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White House Summit on International Development: Sustaining the New Era

Plenary One: Country Ownership

Moderator: Ambassador Mark Dybul, U.S. Global AIDS Coordinator, U.S. President's Emergency Plan for AIDS Relief (PEPFAR), U.S. Department of State

Panel Participants:

U.S. Rep. Christopher Smith

Dr. Sayad Mohammad Amin Fatimie, Minister of Public Health, Islamic Republic of Afghanistan

Dr. Elioda Tumwesigye, Member, Parliament of Uganda, and Chair, Parliamentary Committee on HIV/AIDS and Related Matters

Michael Gerson, Roger Hertog Senior Fellow, Council on Foreign Relations

Announcer: Ladies and gentlemen, please remain seated. Our summit will continue momentarily. Ladies and gentlemen, please welcome the moderator of this morning's first panel, Ambassador Mark Dybul, the United States Global AIDS Coordinator who leads the President's emergency plan for AIDS relief.

Ambassador Mark Dybul: Good morning and welcome everyone to this first panel dedicated to a discussion of country ownership. And we're off to a great start with that plenary talk by Madame President. It's fitting that we begin this panel and our first panel with the topic of country ownership because country ownership is the heartbeat of effective development, and it's been the cornerstone of a new era in development, led by President Bush, with strong bipartisan support. That strong bipartisan support is largely because the principles of a new era in development are not owned by a political party. They reflect who the American people are, compassionate and generous, with a deep belief in the dignity and worth of every human life with a logical corollary that everyone deserves a chance, that seemingly ordinary people will do extraordinary things with a little support, in particular, where people have hope for life, liberty, and opportunity.

Through country ownership we are moving beyond the old era of donors and recipients to a new era of partnership between peoples, between peoples not just governments, but people to people, including non-governmental organizations, faith and community-based organizations, and the private sector; an era when the American people are reaching out to our global brothers and sisters, and they are reaching back to us in friendship, respect, and understanding.

The New York Times has called this break with the past a philosophical revolution that trusts and believes in others and puts people from the village level to the national level and from all walks of life in control of their lives and their destiny through country ownership. I have the great privilege to be engaged in an initiative that is part of this new era and is firmly rooted in its philosophical anchor, the President's Emergency Plan for AIDS Relief, or PEPFAR.

You heard from Secretary Rice that it's the largest international health initiative in history dedicated to a single disease, with strong bipartisan support, $18.8 billion for the first five years, and as Secretary Rice pointed out, for the next five years, we authorize $48 billion for HIV, TB, and malaria. But perhaps more important than the money is the focus on the results that the Madame President just gave to you, aggressive and bold goals for prevention, treatment, and care to save and lift up millions of lives. And we're on track to achieve those goals.

Recently, many people have been asking, why has this program been such a success? The reason is because we are relying on country ownership. 87 percent of our partners are local organization from all sectors and walks of life, because individuals, communities and nations are taking responsibility for their epidemics and transforming their lives and their countries. I'm privileged to see it everywhere I go. The legions of heroes who we are privileged to serve and partner with who are making PEPFAR a success, and that is because PEPFAR is part of this new era in development that begins with country ownership.

We're fortunate today to have a panel at the forefront of country ownership, two who do it every day, who are in their country's owning their problems and transforming their countries, two who have contributed much to the policy and legislative framework here in the United States that's made it possible for people in the countries to do their work. So please welcome our distinguished panelists, Congressman Chris Smith, Minister of Health, Amin Fatimie from Afghanistan, member of Parliament, Elioda Tumwesigye, and Michael Gerson.

We're going to have an interactive and dynamic panel with our extraordinary group here. We're going to have an introductory comment from each of them for about five minutes, and then we're going to engage in an interactive question and answer session. The first speaker is Representative Chris Smith. Representative Smith has been in Congress since he was 27 years old. We are very appreciative that he's here today in the middle of the campaign for his 15th term in our congress. He's been at the forefront of many developmental issues, been a huge supporter of lifting up and supporting people in countries around the world as a member of the House Foreign Relations Committee, and as the ranking member of the African Global Health Subcommittee. So Congressman Smith, we look forward to hearing from you.

Congressman Chris Smith: Thank you, Ambassador. And I'll be brief. Thank you very much, Ambassador Dybul. First of all, I want to thank all of you and thank the White House and President Bush and Dr. Rice for convening this very important summit. And to thank you, Dr. Dybul for the incredible and extraordinary work that you have done in leading the United States and the world in implementing and actually crafting in the first place, the PEPFAR program, and Dr. Elioda, who has done so well in Uganda and has led the world as well, and all of the panelists for being here.

You know I will get into the AIDS issues and obviously, and HIV prevention and all the other aspects during the course of this discussion. And we have two of the absolute premier experts here. So I will, obviously, at the risk of being redundant, not speak to that in my opening, but to say very briefly that I was asked to speak about country ownership. One of the critical and most important parts about country ownership is that we work in partnership.

