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Leadership Interview: A good leader cares for his people

Interview with Admiral Timothy Ziemer, Coordinator, US President's Malaria Initiative

[RBM leadership interview conducted by Katya Halil, Communications Officer, Roll Back Malaria Partnership Secretariat, July 2008]

Q: What led to the launch of the President's Malaria Initiative in 2005?

Admiral Ziemer: President Bush has made unprecedented commitments to Africa and global health through the President’s Emergency Plan for AIDS Relief and Malaria Initiatives.

President Bush has also made a personal commitment to the people of Africa through the African Education Initiative, economic growth, community development, and clearly through public health programs.

In 2003, President Bush launched the largest initiative to fight the global HIV/AIDS crisis. In 2005, he announced a historic five-year expansion of U.S. Government resources to fight malaria in the region most affected by the disease. The President committed an additional $1.2 billion in malaria funding to the PMI with the goal of reducing malaria-related deaths by 50 percent in 15 focus countries. The President’s Malaria Initiative (PMI) was very much consistent with his overall international foreign assistance plan for Africa.

The U.S. is the largest investor in improving health and fighting major diseases. Since 2003, our Congress has committed approximately $20 billion to fight HIV, tuberculosis, malaria, and other neglected tropical diseases. The U.S. has quadrupled its funding for the fight against these diseases since 2000. I believe we owe a debt of gratitude to both President Bush and our Congress for providing critical leadership and the resources to protect the health of millions of people around the globe. For more than two years, Mrs. Laura Bush has lent her voice and position as First Lady of the United States of America to touch the lives of people who have suffered from malaria. Mrs. Bush's compassion and personal commitment has attracted global attention, galvanized action, and spurred grassroots and private-sector efforts to eliminate the disease.

Q: How does PMI choose which countries qualify for financial assistance?

Admiral Ziemer: A country that qualifies for PMI assistance must fulfill the following five basic criteria:

  1. it is malaria-endemic;
  2. it has to have strong leadership - in other words, its leadership is committed to doing something about malaria;
  3. it has a strong national malaria control plan;
  4. it has other funding partners like the World Bank and the Global Fund. President Bush realized that the United States Government can't do it alone - we need to be a partner and not the partner;
  5. it has to be willing to work with the United States although that is at the bottom of the list.

Q: How does PMI operate within countries?

Admiral Ziemer: While the United States Government is very generous, we are also interested in making sure the dollars achieve whatever the targets and the goals are. PMI is a life-saving initiative specifically focused on reducing mortality by 50% in at least 15 focus countries in the two most vulnerable population groups, namely pregnant women and kids, so we are burdened with achieving those goals.

We work through the USAID missions; we provide two people on the ground in each focus country. So we basically come in on the ground laterally, and work directly for the Ministries of Health and the head of the national malaria control plan by supporting their plan. The only condition we have is that all four interventions must be used: indoor residual spraying, artemisinin based combination therapies, long lasting insecticidal nets, and intermittent preventive treatment for pregnant women. So we use those four basic interventions which are proven to be effective.

We also have a high commitment towards providing commodities: 40% to 50% of the money will go into commodities to fill the countries' gaps. The rest is then focused on training, logistics, and getting the commodities the last mile to the beneficiaries; and about 4 and 8% go towards Monitoring and Evaluation. We want to make sure that at the end we can start collaborating with the Global Fund and UNICEF to standardize our database so that it complements theirs or vice versa, and so we can start building a more effective Monitoring and Evaluation component.

So our strategy is to come in at that (lateral) level and not in from the top through central funding. The United States Government steers away from the central funding mechanisms because in the past we have not been able to account for the money, nor have we been able to see the capacity that we all hope for to be developed, to be sustained.

Q: How does PMI lever the power of partnership to deliver results?

Admiral Ziemer: One of the principles of the President's Malaria Initiative is partnership. When the President announced PMI at the G8, he challenged the other G8 countries to step up and do more for HIV as well as malaria through existing funding mechanisms, such as the World Bank or the Global Fund. Then he went to the United States private sector and challenged the business sector to match the 1.2 billion dollars because he realized increased funding was necessary.

So we need funding partners as well as implementing partners. PEFAR and PMI are predicated on the notion that we have to engage our multilateral partners as well as our national partners. While the most important partner is the host country, we also work with NGOs and the private sector through to the Faith Based communities and other partners. So we look at partnering at every level for the President's Malaria Initiative.

Q: What might PMI's comparative advantage be vis-à-vis other bilateral or multilateral donors?

Admiral Ziemer: All I can say is that based on our targets and goals and principles, we enter in where we're comfortable entering in and rely heavily on other donors and partners to do what they need to do to meet their constituency needs.

We're also getting high marks from our Congress for being fully transparent and fully accountable. I can account for every penny that comes in from Congress; every program, and every plan that a country develops and that we're supporting is on the web; all the contracts are on the web, so we can basically show where all the money has gone.

We see that as a positive trend and a demand that our Congress is going to put on additional foreign assistance funded programs. This is going to become the norm-- so those people that are more interested in centralized funding and basket funding are going to be less happy with us because the orientation is towards this kind of behavior rather than dumping it in at the top.

Q: What is the best way to coordinate and align partners to country-defined priorities?

Admiral Ziemer: Coordination, harmonization, and alignment, the buzzwords in our community, are critical. We must partner at every level. In this business of saving lives we can't afford the distraction of identities and egos. We must make sure that we leverage everyone's activity, and not compete.

Q: What more can the donor community do to help countries achieve their malaria-related development goals, in addition to providing funds?

Admiral Ziemer: We're really pleased to see that the donor community, the governments, the private sector and the foundations like the Bill and Melinda Gates Foundation and the United Nations Foundation and Malaria No More are all participating. Let's not fool ourselves--cash is critical. The research and the technical partnerships that come in at every level, but also the training, and some of the systemic capacity building deliverables that we bring, are all part of what needs to be done, but at the end of the day that really does take hard cash.

We need to celebrate what we're getting in cash and hold each other accountable to what the needs are. We must keep moving towards that goal of more funding for these proven programs to which we can hold countries accountable.

Q: What must donor countries take into consideration before they can increase their financial commitments against this disease?

Admiral Ziemer: Clearly there are so many competing priorities in the health world; and then if you add everything else out there in terms of education and development etc, then there is a huge menu of places that foreign assistance can go. I think on public health initiatives where there is an urgent need, where it's clear, and where you can see your funding can actually make a difference which means leadership, good planning, and willingness to collaborate. If you have those three components then you're going to have a successful program and be able to make an impact and therefore attract more funding.

Q: How do you define country leadership against disease?

Admiral Ziemer: I think country leadership is real simple. A leader who is really concerned about his people and demonstrates compassion through multiple strategies. You can tell within a few minutes where someone's focus is. So good leadership means the leader is privileged and burdened with leading a country and caring for the population on behalf of the constituency. That's what democracy is all about.