The Foreign Service Journal, May 2017

28 MAY 2017 | THE FOREIGN SERVICE JOURNAL u 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. u 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. U.S.EMBASSYLUSAKA