I am proud to serve as the Assistant Administrator for Global Health, where I’ve often remarked that I feel like a kid in a candy store when I think about all of the important work going on at USAID, especially in global health. Recently, we reorganized the Bureau to establish an Office of Health Systems, which will be the hub for the Agency’s worldwide leadership network of technical experts in health systems strengthening. This is a key to focusing our work on country ownership, sustainability, and broadening access to critical health services to the most vulnerable populations, as envisioned by the Global Health Initiative.
The new office is important for two main reasons: first, it responds to the changing landscape of health and development and second, it will help meet all of other health goals in global health.
The development landscape is changing. Many countries in Africa and around the world are seeing an unprecedented growth of GDP. World per capita GDP has rocketed from around $2,000 in 1950 to more than $7,500 by 2008, and the MDG for poverty alleviation was met already, years before 2015. This represents an incredible success of the development enterprise launched by President Kennedy half a century ago.
As developing economies grow, they will inevitably spend more on health. Without thoughtful organization of the system, however, there tends to be an explosion of unregulated private services paid for out-of-pocket, which leads to inefficiencies and health bills that cause families to sink back into poverty. But we know this is avoidable.
The time to work on health systems and universal health coverage is now—countries need technical assistance that helps create and sustain an efficient, quality and equitable health system. The political momentum for universal health coverage is growing, and is part of the discussion, on a global level, of framing the post-MDG goals. Because we have aligned ourselves with the changing global health environment, if feel confident that USAID is ready and positioned to respond to this changing needs of our country partners.
As the world moves toward increasing health coverage and financial protection for more and more people through mixed public and private sectors, work on health systems is a way to make a dramatic difference in health and development. The key is not adding more capital from donors, but increasing local capacity to reorganize and manage growing domestic resources. The gains we have made in public health are amazing, and cause for great hope. The new office will allow us to galvanize our work in health systems, examine and communicate successes and gaps, and plot a course for an end game where everyone has access to appropriate health services at a cost that they can afford.
Recently, in Oslo, Secretary Clinton noted the “powerful, inescapable correlation” between strong health systems and saving lives. As a development agency, we have a mandate from the American people to help make lasting changes that ensure a more hopeful future. Good health systems include not only medical care but also public health, and not only diseases of old but new ones as well. And we know that strengthening health systems makes it possible to successfully graduate countries that no longer need financial assistance; so work ourselves out of jobs. That is our ultimate measure of success.