The Foreign Service Journal - May 2017
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MAY 2017




A Partnership-Builder

Our work in health gave us an entrée with important civil

society leaders that strengthened our engagement in sometimes

unexpected ways. Zambia’s three main church groups—the

Catholics, the Anglicans and the Evangelicals—were and are key

partners in fighting HIV. Tribal chiefs invited me to address the

House of Chiefs on male circumcision and other HIV prevention

techniques. The founding father of the Zambian nation, Kenneth

Kaunda, then 86 years old, had emerged as a vocal champion in

the fight against AIDS, and we built a strong relationship with

this great old gentleman by making common cause on health.

In short, health programming became a flying wedge for

greater access among influential people and organizations, with

beneficial results. For example, during the hotly contested 2011

elections, the church groups, tribal leaders and Pres. Kaunda all

served as strong partners to create conditions for fair elections

that heralded a peaceful and democratic change of power.

Heath programming also helped revolutionize bilateral

relations. Zambia had long harbored suspicions about engage-

ment with the U.S. military; one Zambian president had, in fact,

declared that the U.S. Africa Command would never set a single

boot on Zambian soil. U.S. military personnel were not even

allowed to inspect health clinics that we funded on Zambian

military bases. But as the country’s military leadership came to

appreciate the life-saving work U.S. armed forces were doing for

their members and their families, a thaw began. In 2013 Zambia

hosted Africa Endeavor, AFRICOM’s flagship multilateral exer-

cise on the African continent.


Local Ownership Promoter

A constant challenge in our health work overseas is promot-

ing local ownership of health programs. As long as local leaders

rely on the United States to carry out health work without putting

much of their own skin in the game, health programs will fail to

be sustainable. PEPFAR offered us an opportunity for leverage

that ultimately produced stunning results.

The Office of the U.S. Global AIDS Coordinator advised us

that some additional funds would be made available if we could

put them to good use. I went with PEPFAR Country Coordinator

Kristie Mikus to call on the Zambian president. Rather than just

announce new investments, we proposed that we would make

the new investment if the Zambian government matched us by

doubling their own spending on anti-retroviral drugs (ARV). It

took several meetings with the late President Michael Sata and

First Lady Dr. Christine Kaseba—an accomplished OB-GYN—

but the Zambians came around and doubled their ARV spend-

ing. The next year, they doubled it again. We were full partners.

Suggestions for Further Progress

There are prudent steps we can take to make our ambas-

sadors more effective in supporting health programming and

using health as a tool to promote broader American goals.

While progress has already been made, the State Department

should increase the exposure of FSOs to health issues early and

consistently in their careers so that when they reach the level of

ambassador they are already well-versed in health programs. We

should find opportunities for FSOs to do health tours—perhaps

as PEPFAR coordinators, perhaps through postings engaged with

multilateral institutions like the World Health Organization, or

in excursions with leading nongovernmental organizations—so

that health becomes mainstream in American diplomacy.

We can find ways to ensure that ambassadors arrive at post

focused on health—by raising the profile of health in the ambas-

sadorial seminar, for instance. We should ensure that health

issues are not seen as a narrow niche of America’s engagement

From left, Kenneth Kaunda, Zambia’s founding president and

an HIV/AIDS prevention champion, and Ambassador Johnnie

Carson, at the time U.S. assistant secretary for African affairs,

in Lusaka on Feb. 6, 2011.