I believe that country ownership cannot be defined solely in terms of political and business leaders and eager entrepreneurs. We must make an extraordinary effort to include those who tend to be forgotten or left out on the fringes of development. For example, when I wrote the law, the Micro-enterprise Result and Accountability Act of 2004, I included provisions to focus micro-finance resources on the poorest of the poor, the very poor, including poor women and potential victims of exploitation and violence. Granted, there are particular challenges to reaching, educating, and mentoring these populations, but I believe it's absolutely essential to do so not only because these individuals and their families have a right to live in a dignified manner but also because their inclusion is essential for the achievement of any just and stable society. And like I think everyone in this room, I believe the best antipoverty program ever is and always will be a job.

A related second area of extreme importance in the area of country ownership has to do with the most vulnerable members of the human family. Fortunately there are numerous developing countries in the world where the vast majority of women and men still recognize the value and the inherent dignity of the right to life of unborn children. However these countries are under a major bit of pressure from a number of western governments and organizations advocating for the legalization and promotion of abortion under the guise of reproductive health.

High maternal and morbidity rates are a cause of grave concern in many of these countries, but I can't over emphasize the necessity of pro-life countries to exercise country ownership by insisting on solutions to maternal mortality and morbidity that respect the right to life and health of both mother and baby. Those solutions such as proper nutrition, prenatal care, safe blood, and emergency obstetric care are available and are, in fact, the solutions that brought down maternal mortality rates in the western world. By insisting on such positive solutions that comport with their respect for the life of the unborn, these countries will save their children. They will save their women from untold psychological as well as physical suffering and they will preserve the foundation of any durable society the right to life and the family.

Third, country ownership in the developing world, particularly in Africa, must include meaningful participation by faith-based organizations. During my travels to Sub-Saharan Africa, I repeatedly encounter FBOs working in remote areas or urban slum areas with marginalized populations on health and other challenges that few of any other group would want to be involved with. My experience was validated by the World Health Organization report on HIV/AIDS health care and treatment in sub-Saharan Africa, which estimated at between 30 and 70 percent of health care in Africa is currently owned by FBOs. The report concluded that greater coordination and better communication are urgently needed between the private and public health sectors. I would submit that such coordination and inclusion is urgently needed in other sectors as well.

One such sector is in the eradication of human trafficking. Nigeria provides a good example as to where country ownership for overcoming this horrific crime could be better achieved through government coordination with faith-based organizations. Some of you may know that I was the prime sponsor of the Trafficking Victims Protection Act of 2000, 2000, and 2003. I frequently visit countries on trafficking missions. Recently I visited a country where it was apparent that the faith-based organizations, particularly in the area of sheltering had helped women who were absolutely devastated by human trafficking to come to a sense of reconciliation, and that combined with micro-credit, they were learning how they could rebuild their lives.

Finally, I would add a brief commendation for the Millennium Challenge Corporation. I repeatedly hear that the governments of Sub-Sahara Africa and elsewhere are taking serious steps to change a culture of corruption to implement measures to provide transparency in governance and to respect human rights and civil liberties, largely because they want to become or remain competitive for MCA funding and because they care deeply about their own people and good governance.

I know that you will be hearing directly from representatives of the MCA this afternoon, and I believe it is important to note that the MCA in the context of country ownership is one of the vital tools to building the infrastructure so countries can rebuild, grow, and have sustainable development. Thank you so much.

Ambassador Mark Dybul: Thank you, Congressman Smith. We're now privileged to have someone who traveled a great distance to be with us and we appreciate it greatly. Dr. Fatimie is His Excellency, the Honorable minister of Public Health for the Islamic Republic of Afghanistan. You're going to hear from him about some of the extraordinary work he's led under the master plan of reconstruction and rehabilitation of the health system, the minister of health served the Afghanistan people from exile into Pakistan and is also a medical doctor, but as he just told me, he doesn't have quite so much time to practice any longer, because he's too busy rebuilding his country. So Your Excellency, we look forward to hearing from you.

Dr. Sayed Mohammad Amin Fatimie: Thank you very much, Ambassador Dybul, Excellencies, ladies and gentlemen, it a great honor to participate in this panel. Its subject could not be more important. Despite many repose about how the Taliban are becoming stronger and security is becoming weaker, a quiet revolution is occurring in thousands of villages in Afghanistan, which has helped us in our struggle to empower our people to develop and to take greater control over their lives.

Most Afghans, about 80 percent live in rural areas, many in small scattered villages in very difficult terrain where roads are blocked by snow and access to health and other services can be nearly impossible. Recognizing the lack of services and difficult access during the past seven years, we have built hundreds of health facilities and established a very good network of basic healthcare clinics and small hospitals. We have trained hundreds of community midwives, who are recruited from remote rural areas and who return after 18 months training back to their districts.

