The Foreign Service Journal - May 2017
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MAY 2017



first recognized the U.S. Department of Health and

Human Services’ unique value to our diplomacy as chief

of mission in Burkina Faso during a meningitis outbreak,

which had been hidden by local authorities because the

capital was filled with visitors to a biennial African film


Within days, the Centers for Disease Control and Pre-

vention sent three of the world’s leading meningitis experts

to help Burkina urgently map and ultimately control the

outbreak. Later, as HHS assistant secretary for global

affairs from 2014 to 2017, and the first person with a Foreign

Service background to have a leadership role at the depart-

ment, I came to understand and appreciate its contribution

more fully.

HHS is a major global actor. There are nearly 2,000 HHS

staff under chief-of-mission authority overseas—1,500

Locally Employed staff and 500 Americans. These include

HHS attachés, who advise chiefs of mission and country

teams on health policy in Geneva, Beijing, Brasilia, Mexico

City, Pretoria and New Delhi. And the Centers for Disease

Control and Prevention, an HHS agency, has staff in more

than 60 countries, and the CDC country director often pro-

vides wide-ranging health expertise on the country team.

At the same time, HHS is intensely domestic in its

culture, systems and thinking. With unmatched health,

medical and scientific expertise, HHS staff members are

typically hired for domestic priorities, yet their skills are of

clear and growing value internationally. Our relationships

with low- and middle-income countries no longer reflect

a classic “donor-recipient” model. Even poor countries

like Burkina want a technical partnership, where our best

experts help build the capacity of national counterparts.

Because U.S. missions abroad are unaware of it and

because HHS’s own staffing patterns and funding histori-

cally fulfill a domestic mandate and are not easily adapt-

able to overseas activity or assignment, this tremendous

U.S. government asset—expertise-in-person—is under-


HHS’s role and mandate began to change, however,

in 2004 when the President’s Emergency Plan for AIDS

Relief, the President’s Malaria Initiative and the Global

Health Security Agenda all named HHS as an imple-

menter. Approximately $2 billion in PEPFAR money

goes annually to HHS—not just to CDC, but also to the

National Institutes of Health, the Food and Drug Adminis-

tration, and the Health Resources and Substance Abuse

and Mental Health Services Administrations (HRSA and


Proven Value

The value of HHS’s already-on-the-payroll expertise was

nowhere better demonstrated than in the establishment

and staffing of the Monrovia Medical Unit during the 2014-

2015 Ebola outbreak in West Africa.

The U.S. military delivered Ebola treatment unit struc-

tures to Liberia, but did not staff them. USAID-funded

nongovernmental organizations and medical personnel

from around the world, as well as Liberians themselves,

were reluctant to scale up treatment unless they could be

assured a developed-world level of care if they became

infected. To offer that level of treatment, the U.S. military

assembled and customized a field hospital outside of


Ambassador (ret.) Jimmy Kolker’s 30-year Foreign Service career

included five posts in Africa and three in Europe. He was U.S.

ambassador to Burkina Faso (1999-2002) and Uganda (2002-

2005). He then served as deputy U.S. global AIDS coordinator

and, after retiring from State, as head of the HIV/AIDS Section at

UNICEF’s New York headquarters (2007-2011) and in the Depart-

ment of Health and Human Services’ Office of Global Affairs. Until

January 2017, he was assistant secretary for global affairs at HHS.

HHS and Health Diplomacy


HHS staffmembers are

typically hired for domestic

priorities, yet their skills are of

growing value internationally.