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March 22, 2011

Aspen Roundtable sparks candid discussion on tough global health issues

 
   From Right: Tedros, Batson, Dybul and Donnelly

When Amie Batson, the deputy assistant administrator for global health at USAID, traveled to Ethiopia last year with other senior US officials, she said they prepared a brief on the Global Health Initiative for Health Minister Tedros Adhanom Ghebreyesus.

But the tables turned in the meeting, she told an overflow audience yesterday at Global Health and Development (GHD)'s Aspen Global Health Roundtable Series event titled, Straight Talk: A Conversation about Tough Questions in Global Health”. The event was also sponsored by the Ministerial Leadership Initiative for Global Health.

Before the U.S. officials could review their brief on GHI’s priorities for Minister Tedros, “He immediately started the meeting saying let me tell you why GHI is important and let me tell you what it’s going to do…and how it can be translated into its [Ethiopia’s] country plan.” Batson said. The U.S. team welcomed his leadership and U.S. and Ethiopian health leaders jumped in to negotiations on the shape and substance of US assistance.

“Minister Tedros continues to be helping us define how [GHI] really translates to a country and its national plan, and how it can support a country in achieving its objectives,” Batson said.

When moderator John Donnelly turned the floor to Minister Tedros, he asked him what advice he would have for other ministers dealing with strong donors. Minister Tedros’ reply was simple: “It is important to really focus on the issue and help [donors] understand our perspective. We have to make sense of what we are saying and, luckily enough, many listen.”

The roundtable discussion, which featured Tedros, Batson and Amb. Mark Dybul, co-director of the O’Neill Institute for National and Global Health Law at Georgetown University and former U.S. Global AIDS Coordinator, covered a range of cutting-edge issues in global health, from country ownership to the current political environment that threatens funding of global health programs.

Dybul, in particular, seemed to relish playing off the title of the event, “Straight Talk,” by offering candid assessments one after another.

Speaking about the role that country ownership and leadership has in advancing global health, he said, “In every country there are leaders. Sometimes it's not the minister, sometimes it’s the head of state, sometimes it’s the first lady, sometimes it’s a faith leader, sometimes it’s an NGO.”

“Most of the best ideas aren’t coming from [development partners]…we have to trust and believe in and support the countries. That is what country ownership is about. It is country, not government,” Dybul said.

He went on to say, “Often the most remarkable people are the ones in the villages and the local communities that come up with the most innovative, creative solutions…And what is remarkable about what the Minister is doing in Ethiopia is that he is allowing that grassroots initiative and innovation to blossom and then adopting them and growing them nationally.”  

 
  Minister Tedros and Amie Batson

Tedros cited examples of working with civil society, including local women’s groups, that helped attack difficult topics such as early and forced marriage. While the government can enact preventive laws, it’s the community leaders that are able to help translate that law into practice, he said.

Minister Tedros emphasized the importance of integrated health approaches, a main goal of the Global Health Initiative. Women’s health has not just been supported by government health policies, but also through work on expanding education in Ethiopia. “Until grade 8, the number of boys and girls in school is the same…but when you go higher you see less girls attending school…So, we are really working on how to educate girls because that’s one of the most effective strategies [for development],” he said, adding that his government still has far to go.

Dybul applauded progress of GHI’s increasingly integrated approach. He shared a story with the audience from his early days with PEPFAR. He remembered visiting a top-notch US-funded clinic that helped prevent the transmission of HIV from mother to child. But, he said when he walked across the hall to the hospital’s maternity ward the conditions were horrific.

“It doesn’t help that mother or that child if you save her life with anti-retroviral therapy and prevent the transmission and she dies in delivery” he said.

Dybul said GHI funding could bridge money from what had been AIDS-only services to programs that serve the entire health needs of an individual. He suggested that if this is done right, it could continue to be one of the, “very few things in the US programming envelope of trillions of dollars where you can draw a direct line from dollars to lives saved. And that actually means a lot to members [of Congress].”