In addition, we have trained more than 20,000 community health workers, half of them women who voluntarily provide health education on nutrition and hygiene, and who treat common diseases such as diarrhea and pneumonia.

Other sectors have done their part as well. We have a national solidarity program, which includes community development council in communities and provide grants to villages for development projects of their choosing. In addition, thousands of new schools, with girls making up a large percentage of students, have been contracted.

How has this been possible in seven short years? Three things have made the difference. The first is partnership. That one government with the support of donors and partners, particularly the U.S. government support has cause for much of the rural area in such a way that someone who left an Afghan village in 2001 and returned in 2008 would have difficulty recognizing the place.

The second is ownership. We in the Ministry of Public Health developed a basic package of health services that all Afghans in all corners of Afghanistan should have access to a basic set of services that can reduce the most common causes of mortality. In just seven years, we have lowered child mortality by 25 percent, and we have clear indications that maternal mortality is also coming down.

Today about 85 percent of all Afghans have access to basic package; whereas in 2001, less than 10 percent had access. Many villages now have real hope for their future. This has occurred under the Stewardship rule of the Ministry of Public Health, which has managed the process. The third is empowerment. Compared with Taliban times, Afghan women are playing a greater and greater role in their villages and in community, and we have a long way to go, but we have come far in just seven years.

As an example of the distance we still have to travel, you should know that in Afghanistan one child in five dies before his fifth birthday, but in our neighbor Iran, one child in 15 dies before reaching the age of five. Despite recent progress, maternal mortality remains the second highest in the world.

One final point I would like to make is that of when government takes great pride in the fact that the U.S. Government has agreed to provide $218 million U.S. dollars in direct assistance to the Ministry of Public Health over the next five years to support NGOs and provisions of basic package of health services in 13 provinces. This assistance is coming directly to the Afghan government and not through a third party. The MOPH, I mean the Ministry of Public was certified as meeting the standard of fiscal and grants management to receive the funds directly, something that happens only rarely.

With the support from USAID, the HHS, provincial reconstruction teams, and our other partners, we are confident that we can continue to provide health services to our rural population. We look to the day when every Afghan family can celebrate their child's fifth birthday, and every mother's pregnancy is a prelude to a joyful event. Without your support, the sacrifices of few remain, and woman in the determination, tolerance, and sacrifices of our own people, Afghanistan would not have been where it is today.

Let me thank you, the people and the Government of the United States of America for their generous and also for their continuous assistance and help in support to the people of Afghanistan. Thank you very much for your kind attention.

Ambassador Mark Dybul: Thank you. Thank you, Your Excellency. The next set of introductory comments will come from His Excellency, the Honorable Dr. Elioda Tumwesigye, a Member of Parliament, from Uganda, chairman of the parliamentary committee on HIV/AIDS, and also chairperson of the HIV/AIDS Interparliamentary Union. He's also a physician himself and has his own clinic and still works in the field, and is actually one of the PEPFAR implementing partners, so it's a great privilege to have His Excellency Dr. Elioda with us.

Dr. Elioda Tumwesigye: Ambassador Dybul, Congressman Smith, Your Excellencies, ladies and gentlemen, (INAUDIBLE) observant, when I was invited to participate in today's summit and was told that I was to be a panelist after the speech of the most powerful lady and first elected female President of an African country since Adam and Eve were created, I felt humbled and almost turned down the invitation. I did not know how to start and what to say. I went to the library and did research on the definition of country ownership. It's rationale, it's measuring stick, it's indicator, competence and reserves.

While on the plane last Friday from Amsterdam, I observed through my research paper for slight editing. I realized that my presentation looked like an academic paper, an exaggerative summary (INAUDIBLE) of a master student. I dropped the paper and decided on telling you my story, the story of my proud country Uganda in part of Africa as it relates to country ownership and its skilled radiance of national leadership, responsibility, and participation.

Nearly two weeks ago on 6th of October, we celebrated our 46th birthday as an independent country. When Uganda got independence from Britain in 1962, not many British citizens stayed in the country as in other countries. It was only a few Indians who had been brought by the British that remained mainly in the commercial sector. The British left us with one of the best universities in Africa, Makerere, and Western Medical School Tanagra in the capital of Kampala. Ugandans were left on their own to manage or mismanage their country. Although they left us with good education institutions, the British had promoted uneducated people in the army. And one of these was called ”Idi Amin,” was used by the first executive prime minister Obote to overthrow his own government, remove the first president, and change the constitution 1966/'67.

In 1971, after having told him, General Idi Amin overthrew Milton Obote, who went into exile in Tanzania. In the poorly designed brand of enforcing country ownership, Idi Amin expelled all Indians in 90 days and handed over all their property and businesses to ill prepared and scared Ugandans, many from his tribe and religion, in the name of country ownership. The economy eventually collapsed. Amin's army ripped, branded, and dispossessed Ugandans. He killed many educated Ugandans, including the archbishop of the Anglican Church in Uganda, Rwanda, Burundi, and eastern Zaire, and now the DRC, Archbishop Janan Roan. The education, industry and democracy were all destroyed. It took the whole country of Tanzania to remove trough Marshall Zane, then Amin died in 1979, and to allow the educated exiles to return our former government. After Amin's overthrow, there was continued instability and more killings as former President Milton Obote tried to regain power, which he eventually did in 1980. But the country remained highly unstable with more killings.

