Opinions: Defense, diplomacy, development; PMTCT in Africa; perils of DIY aid; cholera in Haiti

Diplomacy, Development Need Equal Footing With Defense

In a Foreign Affairs essay, Secretary of State Hillary Rodham Clinton writes of "the need to elevate diplomacy and development alongside defense - a 'smart power' approach to solving global problems." Clinton outlines the efforts underway - from the hiring of new Foreign Service and Civil Service officers to the "first Quadrennial Diplomacy and Development Review (QDDR), a wholesale review of the State Department and USAID to recommend how to better equip, fund, train, and organize ourselves to meet current diplomatic and development priorities and how to begin building the people, structures, processes, and resources today to address the world's challenges in the years ahead."

"Although the State Department and USAID have distinct roles and missions, diplomacy and development often overlap and must work in tandem. Increasingly, global challenges call for a mix of both, requiring a more holistic approach to civilian power," Clinton writes. "The impact of the Feed the Future global hunger program and the Global Health Initiative [GHI] will turn in part on the promotion of policy reforms in partner countries; the Millennium Challenge Compacts are in part the product of sustained political engagement designed to create positive conditions for development." Clinton explains that the GHI's aims "to put an end to isolated and sporadic care by tying individual health programs - PEPFAR; the PMI [President's Malaria Initiative]; and programs regarding maternal and children's health, family planning, neglected tropical diseases, and other critical health areas - together in an integrated, coordinated, and sustainable system of care, with the affected countries themselves in the lead. … The Feed the Future initiative is based on the same principles."

Clinton continues: "Achieving a more stable and peaceful world depends on the success of all these types of missions - from Iraq and Afghanistan to West Africa - and on the United States' and other countries' ability to mount more of them. The American people must understand that spending taxpayer dollars on diplomacy and development is in their interest, especially when those investments support missions in conflict zones, fragile states, and states that can play a responsible role in their regions and in the world. And Congress, which has a long tradition of bipartisan support for traditional diplomacy and development, must appreciate the scale and scope of the reconstruction and stabilization missions that U.S. civilians are being asked to undertake" (October/November 2010).

PMTCT Of HIV In Africa Possible With Attention To Family Planning, Testing, Care

"Everyday, more than 1,000 babies … do acquire the [HIV] infection. Virtually all of them are born in Africa. More than half of all children living with HIV need life-saving treatment - and only a small minority receive it. Without that care, half of those babies will die before their second birthday. We should all be anguished at the scope and inequity of this catastrophe," Jorge Bermudez and Philipe Douste-Blazy of UNITAID along with Anthony Lake of UNICEF write in a Daily Nation opinion.

The article continues, "But we should also be outraged - because we have the power, the knowledge, and the means to prevent it." Achieving a "generation free from AIDS is now possible," the authors argue, if prenatal care, family planning and access to HIV testing are improved in disadvantaged communities. UNITAID and UNICEF, the authors write, have "worked together" to "support an integrated approach" and partner with 16 countries to provide drugs to prevent mother-to-child transmission of HIV. The authors also discuss specific projects by their agencies, the importance of integrating HIV services into national health systems and the Millennium Development Goals (10/27).

DIY Foreign Aid Can Hurt More Than Help

Dave Algoso, an international development graduate student at New York University, refutes Nicholas Kristof's recent New York Times Magazine piece about American individuals who start foreign aid projects. In a Foreign Policy argument, Algoso writes that "local community members helping their neighbors and themselves - are absent from Kristof's stories. Instead, he gives the reader an American heroine (his stories are mostly about women) who comes to save the day."

Algoso goes on to outline some of the central questions of international development. He notes, "What Kristof misses is that even seemingly obvious solutions are more complicated than they appear. ... The world of aid has spent the last 50 years grappling with these questions. The development industry is by no means perfect, but it has made progress and learned valuable lessons. The lessons are often ignored by newcomers, and the same mistakes are made over and over again." In development, "amateurs don't just hurt themselves," he argues. "A project that misunderstands the community or mismanages that crucial relationship can undermine local leaders, ultimately doing harm to the very people it was meant to help," he adds.

"Despite all my complaints, I think Kristof's article does some good if it convinces more people to pursue international development as a career. We all start as amateurs. The difference is whether we seek to learn more or assume that we can just start doing something, muddling through as we go. The 'DIY foreign aid' concept might spur a few people to launch ill-advised ventures that eat up scarce resources and get in the way of better efforts, but it might also convince a few others to read a couple books, go to graduate school, get jobs with professional aid organizations, and spend their whole careers making a real impact," he concludes (10/26).

Weakened Government Fueling Cholera Outbreak In Haiti

In a Foreign Policy opinion piece, titled "Why Democracies Don't Get Cholera," Joe Amon, director of Human Rights Watch's health and human rights division, discusses factors other than unsanitary conditions that he feels contribute to outbreaks: government "denial and cover-up," inaction, and a weakened central government. The article focuses on Haiti's recent cholera outbreak which, even though predicted, couldn't be avoided "because disease and democracy often work in opposite directions: vulnerable populations and inadequate government action create both the conditions for cholera epidemics to emerge and to become unmanageable."

"Governments don't want to admit the failure of health-care or surveillance systems, and they are afraid of the trade and travel sanctions that may result from a large outbreak. But inaction leads to larger epidemics," Amon continues, noting examples of cholera epidemics in Zimbabwe, Nigeria, Kenya and Iraq. He also discusses the need for a central government to pay attention to housing and human rights, including the "squalid living conditions" in relief camps, which in Haiti "is not a task easily conducted by NGOs in piecemeal." The author concludes: "By listening to the needs of rural residents, by ensuring that planning is participatory and inclusive, by building the capacity of the government to deliver services and fulfill the rights to health, water, and shelter, post-earthquake-rebuilding efforts can reduce vulnerability to cholera and ensure that the Haitian government can protect and fulfill the rights of its people" (10/25).