This past week, Secretary of State Hillary Clinton headed to Africa for an extensive tour of the continent. Keeping a jammed packed itinerary, Hillary plans to travel to Kenya, South Africa, Angola, the Democratic Republic of the Congo, Nigeria, Liberia, and Cape Verde. She continues the pattern of mounting attention on Africa; earlier this summer, President Obama spoke in Ghana on July 10 after the G-8 summit had rolled out a wieldy global food security effort and after he pledged a $63 billion, six year Global Health Initiative. Interestingly though, little time appears to be dedicated to fleshing out these health-related initiatives while Mrs. Clinton prepares to meet with some of the most important figures in African politics today. Is the lack of discussion purposeful or unintended? Isn’t it about time that we critically examine health care in Africa? Especially when these health-initiatives are fresh within the international scene?

The Official Record:
The White House’s John Carson has concisely stated that Clinton’s trip is meant to “highlight and underscore the Obama’s Administration’s commitment to making Africa a priority in U.S. foreign policy.” In a more specified agenda, Clinton plans on addressing issues of sustainable democratic governance, sustainable economic development, public health, education, and peace-conflict efforts. It looks as if she will talk with South Africa President Jacob Zuma and Ambassador Mashabane to discuss the HIV/AIDS crisis (which I wrote about in an earlier piece). But at that point, no more discussion on health-related goals and initiatives appears on the Secretary’s agenda, according to a government website. Even in her past trip to Kenya (one of the key countries for the President’s Malaria Initiative), public health and malaria were overlooked by talks about economic stability and the new African Growth and Opportunity Act.

Off-the-Record:
A Newsweek article published this week argues that Clinton’s trip is more or less a way to build relationships rather than instigate real diplomatic action. I am not going to agree or disagree; instead, I’m passing on such their opinion. However, I will say that such intentions may not be such a bad thing, per say. We should have comfortable, amicable relationships with foreign countries so that international efforts may be facilitated. Yet, my concern is that as Clinton tours the continent, her discussions about the economy and financial stability appear to trump all else (whether or not she plans on turning ideas into action or just forming relationships is not

important in this case). As I said before, so much activity on global health has preceded this trip and remains fresh. Clinton may be making a mistake by allowing these current announcements go stale.

That being said, it may not be all her fault. She actually may be deflecting attention on the degrading U.S. Agency for International Development (USAID), which idles as the Directorship post continues to be vacant after 6 months. USAID is meant to support US foreign policy objectives; global health is one of the three most prominent goals stated on its website. While staff has shrunk by 40% in the past twenty years, the amount of aid it oversees has doubled to upwards of $13 billion in 2008. It is in no shape to execute the latest set of programs in rural development and health. This is curious: how can USA appear to have such fervor for improving health in foreign countries while one of its largest directives falters?

Maybe Hillary is trying to delicately avoid this issue, the paradox of a floundering aid agency at the precipice of billions of dollars promised towards foreign aid. It’s disappointing to expect little progress made in global health issues; Clinton appears to be in an ideal situation by talking with important officials and under the international spotlight. Hopefully, this missed opportunity builds a sense of urgency within the administration so that they don’t stumble over their own feet.

That’s what appears to be happening, although in very small steps and quietly so. The administration has asked for 350 new positions in USAID in the 2009 budget request. The future of USAID is, however, still unclear while many government officials debate its fate. Regardless, the White House hopes to collaborate with two dozen government agencies, experienced in assistance programs, to shape development policy. Such reorganization could focus and enable efficient use of the Global Health Initiative.

In an address in Nairobi on August 5th, Hillary recognizes that all aid is not good aid: “While our past assistance has yielded gains, we have spent too many dollars and too many decades on efforts that have not delivered the desired long-term results… too little has reached the intended target or contributed to lasting progress.” She makes a great point – we would be irresponsible to continue a pattern of wasteful spending.

Looking over the circumstances, Clinton may not be making a mistake by passing over global health issues. If she did, it would be similar to a plane taking off without a pilot and the “check engine” light still on – there’s much doubt that the plane would deliver its goods at the intended destination. Let her establish relationships with foreign countries so that when the USA is ready to support aid programs, the giver and the recipient have a reciprocal understanding of each other.

The importance of Hillary Clinton’s trip to Africa with respect to global health was not found in what she said, but more so, the lack of what she had to say. Whether this silence will motivate change remains uncertain – but – if the United States wants to remain loyal to its promises and embrace global health as a priority (amongst other development issues) then it better start listening…

***This blog was written as Clinton traveled between Kenya and South Africa on Thursday, August 6th. I will be sure to make comments if any discussion involves global health initiatives.

This post was written by melissa.frick

This entry was posted on Friday, August 7th, 2009 at 8:13 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.