Between 1981 and 1986, a group of highly educated young men, mainly from the Makerere University left by the British, gave up white-collar jobs and eating of sausages, went to the bush and (INAUDIBLE), the national resistance (INAUDIBLE) to fight for real country ownership, freedom, peace, and dignity of the Ugandan population. When Museveni took over power in 1986 as President, the economy had collapsed and the country had first two major challenges, new challenges. First, the hidden epidemic of HIV/AIDS, that was role of 15 million Ugandans, and secondly, the largest two countries in Africa who are neighbors of Uganda, Zaire and NOW DRC (INAUDIBLE) and Sudan and El Bashir (INAUDIBLE) were not comfortable with the new revolutionaries in Uganda and did not want Uganda to be stable.

These countries heavily supported various rebel groups to fight the new Uganda Government. Uganda was also later to be affected by this in a cleansing and instability in Rwanda. Despite the above two major challenges, Museveni was able to stop extra-judicial killings, restore security of Ugandans and their properties, protect the sovereignty of the country, maintain peace and stability, free democracy from village to international level, retain properties of the Indian owners, halt the decline of the economy, and reduce the sustained economic growth indexes of five percent per annum.

We also know that education is key to meaningful country ownership. The President and interim-government chose to expand educational opportunities for millions of his people and was able to use aid money through the country's own budget abolish school fees at most primary and secondary level through the programs at primary education and universal secondary education. On AIDS Museveni had two choices in 1986; either to keep quiet like other leaders in Africa, fearing losing tourists, or speak out. He chose the latter and he spoke out, emphasizing ABC as AIDS was heterosexual-driven epidemic in Uganda at the time.

Enhanced country ownership of AIDS programs and institutionalizing process called the Partnership Forum where the partnership committee was established for the participation as equal partners of government, the United States acted as (INAUDIBLE) in the private sector and primary in the development implementation and monitoring of mono-national brands. A market-sector approach was adopted and coordinated by the Uganda AIDS Commission. Members of the partnership agreed on national strategic plans and hold annual joint AIDS review for programs, share research, and make public accountability.

This partnership would bring most public and private bodies, including AID Works arose for participation and involvement, thereby promoting ownership accountability, harmonization, and alignment, which in turn, links sustainability. The government encourages strong partnership with the face of institutions and this has had a significant impact on the fight against HIV/AIDS.

Indeed the Uganda AIDS Commission has since inception been chaired by Church bishops and one of the Church bishops, the Church Bishop Komar, made a notable statement that if you are stupid enough to have sex outside marriage, don't be so foolish as not to use a condom because you'll be committing two sins.

Uganda has since shown that high level political and holistic commitment, (INAUDIBLE) and visional leadership are indispensable prerequisites for nations to adjust to unprecedented, unparalleled and tremendous achievements of set goals and meaningful country ownership. Under President Museveni's leadership, the prevalence of HIV was reduced from 86 percent in less than a decade. The potential of community efficacy was unlocked, rapidly leading to high levels of community AIDS competencies where brief of common humanity reigns supreme. As a consequence, many lives were saved and hopes of Ugandans restored in the country that was devastated by AIDS and war in western and northern parts of the country in a geopolitically unstable African country.

With hope and development people are lees spread in radical groups, and antiterrorist activities contribute to global security. Ugandans now are at the forefront of maintaining global security because of the confidence and hope in the future. Ugandan troops are now restoring peace in Somalia, and Uganda was, last week, erected unopposed to serve on the United Nations Security Council, while Turkey and Austria were tussling out with Iceland and Japan was tussling out with Iran, Uganda was unopposed.

Ladies and gentlemen, saving a life is the highest act one can ever do to humanity on this our own shared planet and should be the ultimate goal of international development. Americans, you have saved millions of lives through government programs like PEPFAR and the Millennium Initiative initiated by President Bush, and through non-government American philanthropists like Bill and Melinda Gates Foundation. In Uganda although the U.S. G8 funds for (INAUDIBLE) are not general basket funding, they are used to support national priorities identifying the country-owned national strategic plan and PEPFAR supported programs I implement within the existing framework and I link the three ones, one country plan, one coordination entity, and one monetary revolution matrix.

As there are a lot of PEPFAR programs in Uganda, more than 130,000 Ugandans are receiving life-saving treatment through 154 PEPFAR-supported sites. In 2007 alone, more than 400,000 HIV positive individuals received care and support, more than 300,000 orphans and vulnerable children received OVC program, and over 60,000 HIV positive women and children received AIV Propraxis for PMTC. 70 million people were enriched by community outreach provision activities.

