Celebrating World AIDS Day: A Commitment to Country Ownership

November 26, 2012 • By Nils Daulaire, M.D., M.P.H., Director, Office of Global Affairs, U.S. Department of Health and Human Services • no comments

Dr. Nils Daulaire

As World AIDS Day 2012 approaches, it is a timely opportunity to reflect on what we learned at this year’s International AIDS Conference

. It’s also a moment to recognize what we as Americans are doing – and the progress we are making – to help the world end its chapter on AIDS. The United States, through the President’s Emergency Plan for AIDS Relief (PEPFAR) has been a remarkable vehicle in this fight, employing sound science to offer the highest quality interventions and treatment.
Today we are at a critical moment in the epidemic, marked by optimism despite a challenging road ahead. One thing is certain: we now have the science and know-how to prevent HIV/AIDS and to follow a path toward an AIDS-free generation. We also know that science on its own will not end AIDS. It must be matched by political will and country ownership. In its second phase, PEPFAR has moved away from an emergency approach to one of country-led action and stronger human resources for health. To ensure long-term sustainability, PEPFAR country programs and its implementing agencies are transforming their partnerships so that countries direct, implement, and evaluate their own responses with strong U.S. support.
The U.S. Department of Health and Human Services (HHS) is committed to supporting country ownership through its agencies and plays an important role in strengthening country capabilities, one of the four key dimensions of country ownership. Another key principle, building local capacity, is outlined in the 2012 HHS Global Health Strategy.
Strengthening country capabilities means enhancing the ability of government, civil society, and community institutions to manage and implement HIV programs. The U.S. Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) supported some of the first PEPFAR care and treatment programs in 2004. Managed by international non-governmental organizations (NGOs), the programs provided antiretroviral therapy to more than 500 facilities in PEPFAR countries by 2009.
As PEPFAR entered its second phase in 2009, CDC, HRSA, and other implementing agencies sought to transition responsibility for these services from the international NGOs to local organizations. Working jointly with Catholic Relief Services

and other international NGOs, ministries of health, universities, and local organizations, CDC and HRSA developed strategies to transfer technical and managerial capability to local partners on the ground in several sub-Saharan African countries.
These local organizations were uniquely positioned to lead as sometimes they were the only entities providing health services to under-resourced regions and neighborhoods. According to staff involved in the transition, it was successful because a diverse cross-section of stakeholders came together to leverage their individual strengths. Together, they were able to improve the capacity of the local organizations and contribute to building better health systems.
Strengthening the healthcare workforce is another important component of local capacity and better health systems. HHS supports programs to strengthen the healthcare workforce in PEPFAR countries. For example, PEPFAR’s Nursing Education Partnership Initiative (NEPI) helps five countries develop and strengthen their nursing and midwifery education programs. Its Medical Education Partnership Initiative

(MEPI) links African and U.S. academic institutions so they can develop, enhance and expand medical education programs in 12 Sub-Saharan African countries. CDC’s Field Epidemiology Training Program (FETP) and Field Epidemiology and Laboratory Training Program (FELTP) build local capacity within Ministries of Health to respond to disease outbreaks, as well as conduct laboratory analysis, surveillance, and evaluation in PEPFAR and other countries.
PEPFAR helped shape the HHS Global Health Strategy, which in addition to “building local capacities,” also sees “leveraging strengths through partnership and coordination” as an underlying principle. HHS is committed to continue implementing PEPFAR programs in partnership with countries and civil society as they build a sustainable response to global AIDS and work towards achieving an AIDS-free generation. As Secretary Clinton stated at the International AIDS Conference this past July, “We have already come so far – too far to stop now.”