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U.S. Global Health Initiative

Country Ownership

A man holds a newborn baby in his arms.
Source: AFP

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.”

Greater Responsibility

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.

Progress on Child and Maternal Survival

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.

                                                October 2012
                                                President Goodluck Jonathan launched “Saving One Million Lives “, comprehensive initiatives to scale up access to essential primary health services and commodities for Nigeria.
                                                January 2013
                                                The Government of Ethiopia convened Ministers of Health, global health policy analysts, and technical experts from 20 African countries to review regional progress on child survival lessons learned, call for greater accountability and reaffirm commitment to reducing under-five mortality rates to fewer than 20 deaths per 1,000 live births.
                                                April 2013
                                                The First Lady of Zambia hosted a national launch of AFR and unveiled a four year road map that aims to save and average of 27,000 maternal and child lives per year.
                                                May 2013
                                                Sierra Leone 
                                                The government launched a national effort to accelerate a decline in maternal and child deaths and developed  a scorecard with stakeholders to symbolize a commitment to tracking reproductive, maternal, newborn and child health (RMNCH) interventions at subnational levels.
                                                Democratic Republic of Congo
                                                DRC launched a national acceleration framework to reduce infant by 48% and maternal mortality by 31% over the next three years.
                                                July 2013
                                                Senegal’s Minister of Health launched APR with the goal of working with partners to save 10,000 children by the end of 2015.
                                                President Ellen Johnson Sirleaf launched APR: Committing to Child Survival in Liberia.
                                                August  2013
                                                African Union Conference
                                                The Campaign for Accelerated Reduction of Maternal Mortality in Africa targeted cross-sectoral leadership to mobilize actions and build greater accountability and transparency for child an maternal survival
                                                November 2013
                                                The government launched a national effort to support increased maternal and child survival.
                                                Vice President Khhimbo Kachali launched Malawi’s scorecard and highlighted the nations’ sharpened plan, emphasizing newborn health.
                                                Vice President Dekani unveils a sharpened reproductive, maternal, newborn and child health plan that aims to prevent an additional 40% of under-five death and 26% of maternal deaths by 2017.