My best, most vivid experiences in government concerned global health. I sat in the Oval Office and watched President George W. Bush approve the Emergency Plan for AIDS Relief—the largest program in history to fight a single disease. I watched the president give his go-ahead for the President's Malaria Initiative, designed to cut mortality rates in half in 15 highly endemic African countries.
Five or six years ago in a place such as Rwanda, about 4 percent of people who needed AIDS drugs received them. Today, that figure is above 70 percent. With American help, Rwanda cut its death rate from malaria by two-thirds in less than two years, mainly saving children under 5 years old.
These are some of the fastest, broadest achievements in the history of public health, and the progress is repeated across the continent. AIDS treatment in particular has not only saved lives—saved mothers to raise their children and teachers and nurses to serve their communities—it has also encouraged testing and decreased stigma. An infectious disease becomes less terrifying and more manageable when it is not a death sentence. Not all American foreign assistance is effective. But these two programs prove that overseas aid, under the right conditions, can be effective.
Six or seven years into a noble experiment, we have learned some lessons. We have learned that measuring outcomes matters. We have learned that boldness matters. National scale-ups and countrywide plans encourage real development, because they require the creation of supply, management, and human resource systems—the kind of accountability and transparency that can benefit an entire health system and society.
We have learned that, like an effective military, effective ...1
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