Reflections on Advancing Health In Ethiopia

Blog Post — June 6, 2012

J. Stephen Morrison, Director, Global Health Policy Center
& Suzanne Brundage, Former Assistant Director and Research Associate, Global Health Policy Center

J. Stephen Morrison, Director, Global Health Policy Center
& Suzanne Brundage, Assistant Director and Research Associate, Global Health Policy Center 
I and my former colleague, co-author and good friend, Suzanne Brundage, are very pleased to release today an analysis entitled ‘Advancing Health in Ethiopia: With Fewer Resources, An Uncertain GHI Strategy, and Vulnerabilities On the Ground.” 
The report is timely in two important respects. 
It focuses on the complexity of the U.S.-Ethiopian bilateral relationship just prior to the June 14-15 Call to Action on Child Survival, to beheld in Washington DC, co-convened by the Governments of the United States, Ethiopia and India, in close collaboration with UNICEF. As USAID Administrator Raj Shah has described it, “This event will bring together decision makers and thought-leaders from governments, multilateral agencies, civil society, the faith community, academia and industry to identify the smartest investments in the fight to end preventable child deaths.” 
Second, it examines the GHI experience in Ethiopia at a moment when the Obama administration is critically engaging with Congress over what modifications in the GHI approach make sense for the future. 
This study is an effort to understand both the many remarkable health gains achieved in recent years through the close partnership between the United States and Ethiopia, and to reflect on the key considerations which should guide U.S. policy looking forward, taking into account shifts in available resources, the mixed record of the Global Health Initiative (GHI) and the broader governing environment in Ethiopia. 
I believe this is a fair, informed, and balanced study which has benefited from the good will and expert insights of many friends in the U.S. and Ethiopian governments, the NGO sector, and independent experts. I hope you will have time and interest to read it, I expect it has meaning beyond Ethiopia per se and will stir some debate. I ask that you freely share your reactions with us.
We have organized our thoughts around four propositions. 
In an era of flat and declining resources, in key countries like Ethiopia, a de facto marriage of PEPFAR and Global Fund HIV/AIDS programs is unfolding. Because the PEPFAR-Fund interface has taken on ever greater strategic importance, a spotlight is now fixed upon how and with what results can the PEPFAR-Fund collaboration be accelerated. 
Second, the United States has contributed to the advance of maternal and child health in Ethiopia by stretching its PEPFAR platforms and making smart use of USAID’s investments. But realism is warranted looking forward. We argue that the United States should shifts its strategy and make a major investment in the Minister of Health’s strategic planning and implementation capacities. It is a critical gap that begs attention. Further, we argue the World Bank, which is making a massive multi-year investment in Ethiopia’s ambitious accelerated development strategy, needs to step forward. It can and should do more in the area of maternal and child health.
GHI’s experience in Ethiopia has been mixed. The ambassador and country team have responded to the challenge to change practices and have demonstrated progress. But that has been against the backdrop of unclear goals and guidance, aggravated and visible rivalry between USAID and CDC, and enduring stovepiped planning and reporting requirements. The latter rigidities ultimately can only be remedied in Washington through a better interagency process and a new dialogue with Congress. 
Lastly, and paradoxically, the success of the US-Ethiopian partnership has evolved in the midst of a rigid and autocratic governing environment that contains significant risks and vulnerabilities. We need to acknowledge these, understand them, and take steps which can protect investments. 

Along with my co-author, good friend, and former colleague Suzanne Brundage, I am very pleased to release today an analysis entitled, Advancing Health in Ethiopia: With Fewer Resources, An Uncertain GHI Strategy, and Vulnerabilities On the Ground. 

The report is timely in two important respects. 

It focuses on the complexity of the U.S.-Ethiopian bilateral relationship just prior to the June 14-15 Call to Action on Child Survival, to be held in Washington DC, co-convened by the Governments of the United States, Ethiopia and India, in close collaboration with UNICEF. As USAID Administrator Raj Shah has described it, “This event will bring together decision makers and thought-leaders from governments, multilateral agencies, civil society, the faith community, academia and industry to identify the smartest investments in the fight to end preventable child deaths.” 

Second, it examines the Global Health Initiative (GHI) experience in Ethiopia at a moment when the Obama administration is critically engaging with Congress over what modifications in the GHI approach make sense for the future. 

This study is an effort to understand both the many remarkable health gains achieved in recent years through the close partnership between the United States and Ethiopia, and to reflect on the key considerations which should guide U.S. policy looking forward, taking into account shifts in available resources, the mixed record of GHI and the broader governing environment in Ethiopia. 

I believe this is a fair, informed, and balanced study which has benefited from the good will and expert insights of many friends in the U.S. and Ethiopian governments, the NGO sector, and independent experts. I hope you will have time and interest to read it, I expect it has meaning beyond Ethiopia per se and will stir some debate. I ask that you freely share your reactions with us.

We have organized our thoughts around four propositions. 

In an era of flat and declining resources, in key countries like Ethiopia, a de facto marriage of PEPFAR and Global Fund HIV/AIDS programs is unfolding. Because the PEPFAR-Fund interface has taken on ever greater strategic importance, a spotlight is now fixed upon how and with what results can the PEPFAR-Fund collaboration be accelerated. 

Second, the United States has contributed to the advance of maternal and child health in Ethiopia by stretching its PEPFAR platforms and making smart use of USAID’s investments. But realism is warranted looking forward. We argue that the United States should shifts its strategy and make a major investment in the Minister of Health’s strategic planning and implementation capacities. It is a critical gap that begs attention. Further, we argue the World Bank, which is making a massive multi-year investment in Ethiopia’s ambitious accelerated development strategy, needs to step forward. It can and should do more in the area of maternal and child health.

GHI’s experience in Ethiopia has been mixed. The ambassador and country team have responded to the challenge to change practices and have demonstrated progress. But that has been against the backdrop of unclear goals and guidance, aggravated and visible rivalry between USAID and CDC, and enduring stovepiped planning and reporting requirements. The latter rigidities ultimately can only be remedied in Washington through a better interagency process and a new dialogue with Congress. 

Lastly, and paradoxically, the success of the US-Ethiopian partnership has evolved in the midst of a rigid and autocratic governing environment that contains significant risks and vulnerabilities. We need to acknowledge these, understand them, and take steps which can protect investments. 

Click here to download the full report. As always, I welcome your questions and comments. Please leave your thoughts below.

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