Thanks to Mark Dybul and your Bedford team for your great humility and service to mankind. This enormous compassionate generosity to Uganda by Americans is highly appreciated, and many people in Uganda have a positive view and love Americans. However, it appears that despite the significant contribution by Americans in saving millions of lives and promoting human development all over the world, many people in many other countries do not seem to appreciate, U.S. aid is often bashed at many conferences and general attitude towards America is often poor in many countries.

Although good wine needs no advertisement I think more work needs to be done in public diplomacy to repeatedly bring out the good deeds by the American people in order for U.S. meaningful role in international development be appreciated and for the new era in development to be sustained. Lastly, I hope Uganda and the USA will remain friends in respect of who wins on November 4th. For yesterday is but a dream and tomorrow only a vision. But today's friendship makes every yesterday a dream of happiness and every tomorrow a vision of hope. I thank you for listening.

Ambassador Mark Dybul: Thank you. Thank you very much, your Excellency, for those inspiring words. The final introductory comments will be provided by Michael Gerson, senior fellow on the council on foreign relations. I'm very privileged to call him a close friend. Mike had many physicians working and supporting President Bush's efforts. Most recently he is the assistant to the president for policy and strategic planning. Mike was at the heart of many of the initiatives that you will hear about today and of compassionate conservatism, summarized in his book, “Heroic Conservatism.” And it's a great pleasure to have him here today to talk about country ownership.

Michael Gerson: Thanks. Before I start, I wanted to say a few words about Mark Dybul. In many ways, Mark introduced me to the challenge of disease in our world. When I was at the White House, we traveled to many troubled places together. But most of all Mark introduced me to the courage, and dignity, and faith and, and character found in those troubled places, and he showed me how a public official can be a man of skill and conscience and integrity, and I want to take this opportunity to publicly thank Mark for being a friend and a personal example. The last eight years have been a period of foment, and sometimes of controversy, but it has also been a time of great American generosity. Under President Bush, Americans overseas development assistant budget more than doubled, almost quadrupled to Africa. I sat in the oval office and watched the President of the United States make the decision to pursue the Emergency Plan for AIDS relief, an initiative for the benefit of non-citizens with very little political pressure at home to pursue. It was the highlight of my time in government, and it will be a tremendous legacy for the President of the United States, who I know to be a man of deep conscience and compassion. But this has not just been a period of generosity, it's been a period of creativity. Through PEPFAR, the President's Malaria Initiative, and especially MCA, the administration has set a new vision, partnership not paternalism, country ownership tied to high expectations on government's investment in people, and above all, results. It has perhaps been the most creative time in American development policy since the new frontier, and it needs to continue. There are always challenges to foreign assistance in difficult economic times in American politics, and we are seeing them today too often this is seen as an expendable add-on to American policy instead of being at its center. In fact, this is a priority, and essential of American policy. It remains essential for moral reasons that do not change over time. It is the practical expression of American commitment to human rights and dignity. As a people we are offended by unnecessary suffering, and there is too much unnecessary suffering in our world. But assistance remains essential for other reasons, we know that some of the world's worst challenges, terrorism, drug trafficking, human trafficking, criminal gangs, refugees, disease, emerge from weak states and ungoverned regions, and hopeless parts of the planet. And by encouraging hope and progress and good government we are helping partners who add to the peace of the world. And this should be a firm commitment of both parties in every time. Americans should know the results can be extraordinary. I was recently in Rwanda speaking with health officials and I saw how a partnership can help change a nation. With the help of the President's Malaria Initiative, child malaria deaths have been cut by two-thirds in the less than two years. In 2003 in that country, about four percent of people who needed AIDS drugs got them. In 2007, it was about 92 percent. These are some of the largest achievements in the history of public health, and these kinds of achievements leave two reactions. First, it is amazing what partnership can accomplish in a short period with serious resources and serious good will and serious partnership with non-governmental organizations. And second, why didn't we do it sooner and why don't we do it more? Thank you.

Ambassador Mark Dybul: Thank you very much, Mike, and thank you to all of our panelists for great opening comments, which will get us into a very exciting discussion period. We have a number of questions from the audience, and I'm going to try to weave them in. I'd like to begin with you Honorable Minister. There was a recent article on the economics of hope that basically argued that hope for life, liberty, opportunity, can change how people view the future and change their actual habits, pursuing education, work, and other environments because they have hope. Now you have a national solidarity program for development ownership at the village level. Is hope at the heart of that? Is creating hope at the village level a part of that? And what is the impact of this type of hope and creation of hope at the village level on the social environment of the country, and, in fact, on long-term security?

Dr. Sayed Mohammad Amin Fatimie: Mr. Ambassador it is a very, very important question. I think all honorable panelists, as well as the distinguished participants are well aware of the fact that the entire socio-economic infrastructure of my country, Afghanistan, was damaged catastrophically during the past three decades. I mean from 1978, from the time when former Soviet Union invaded Afghanistan from the invasion of former Soviet Union, to 2001. I mean when the Taliban regime collapsed.

