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February 09, 2011

PEPFAR’s Ryan: South-to-South collaboration critical to success

  Dr. Caroline A. Ryan

For many U.S. government officials working in global health, the term “country ownership” is not an abstraction. It’s something that many deal with on a day-to-day basis.

Without country ownership of a donor-funded program, the program’s chances of failing increase. With it, the program has a greater chance to flourish.

So says Dr. Caroline A. Ryan, M.D., M.P.H., Director of Technical Leadership at the Office of US Global AIDS Coordinator, who has been a leading scientific authority implementing the President’s Emergency Plan for AIDS Relief (PEPFAR) program nearly since its inception in 2003.

She said in an interview with MLI’s Leading Global Health blog that country ownership – with Ministries of Health leading the way -- “can mean everything” to a project. “We have examples of where country ownership has been so helpful and examples of when countries not buying in have not made the program go forward.”

Ryan is now spending much of her time overseeing the scale up of male circumcision programs in PEPFAR countries. Over the last four years, she estimates that the US has spent nearly $200 million to expand these programs, which now are active in 14 countries, most of them in sub-Saharan Africa.

One of the lessons learned in the male circumcision initiatives goes beyond country ownership, she said. US officials have remarked upon the critical factor played by South-to-South relationships.

Ryan told a story to illustrate her point.

“We did modeling on male circumcision about what the impact would be in every country – we gave them a white paper with scenarios until the year 2025. We showed what would happen if you did it slowly, and what would happen if you did it rapidly over five years,” she said.

The US AIDS coordinator’s office then brought together experts from Ministries of Health in Kenya and Swaziland to talk about next steps on ramping up male circumcision programs.

“It was when the Ministry of Health folks in Swaziland saw what happened in Kenya that something started to happen,” Ryan said. “They said to the people in Kenya, ‘Would you help us do this in Swaziland?’ That’s how this initiative in Swaziland really got moving. It’s really been a South-to-South collaboration. It was Kenyans and other folks talking and taking the lead.”

Then, in a step that ran parallel to several MLI efforts – most notably groups from the Mali and Senegal ministries visiting Rwanda to see first-hand its expansion of a community-based health insurance plan and then returning home energized to advance their programs – Kenya played host to delegations from Zambia and Swaziland to view their male circumcision campaigns, Ryan said.

“That South-to-South interaction really encouraged the other Ministries of Health people from other countries to move forward on male circumcision,” she said. “It was critically important.”


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