Healthy lives and well-being are essential to sustainable development and building prosperous societies. A United States whole-of-government approach saves lives, protects people most vulnerable to disease, and promotes stability in communities and nations. US investments leverage other resources to address shared global health challenges.
The United States’ whole-of-government approach to global health challenges
Abstract
Challenge
Healthy lives and well-being are essential to sustainable development and building prosperous societies. Infectious diseases constitute a global threat in an increasingly interconnected world. In 2019, malaria and HIV/AIDS were two of the top ten causes of death in low-income countries. Tuberculosis, neonatal conditions, lower respiratory infections and diarrhoeal diseases were among the top ten causes in both low-income and lower middle-income countries. Harnessing a whole-of-government approach enables US expertise and resources to save lives, protect people most vulnerable to disease, and promote the stability of communities and nations. US investments leverage other bilateral, multilateral, private sector and partner country resources to address shared global health challenges.
Approach
The US whole-of-government approach, involving 15 agencies, saves lives, protects people most vulnerable to disease, promotes stability in communities and nations, and leverages resources to address shared global health challenges. In 2014, the United States helped launch the Global Health Security Agenda, which aims to enhance the world’s ability to prevent, detect and respond to infectious disease threats. US responses to the Ebola outbreak in West Africa and the ongoing COVID-19 pandemic harness extensive cross-government experience with malaria, tuberculosis and HIV/AIDS. Each government agency brings particular strengths built on distinctive authorities and competencies, for example.
The US Centers for Disease Control and Prevention (CDC) contributes infectious disease outbreak response and elimination and eradication efforts that draw on expertise in epidemiology, surveillance, laboratory systems, emergency response and workforce development.
The US Agency for International Development (USAID) works directly with communities and partner governments to build in-country capacity to prevent, detect and respond to infectious diseases and outbreaks through technical assistance, training, commodity purchases and private sector partnerships, and to strengthen health systems.
The US Department of State co-ordinates global health security programming in select partner countries.
The President’s Emergency Plan for AIDS Relief (PEPFAR), led by the Department of State and implemented by six other government departments and agencies, provides technical assistance, training and commodity support including through public-private partnerships and data-driven investments in areas with the greatest HIV/AIDS burden. The CDC-funded Population-based HIV Impact Assessment Project works with health ministries to conduct surveys on the HIV epidemic.
The Department of Defense supports humanitarian assistance and disaster relief efforts, and its laboratories around the world conduct essential surveillance of biological threats and research on infectious diseases.
The US International Development Finance Corporation (DFC), through the Global Health and Prosperity Initiative, provides financing for global health services and infrastructure, health commodity manufacturing and supply chain, and digital health.
The US Department of Agriculture provides critical leadership, research, information, and programmes on plant and animal health and food safety to enhance US interdisciplinary One Health capacities to deliver foreign assistance to prevent disease.
Peace Corps volunteers, in partnership with community counterparts and host country governments, work to build capacity, support health promotion and strengthen health systems.
Results
Malaria: Since 2006, the President’s Malaria Initiative has helped save almost 7.6 million lives and prevent more than 1.5 billion malaria cases in sub-Saharan Africa and the Greater Mekong Subregion of Southeast Asia.
Tuberculosis: In 2021, investments of USD 310 million resulted in the detection of 3.8 million tuberculosis cases, a 20% decrease in notifications, a treatment success rate of 89%, the training of 33 000 health workers and 82 000 people starting treatment.
HIV/AIDS: PEPFAR has saved more than 21 million lives, prevented millions of HIV infections, and supported at least 20 countries in achieving epidemic control of HIV or reaching their HIV treatment targets. The initiative helps countries build a firm local foundation to prevent, detect and respond to other health threats, thus enhancing global health security.
Global health security: In 2021, the United States partnered with over 40 countries, including 19 Intensive Support partner countries to provide operational and technical assistance to build their health security capacities.
COVID-19: The United States assisted more than 100 partner countries to accelerate widespread and equitable access and delivery of safe and effective COVID-19 vaccines and strengthen vaccine readiness.
Lessons learnt
Bipartisan support in Congress is critical, enabling significant resources to be committed to combatting infectious diseases around the world.
Joint strategies facilitate whole-of-government efforts such as the US government strategy to reduce transmission of Ebola in West Africa, the President’s Malaria Initiative, PEPFAR, the global response to the COVID-19 pandemic and the Global Health Security Strategy.
Fragmentation, overlap and duplication can be countered by ensuring that joint and individual agency strategies delineate roles, responsibilities and co-ordination mechanisms; integrate with other related strategies; and provide for assessing progress towards goals, including through activities to achieve results, performance indicators, and monitoring and evaluation plans.
An infectious disease focus should be complemented by health system strengthening across all relevant sectors (i.e., One Health) and investment in combating non-communicable diseases. PEPFAR and the President’s Malaria Initiative work to strengthen health systems and support capacity building.
Broader targets beyond the data-driven focus on infectious disease efforts would track the social and legal impediments that hamper access to services.
Greater use of strategic evaluation could determine if programmes are achieving their goals and inform improvements.
Further information
Centers for Disease Control and Prevention (2022), About Global Health Security - What We Do: Prepare Countries to Prevent, Detect, and Respond to Global Health Threats, https://www.cdc.gov/globalhealth/healthprotection/ghs/about.html.
Global Fund (2022), https://www.theglobalfund.org/en.
Global Health Security Agenda (2022), https://ghsagenda.org.
Government of the United States (2019), United States Government Global Health Security Strategy, https://trumpwhitehouse.archives.gov/wp-content/uploads/2019/05/GHSS.pdf.
US Department of State (2022), The United States President’s Emergency Plan for AIDS Relief (webpage), https://www.state.gov/pepfar.
USDA (2022), One Health, https://www.usda.gov/topics/animals/one-health.
USAID (2022), What We Do: Global Health, https://www.usaid.gov/global-health.
USAID (2022), What We Do: U.S. President’s Malaria Initiative, https://www.usaid.gov/global-health/health-areas/malaria/pmi.
OECD resources
OECD (2022), OECD Development Co-operation Peer Reviews: United States 2022, https://doi.org/10.1787/6da3a74e-en.
OECD (2020), Development Co-operation Report 2020: Learning from Crises, Building Resilience, https://doi.org/10.1787/f6d42aa5-en.
OECD, “Key policy responses from the OECD”, Tackling Coronavirus (Covid-19), https://www.oecd.org/coronavirus/en/policy-responses.
OECD, “Whole-of-government development co-operation”, Development Co-operation Fundamentals (forthcoming).
To learn more about the United States’ development co-operation, see:
OECD, “United States”, in Development Co-operation Profiles, https://doi.org/10.1787/45472e20-en.