Schools during these 30 years were closed. Taliban didn't allow girls to go to schools. Almost 80 percent of existing health facilities were badly damaged or closed. The physical infrastructure was badly damaged of the clinics and health facilities. And for your kind information, in 2001, shortly after the collapse of Taliban regime, we had only about 300 health facilities. They were functional but they were not able to deliver comprehensive primary healthcare services. Maybe only one or two components of family healthcare services were delivered to the people.

When Afghanistan was freed, the Taliban regime was collapsed, I mean during that 30 years Afghans really became very disappointed. They think that their children would not have bright futures. They were not hopeful about their future. But when Afghanistan was freed, with support of United States of America and the Taliban regime was collapsed, the new government has started many, I think, social economic activities, I mean in order to reconstruct and rehabilitate the socioeconomic infrastructure of the country, which was badly damaged.

One of the most important problems was this national solidarity program. This was based on grass root -- I mean to empower the villagers, to empower the people who had been living at grassroots level. And I strongly believe that development performed by or partnership with communities is owned by them and is a sustainable development. So this important Program of National Solidarity, you know, this National Solidarity Program is based on this philosophy. I think the U.S. Government, the World Bank, and other donors really supported this program, and we have about 35,000 villages in Afghanistan. So far I mean since 2001, more than two-thirds of the villages are covered by this program, and we have now more than 21,000 National Solidarity consuls and communities at the village levels. They are responsible to manage all socioeconomic activities and projects at the village level. So there I think the communities are involved in planning, in decision making, and in implementation of the program. That is why the programs are owned by them, and they have benefitted a lot.

As I mention in my opening remarks, now many people who return to Afghanistan, when they left in 2001, and they returned to the same village, they didn't recognize their village, it's completely changed, you know, and it is really in a better stated condition. And now the people, because of not only National Solidarity Program, which has created hope for the bright future of our people, I think this is one of the good examples for other war-torn countries if they are going to implement the same I mean programs or projects in their countries. Without that the people will be really hopeful for their future. And the implementation of this National Solidarity Programs and other good projects, for example, the health projects, you know, the people have become hopeful. They think that their children will have a bright future. That is why they are grateful to the government -- to the respective Government of the United States of America. That is why all people are deeply grateful to the Congress of United States of America. That is why the people of Afghanistan are greatly, you know, thankful to the great nation of United States of America, as well as they really appreciate the sacrifices of the brave soldiers of the United States.

Ambassador Mark Dybul: Thank you very much. And maybe we can come back to that notion of hope and whether or not hope at the community level actually changes the outlook for the future and security and stability. Dr. Elioda, you talked about achieving results and some of the results that have been achieved in Uganda. A very important principle will be discussed later, “results base.” But sometimes results, which we tend to think of as things to show international partners, have an impact locally that people use David to change their programs and feel a sense of ownership. In fact, a young Namibian once told me that he thought these programs based in results are building democracy because they're creating a sense of transparency and accountability. Does that sense -- does that comment by the young Namibian make sense to you that by focusing on local ownership, looking at data, using data to improve your programs, in fact, build local accountability, transparency and democracy, have you seen that in your own country?

Dr. Elioda Tumwesigye: Yes, thanks, Mark, for that and for the Namibian example. In Uganda, for us to be able to ensure that results are achieved in every program area, we've set up what we call “counter-specific sector performance and result oriented indicators.” And also every sector in Uganda, we have unused sector reviews. We have the education sector review. We have the health sector review, and just before I came last week we had the Joint AIDS Review, and all the donors, all the program mentors are required to come to these reviews, and they indicate what the objectives of the last year; what activities they had; and what were they able to achieve during that period. This process is back today in the sense that before those reviews, we send out teams into the communities, to the different areas of the country to be able to come out with a report, and these reviews also have a lot of expense from every sector and every part of the country.

So it's true that for us to be able to able to have meaningful development to have country ownership, people must be involved in designing programs, implementing, monitoring, but also review, and in the reviews, we don't call them donors we call them development partners, and the government actors and the United States actors must come together, and each one is held accountable for what you are supposed to do in the previous year. And we found that very, very interesting and very helpful.

Ambassador Mark Dybul: Thank you very much. For the rest of the panel, this type of transparency and accountability from development could be a spillover effect – viewed as a spillover effect, a good spillover effect of development programs. Are there other specific types of spillover effects that you've seen from your experience or your travels, and can we do a better job trying to evaluate them to make the case even more for why development is important for a larger impact from some of these programs. I leave that open to anyone, if people have precise examples that they'd like to give. If not, I've got lots of other questions.

