Strengthening U.S. Investments in Women’s Global Health: A CSIS Delegation to Zambia

May 22, 2013

Janet Fleischman, Senior Associate, and Alisha Kramer, Program Coordinator and Research Assistant
Global Health Policy Center, Center for Strategic and International Studies

In March 2013, a delegation led by the CSIS Global Health Policy Center met with the first lady of Zambia, Dr. Christine Kaseba Sata, in Lusaka. As an obstetrician and gynecologist, Dr. Kaseba Sata has championed women’s health issues, and she adeptly articulated the world-wide imperative to strengthen women’s health and empowerment: “At the end of the day, mothers and women make the difference. Whatever you do should be woman centered. . . . It’s the cornerstone for every country.”

The CSIS delegation traveled to Zambia to examine the opportunities and challenges of strengthening U.S. investments overseas in women’s health. The delegation included senior staff from four congressional offices and a representative of the Bill & Melinda Gates Foundation. CSIS chose Zambia because of that country’s remarkable  new level of political will and leadership on women’s health issues. Zambian women leaders, in particular, have established an exceptional position to drive forward country ownership, including Zambia’s first lady and other high-level government officials. The report of the delegation’s visit can be found here.

The report focuses on three women’s health issues—maternal mortality, cervical cancer, and access to voluntary family planning—and explores how the United States leverages the President’s Emergency Plan for AIDS Relief (PEPFAR) and works with its other partners to prioritize women’s health. The delegation paid special  attention to  two recent public-private partnerships: Saving Mothers, Giving Life (SMGL), which addresses maternal mortality; and Pink Ribbon Red Ribbon (PRRR), which integrates cervical cancer screening and treatment with HIV/AIDS services and increases breast cancer awareness. These two innovative initiatives illustrate new ways to make the best use of U.S. investments in women’s health, as well as challenges to achieving health goals.

This report comes at a timely and important moment; the U.S. government and its partners have an opportunity to build on the current momentum and incorporate lessons learned into the next phase of SMGL and PRRR planning and implementation. These new initiatives, combined with long-standing U.S. investments in voluntary family planning, have considerable promise to improve women’s health in Zambia. While the early results are encouraging, the initiatives will also require heightened attention and support by the U.S. and Zambian governments and their partners if they are to achieve scale and sustainability.

In some ways, the partnership approach itself creates a paradox: While its short-term impact will depend on U.S. leadership—including greater attention to building sustainable structures, oversight, and financing—its longer-term results will require engaging new funding sources and transitioning to national leadership and direction. This will require the U.S. government and its partners to adopt a nimble, evolving approach based on ongoing evaluations of progress, with a longer-term outlook to reach scale and sustainability. In addition, all levels of the Zambian government and health system—from health care providers and community leaders to high-level government officials—will need to demonstrate strong leadership and ownership if progress on women’s health is to be secured.

To carry this progress forward and to achieve real impact in women’s health, the CSIS delegation recommends five priority steps:

1. High-level and committed leadership from congressional leaders from both political parties and the Obama administration should prioritize women’s health and support leadership in national governments and in U.S. government agencies.

2. The U.S. government should build on prior U.S. investments in women’s health and promote new partnerships.

3. The U.S. government, the Zambian government, and their partners should plan for scale and sustainability.

4. Congress and the administration should protect and expand U.S. investments in women’s health initiatives; increase linkages between PEPFAR and maternal health, cervical cancer, and family planning; support access to voluntary family planning as a public health priority; and encourage the Zambian government to fulfill the commitments it has made in these areas.

5. The U.S. government should measure the impact of the new partnerships and invest where progress is being made toward achieving women’s health goals.

The challenges ahead in implementing these women’s health programs are considerable, ranging from weak health systems to gender inequality to worsening U.S. budget constraints.  Yet in Zambia, the delegation saw the importance of U.S. investments in women’s health to achieve global health and development outcomes. As U.S. ambassador Mark Storella put it: “[Women’s issues] are not sidebar issues. They affect everything. . . Women’s health, rights, empowerment, gender-based violence—these affect everything a country can do in development.”