to play a
leading role in coordinating health policy.

9. (SBU) More specifically, the SOI is tied to the re-establishment
and terms of reference for the HPG. This is the umbrella forum for
all health-related partnerships. Originally a place to exchange
information for the purposes of coordination, it has become a forum
for policy development, using outside input from donors. While we
anticipate that we could still participate in the HPG, our voice
could be diminished and it would be awkward if we were the only
country not formally part of the health alliance, founded on HCS and
the follow-on SOI. [Note: Japan is likely the only other country
that might have policy-related issues with the SOI; however, we have
no evidence this is the case, and current conversations indicate
that they intend to approve the document.] Further, there are other
minor likely practical coordination challenges that will most
certainly arise, such as being left off of various lists and
meetings, which without increased diligence on our part, could
result in decreased recognition of USG contributions in health,
including in media reports.

10. (SBU) We do not think the process will come to a standstill if
we do not concur with the SOI. If, in fact there is concern that we

HANOI 00001339 003 OF 003


are somehow giving undue acceptance or weight to the AAA, we find it
hard to draw that conclusion from the documents. In any case, this
is not the kind of document that is going to influence global
agreements or global assistance behavior. Indeed, the document
provides explicitly for project and program funding in addition to
budgetary and sectoral support as modalities for providing support.

MICHALAK

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