Congressman Chris Smith: You know I've learned, especially working on the trafficking issue, that best practices need to be shared. As you combat it through protection of the women who are trafficked into modern-day slavery or whether it be the prevention side or the prosecution side, we need to be talking more. And the same holds true obviously on the health side. Don't be shy about saying, “this works.” I remember visiting Dr. Elioda's work in Uganda, and he was sending people out two-by-two to go to individual villages and to talk to the people. And we sat through one of those meetings, and the way and with the great sensitivity that the testing was done and people were told what their options were, safe water was also promoted on these visits so that there's this integration effect, but that's a model that needs to be replicated everywhere. And so, you know, when I find very often there is a shyness or “doesn't everybody know” mentality out there. You have an idea that's good, make sure it percolates to all sectors, including the legislative sector so we can write it into laws.

Ambassador Mark Dybul: Thank you, Congressman. Minister, does that comment from the Namibian make sense to you that transparency and accountability for specific programs actually contributes to development of democracy?

Dr. Sayed Mohammad Amin Fatimie: Absolutely. Absolutely. As far as Afghanistan is concerned, we are seeing spillover effects from a number of programs, but I don't want to comment on others, but please allow me to share my experience in the health sector.

As I mentioned in my previous comments, women were not allowed to education. In 2001, we had only 400 female nurses and midwives, only 400 for the entire country, for 25 million Afghans. But with support of U.S. aid and other donors, we have started to train community midwives. Today we have more than 4,400 community midwives.

In order to improve the health situation in villages, we have started another training program, which is called “Community Health Workers Program.” We trained more than 20,000 community health workers, and half of them are women. So these women, I mean 4,400 community midwives who are recruited from villages and they promise and they fulfill their promise to go back to their respective villages after finishing their 18 months training, and also the community health workers, I think they have been working voluntarily at their villages, I think their work has had significant impact, not only on improvement of the health but really they've become a model, an example for women in the villages to take part, you know, in socio-economic development and also to know about their basic human rights. That was something I think which is beyond the responsibilities of the health workers, so now the Afghan women in the villages, they know about their rights, and they're very ambitious about that.

Ambassador Mark Dybul: That's a great example. That's a great example. Thank you very much.

Michael Gerson: I've seen exactly the same thing in other contexts in Zambia and other places where women, often HIV positive women, who become community health workers, they gain a kind of respect and standing in their community, they demonstrate what women's empowerment and rights means. It's very, very important. In addition to that, a number of AIDS groups are led naturally into micro-enterprise because women on treatment, men on treatment need to have sources of income, they're, you know, living normal life spans and so it's often said or sometimes argued at least that a large sectoral emphasis on health or AIDS somehow undermines other priorities in a society, and there can be tensions. Okay. But I've seen quite the opposite, where you see high levels of professionalism, accountability, reporting in the AIDS area, it spills out over into other health areas and starts to reveal other social priorities with women's empowerment, with trafficking issues, with a lot of other problems, you know, that particularly concern often the treatment of women and their rights in society.

Ambassador Mark Dybul: That's excellent. Thank you, Mike. Congressman Smith, these answers, excellent discussion, actually leads into the discussion I wanted to ask you, which is something you care deeply about. Often when we talk about country ownership, people think about government only, and we've been talking a lot about the non-governmental sector. So if you could talk, quickly, about the important role of other sectors, in particular faith-based organizations.

Congressman Chris Smith: Thank you, Mark. You know the United States has had a long hundreds of years of integrating the faith-based component with the government, Catholic charities, Lutheran services, Hebrew immigrant society. There's all these various ways of reaching larger numbers of people, often at lower cost, volunteers usually are very large in these efforts. And it reaches people who might other wise not be reached. There is a passion there. I mean I believe that non faith-based groups do have a passion as well, but I think there's been an artificial exclusion in many cases, and especially in countries that are emerging from human rights problems. Very often it is the churches that have spoken out boldly on human rights abuse. And then when various ministries and government leaders look to implement, they don't necessarily see the church as a partner because they've been speaking out about and holding into account, particularly on human rights violations. So if you really want to mitigate and hopefully combat and end HIV/AIDS in Africa and other problems around the world, including the United States, it is to our detriment, it is to everyone, and especially the victimized detriment not to fully embrace and include faith-base. We've seen with the global fund that there has been a lack of inclusion. That's in the process of hope of changing, and you have done much to try to focus on that. But it mean it's opportunity missed in a very large way, and again, I have visited faith-based groups all over, as well as other NGOs, we can't do it without them.

Ambassador Mark Dybul: Thank you very much. It really emphasizes the people to people, not just government to government. Mike, if I could ask you, you know, country ownership, we're talking about mostly the host country. But there's another country, which is the American people owning the development and need to continue with development. So as we move to a new administration, a new congress, are there messages to them under the American people about how we can enhance country ownership here for the need for development, and in particular, how important is presidential leadership since you've had such a close tie with that.

