The Foreign Service Journal, May 2017

THE FOREIGN SERVICE JOURNAL | MAY 2017 29 I 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 festival. 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- utilized. 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 SAMHSA). 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 Monrovia. 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 BY J I MMY KOLKER HHS staffmembers are typically hired for domestic priorities, yet their skills are of growing value internationally.