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Cablegate: Global Health Initiative: Namibia Comment

VZCZCXRO9341
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHWD #0484/01 3511606
ZNR UUUUU ZZH
R 171606Z DEC 09
FM AMEMBASSY WINDHOEK
TO RUEHC/SECSTATE WASHDC 0020
INFO SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE

UNCLAS SECTION 01 OF 03 WINDHOEK 000484

SIPDIS
STATE FOR D(L) CHBONNER
O/GAC
AF/S MHARRIS, PGWYN
PLEASE PASS TO USAID, CDC

E.O. 12958: N/A
TAGS: EAID KHIV KWMN KOCI WA
SUBJECT: Global Health Initiative: Namibia Comment

REF: 09 STATE 125761

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SUMMARY

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1. (U) Post welcomes the opportunity to respond to reftel, "Global
Health Initiative: Promoting Greater Awareness and Participation."
The USG team in Namibia strongly supports GHI's seven guiding
principles. Specifically, the focus on women and girls as the
"gateway" to families is crucial, but it is important that men and
boys remain key targets for awareness and advocacy. We welcome the
emphasis on sustainability, but stress the need to integrate health
programs with broader USG foreign policy initiatives, and with the
host governments' financial and political leadership. GHI
investments should be focused on systems (e.g., human resources,
legal frameworks, finance) to improve healthcare access and equity,
and to leverage the involvement of the private sector and civil
society in supplementing the host governments' healthcare programs.
We applaud the GHI's emphasis on integration and coordination,
health systems strengthening, and metrics, which are critical
issues for Namibia. End Summary.

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BEST PRACTICES, LESSONS LEARNED, AND OPPORTUNITIES

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2. (U) As the largest bilateral donor in the health sector in
Namibia, the USG has produced several valuable lessons:

--The co-location of USG personnel within partner government
ministries has greatly strengthened the quality of our
collaboration with the government.

--In the second five-year phase of PEPFAR we are emphasizing direct
government-to-government support to key host country ministries.

--Engagement with the local private sector (beyond public-private
partnerships). Best practices include: 1) Private insurance schemes
to include low cost HIV/AIDS coverage. 2) Inclusion of public and
private sector providers in USG sponsored trainings. 3) Development
of community health care systems financed and managed by a
public-private trust fund. 4) Corporate social responsibility
activities coordinated to maximize health impact.

--Empowering communities and civil society through support to
Community Coalitions/Community Advisory boards and other
non-governmental frameworks. These entities have helped strengthen
local involvement in decision making for health system investments
and health policies. They have also increased accountability, given
a voice to marginalized populations, expanded access to underserved
groups and areas, and improved the ownership of health at the
household level. Community-based interventions such as
microfinance/microenterprise have also proved effective.

--Task-shifting: PEPFAR's support for training for nurses has
allowed resource-constrained countries to address human resource
shortages in the clinical setting quickly, efficiently, and without
sacrificing patient safety. Task-shifting at all levels of the
healthcare system should be a cornerstone of GHI's human resources
for health strategy. In Namibia, task-shifting has led to the
creation of a "Health Extension Worker" cadre within the civil
service.

--Scholarships: Support for pre- and in-service training through

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scholarships and "twinning" exchanges has been critical in helping
build local capacity. GHI should also support host country
governments to develop post-graduate fellowship or internship
programs within existing civil service systems.

--Leveraging HIV/AIDS investments. Namibia's ability to conduct
tuberculosis drug resistance monitoring and molecular screening for
H1N1 are direct results of PEPFAR investments in laboratory
infrastructure. Investments in blood safety have improved access to
screened blood and blood products, critical tools for clinicians in
the management of obstetric emergencies and childhood anemia.

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RECOMMENDATIONS

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3. (U) Post provides the following recommendations for
consideration in the development of GHI:

--Broader engagement of USG staff: To link health programs to
Missions' broader foreign policy activities, Missions' political
and economic officers as well as other agency representatives
should be integrated into GHI Country Teams as appropriate.

--Resource tracking for health should allow host governments and
USG teams to understand how funds are spent, and how to set
sustainability targets. National Health Accounts and sub-accounts
will help ensure accountability, transparency and evidenced-based
resource allocation.

--Human Resource Retention: Greater emphasis to develop innovative
strategies to retain trained personnel.

--GHI should include male engagement and involvement.

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COMMENTS AND QUESTIONS ON CORE PRINCIPLES

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4. (U) Post has the following comments and questions regarding
GHI's core principles:

--Women and Girl-centric approach. Male involvement strategies are
critical.

--Strategic Integration and Coordination. USG strategic integration
and coordination is welcome and should be linked to Agencies' core
competencies.

--Strengthen and Leverage Multilateral Institutions. What role will
PF Agreements, which take multilateral contributions into account,
play in GHI?

--Country ownership. Civil society and private sector involvement
is critical. Post would like to contribute to discussions on
strategies to engage host governments.

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--Health Systems Strengthening (HSS). HSS strategies should focus
on sustainability, quality, access and efficiency. The cable
mentions the need to make "measurable improvements" in the six
building blocks. Post suggests using the same HSS M&E indicators as
used by the GFATM.

--Metrics, M&E. Support for host country and multilateral
stakeholder planning, coordination and ownership should be driven
by quality evidence.

--Research, Development and Innovation. Implementation of research
initiatives should be streamlined.
MATHIEU

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