The U.S. Government is taking significant steps across major investment areas to evolve its approach to country ownership in support of accelerated results. The Country Ownership Principle paper provided an important framework for all U.S. Government agencies to guide how investments are made in country. The U.S. Government defines country ownership as “the continuum of actions taken by political and institutional stakeholders in partner countries to plan, oversee, manage, deliver, and finance their health sector and achieve health goals. These actions advance sustainable, quality health programs that are locally owned and responsive to the needs of host country nationals.”
While rapidly expanding access to lifesaving HIV services to achieve its goal of an “AIDS-Free Generation” and sustained epidemic control, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) took significant steps to move from an emergency plan to a more sustainable program in its partnerships with countries. Similarly, the President’s Malaria Initiative (PMI), also embraces country ownership by carrying out annual planning visits to collaboratively develop PMI Malaria Operational Plans with national malaria control programs and other ministry counterparts. The initiative also provides significant support for health systems strengthening activities, such as training health workers at all levels of the health system, building the capacity of Ministry of Health staff to collect, analyze, and use data for decision-making, and strengthening supply chain management. In a growing number of countries (e.g., Ghana, Senegal), PMI funding is provided directly to government entities for the implementation of malaria control activities. Through these programs, the United States signaled its intention to shift its relationship with host countries to a partnership – engendering a fundamental shift from aid to co-investing and collaboration, and positioning countries to assume greater responsibility for caring for their own people.
The U.S.-South Africa partnership on HIV and AIDS is a leading example of moving the country-owned and -led principle from paper to practice. In recent years, South Africa has dramatically increased its own financial contributions to its national AIDS response. It has assumed greater managerial and technical oversight of its national AIDS programs, exemplifying President Obama’s vision of shared responsibility. Building on the successfully negotiated U.S.-South Africa Partnership Framework Implementation Plan signed in August 2012, which documents how the assumption of greater country ownership in the context of the HIV and AIDS program will occur over the next 5 years, a gradual transition will be made in PEPFAR’s investments in South Africa. These measures include shifting some of PEPFAR’s support from the delivery of clinical care and treatment services and toward strengthening the capacity of the South African health system and health care workforce to expand HIV prevention, treatment, and care services as well as improving the quality, effectiveness, and efficiency of the HIV and TB responses. This has laid an important foundation for the South African Government and PEPFAR partnership toward achieving epidemic control and an AIDS-free generation in South Africa.
The U.S. Government is a critical leader in reenergizing the child survival global movement with a country-owned focus through the Call to Action, which launched in June 2012. The meeting, which was co-hosted by the U.S. Agency for International Development (USAID), United Nations Children’s Fund (UNICEF) and the Governments of India and Ethiopia, resulted in over 175 countries and 400 civil society and faith organizations signing a pledge that became known as A Promise Renewed (APR) to accelerate global progress on ending preventable child and maternal deaths by 2035. With a goal of fewer than 20 child deaths per 1,000 live births and fewer than 50 maternal deaths per 100,000 live births by 2035, the global movement has initiated country-level commitments and movements in over 16 countries and several regional institutions with clear goals, targets and data-driven approaches.