Michael Gerson: Sure. No, I think it's fair to say that there are many generous nations in the world, but that not many large projects get done without American support. And within the government there are many responsible voices pushing on this agenda in the Congress, you know, and in the community, but not many large things happen without the fundamental commitment of the President of the United States and his staff. That's been the recent experience. It requires often someone who sits in those meetings who is an advocate, because so many of the budgetary pressures, so many of the pressure of immediate crisis lead, you know, the U.S. Government in other directions not to emphasize these issues. And unfortunately I think we're beginning to see that.

I was very, very happy with the reauthorization of AIDS and the President's Malaria Initiative in this last session, which was really kind of a heroic achievement of the Congress in many ways. But I'm afraid that MCA in particular is in serious political trouble. It's been politicized. It's gained some -- you know there are disturbing signs in the budget process, in the Senate in particular, and that it's going to take the next President, republican or democrat, to stand up and say, this is not a Bush program, this is an American program. It's vitally important. It presents one of the difficulties in the public support of these programs. In the some ways, it's easier to gain public support for disease specific initiatives, because you can see the results, you can bring someone whose** life is saved. But in the long term, the best kind of country ownership is countries that own their own prosperity and do that through trade, foreign direct investment, and helped by effective foreign assistance. Okay. And sometimes those are 10 year, 20 year commitments where the results are not as immediately evident. And so it's going to be one of the elements of presidential leadership for the next president to try to build the constituency. We've built the constituency in many ways for these disease-specific initiatives, which I think you've seen in the last session of Congress. They've become bipartisan. But we need to build those political constituencies for long-term assistance so that countries can realize kind of that great country ownership of being able to help their own citizens.

Ambassador Mark Dybul: Thank you. And for emphasizing that country ownership counts for us too. We're down to the last five minutes. We could go on forever, so I'm going to ask each of you to just deliver, in less than a minute, the one message you would want to give to the next administration, the next Congress, and back to the American people about where we should go and what needs to be done, and perhaps Minister and Dr. Elioda, if you could address specifically how these programs at the grassroots levels have changed the perception of the American people in your country. So why don't we begin with Congressman Smith.

Congressman Chris Smith: First, I think, Ambassador Dybul, we have to guard against compassion fatigue, the idea that we've been there, we done that, we got the T-shirt, we move on. This has to be sustainable, but not just sustainable, it needs to be enhanced. Including faith-based organizations robustly, I think that multiplies. There's a multiplier effect there. And even though there is very little political upside in elections, this is all about being our brothers' and sisters' keeper. And as Mike said, when you see disease and you see it ravaging people, it does move you to action. You have to stay at it. But fixing roads and bridges, clean water, which obviously has a health component as well, you know, I was in D.R. Congo earlier this year, and a farmer told me that he could not get his produce to market. And so much of it spoiled before it got to the people. Roads, bridges, get it there, that is part, I think, of economic growth and prosperity for any country.

Ambassador Mark Dybul: And we look forward to you pursuing that in Congress. Minister of health.

Dr. Sayed Mohammad Amin Fatimie: Thank you very much, Mr. Ambassador. I strongly believe that stable peaceful development and prosperity of Afghanistan is very, very important and crucial for stable, prosperous, and peaceful work. My humble request from the future administration is to continue even to increase its financial and technical support in Afghanistan. Stable Afghanistan means stable worth. Peaceful Afghanistan means peaceful worth. And Americans are viewed by Afghans, you know, as liberated friends. And the soldiers who are stationed in Afghanistan, they are viewed as liberation forces, not as occupying forces like Russians and former Soviet Union troops were viewed by Afghans. So we have had many, many significant achievements in Afghanistan with your help. But much remains to be done, so the future administration, I mean, should take into consideration the present situation of Afghanistan. I mean it shouldn't freeze their funds and technical support of Afghanistan to become much more stable and prosperous, and that will have significant impact on stability and prosperity of the world.

Ambassador Mark Dybul: Thank you, Minister. Dr. Elioda, as quickly as you can, please.

Dr. Elioda Tumwesigye: Yeah. The American supporters have changed people's views on the communities at the grassroots level. But what's happening -- we have tackled the problem of AIDS and people have hope and they're living, but people want money in their pockets. And as Congressman Smith said, for us, we have taxist markets. In many countries like Uganda, Rwanda, Tanzania, Zaire, D.R.C., the major challenge is access to the sea. And the American President if I saw him, the next president would be to ask him to assist us in establishing infrastructure. View the labor line from Mombasa to Uganda to D.R.C. to southern Sudan; open and unlock the potential of the African countries, especially in the hinder land. That would be great.

Ambassador Mark Dybul: Thank you, doctor. Michael.

Michael Gerson: And I would just say very quickly, you know, my message would be that this is not an altruistic add-on to American policy. It is a centerpiece commitment of American's role in the world. It expresses our values. It defends our interests, and it needs to remain a priority. Thank you all very much. And please thank you to his First Excellency.

Announcer: Thank you once again to our panelists.