Strengthening U.S. Investments in Women’s Global Health through Public Private Partnerships

Guest blog post by Janet Fleischman and Alisha Kramer

In March 2013, a delegation led by the CSIS Global Health Policy Center met with the first lady of Zambia, Dr. Christine Kaseba Sata, in Lusaka. As an obstetrician and gynecologist, Dr. Kaseba Sata has championed women’s health issues, and she adeptly articulated the world-wide imperative to strengthen women’s health and empowerment: “At the end of the day, mothers and women make the difference. Whatever you do should be woman centered. . . . It’s the cornerstone for every country.”

The CSIS delegation traveled to Zambia to examine the opportunities and challenges of strengthening U.S. investments overseas in women’s health, including through new public private partnerships. The bipartisan delegation included senior staff from four congressional offices and a representative of the Bill & Melinda Gates Foundation. CSIS chose Zambia because of that country’s remarkable new level of political will and leadership on women’s health issues. Zambian women leaders, in particular, have established an exceptional position to drive forward country ownership, including Zambia’s first lady and other high-level government officials. The report of the delegation’s visit can be found here.

With U.S. budgetary constraints worsening, progress in women’s global health will require maximizing investments by engaging new partners, identifying program synergies, and aligning with countries’ national priorities to meet women’s needs. Two new public private partnerships on women’s health in Zambia — Saving Mothers, Giving Life (SMGL), which is addressing maternal mortality, and Pink Ribbon Red Ribbon (PRRR), which is focusing on breast and cervical cancer prevention, screening, and treatment — demonstrate new ways to make the best use of U.S. investments in women’s health. CSIS visited PRRR sites in Zambia and made this video, illustrating the importance of integrating cervical cancer and HIV services to save women’s lives.  Yet these partnerships face also serious challenges, including coordinating the partners, securing short- and long-term financing, and advancing country ownership.

This is a timely and important moment to look at new initiatives in women’s health; the U.S. government and its partners have an opportunity to build on the current momentum and incorporate lessons learned into the next phase of SMGL and PRRR planning and implementation. These new initiatives, combined with long-standing U.S. investments in voluntary family planning, have considerable promise to improve women’s health in Zambia. While the early results are encouraging, the initiatives will also require heightened attention and support by the U.S. and Zambian governments and their partners if they are to achieve scale and sustainability.

In some ways, the partnership approach itself creates a paradox: While its short-term impact will depend on U.S. leadership—including greater attention to building sustainable structures, oversight, and financing—its longer-term results will require engaging new funding sources and transitioning to national leadership and direction. This will require the U.S. government and its partners to adopt a nimble, evolving approach based on ongoing evaluations of progress, with a longer-term outlook to reach scale and sustainability. In addition, all levels of the Zambian government and health system—from health care providers and community leaders to high-level government officials—will need to demonstrate strong leadership and ownership if progress on women’s health is to be secured.

To carry this progress forward and to achieve real impact in women’s health, the CSIS delegation recommends five priority steps:

1. High-level and committed leadership from congressional leaders from both political parties and the Obama administration should prioritize women’s health and support leadership in national governments and in U.S. government agencies.
2. The U.S. government should build on prior U.S. investments in women’s health and promote new partnerships.
3. Congress and the administration should protect and expand U.S. investments in women’s health initiatives; increase linkages between PEPFAR and maternal health, cervical cancer, and family planning; support access to voluntary family planning as a public health priority; and encourage the Zambian government to fulfill the commitments it has made in these areas.
4. The U.S. government should measure the impact of the new partnerships and invest where progress is being made toward achieving women’s health goals.
5. The U.S. government, the Zambian government, and their partners should plan for scale and sustainability.
    

The challenges ahead in implementing these women’s health programs are considerable, ranging from weak health systems to gender inequality to worsening U.S. budget constraints.  Yet in Zambia, the delegation saw the importance of U.S. investments in women’s health to achieve global health and development outcomes. As U.S. ambassador Mark Storella put it: “[Women’s issues] are not sidebar issues. They affect everything. . . Women’s health, rights, empowerment, gender-based violence—these affect everything a country can do in development.”

Janet Fleischman is a senior associate with the CSIS Global Health Policy Center, Alisha Kramer is a research assistant and program coordinator with the CSIS Global Health Policy Center. This is adapted from their blog on smartglobalhealth.org from May 21, 2013.