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This is an archived USAID document retained on this web site as a matter of public record.
Statement of E. Anne Peterson
Assistant Administrator-designate
Bureau for Global Health
Before Senate Committee on Foreign Relations
Washington, D.C.
October 9, 2001
Mr. Chairman, and Members of the Committee, I am honored that President Bush nominated me for the position of Assistant Administrator of the Global Health Bureau at the United States Agency for International Development. I appreciate the opportunity to address this Committee. The prospect of heading USAID's international health program is exciting. The vision of USAID and the steps required to fulfill that vision match well with my background and life goals. I seek your confirmation of the President's nomination; my hope is that my testimony today will reassure you that I will serve the President and the Congress well in this post.
Under the USAID reorganization, the Global Health Bureau will provide strategic support, leadership, research, evaluation, and technical assistance in the key areas of HIV/AIDS, family planning, child survival, maternal health, and infectious diseases. These endeavors represent tremendous opportunities for helping people around the world as they strive to establish and maintain healthy families, communities, free societies and thriving democracies. Our assistance is not only an opportunity to aid other countries and build friendships but is also part of our response to the recent tragedy. Countries whose people are healthy can maximize their economic potential, participate meaningfully in events that control their lives and, therefore, are less likely to grow or export terrorism.
I believe that my education, background and career experience have prepared me for the unique challenges and important humanitarian activities of the bureau and the agency. I am a physician, and I am board certified in public health and preventive medicine. My commitment to public health grew out of my work in a mission hospital in what was then Zaire. One day a baby girl came to me with the red hair and swollen belly of malnutrition, a hugely enlarged spleen due to malaria, infected scabies on all extremities and both legs paralyzed by polio. It was clear that this child wouldn't live long despite whatever treatment I gave that day. It was also striking that everything this child suffered from was preventable by simple interventions in the community.
Since then most of my career has been dedicated to addressing health issues from a prevention perspective through policy development, program interventions, and health education carried out in or through local communities. Public health works by tracking health trends across populations, then trying to identify, understand, prevent or mitigate the disability and premature death caused by many diseases. In resource poor regions, disease devastates and destabilizes individuals, families, communities and nations. As recently and tragically demonstrated, free, democratic societies including our own can be in jeopardy.
My international health experience includes having lived a number of years in Africa (mainly Kenya and Zimbabwe) as well as having consulted for programs in Haiti and Brazil. I have worked in disease specific areas, such as AIDS prevention and elephantiasis treatment. I have also worked on community development initiatives in desperately poor rural villages and urban slums. This experience has given me a better understanding of the problems USAID is working to alleviate and empathy for the people we seek to serve.
As you know, USAID has an active research and development program designed to reflect the needs and conditions of the developing world. My research experience positions me to oversee this program. I have conducted basic biomedical research in the United States as well as programmatic and intervention research on international issues such as nutritional status or soap use in refugee camps. In the United States, I have worked in outbreak investigations and control, food safety, and chronic disease surveillance.
Most recently, I have served as State Health Commissioner of Virginia. These last three years have been an opportunity to add political, legislative, policy and administrative skills to my public health background. I have advised the Governor and key state policy makers on a broad range of public health program, policy, and legislative issues and provided leadership to a workforce of 4,000 employees serving more than seven million Virginians throughout the state. I have managed a $420 million budget and a range of services including epidemiological surveillance, communicable disease control, environmental health, water programs, medical examiner services, maternal and child health, family planning, nutrition services, emergency medical services, health education, health facilities regulation, and managed care quality assurance.
Since September 11th, I have been very involved in the Virginia response to the Pentagon attack, implementing Virginia's bioterrorism surveillance, and responding to the press and constituent concerns on bioterrorism. As Governor Gilmore, who heads the "Gilmore" Commission on terrorism preparedness, has recently said, "There is much more that needs to be done to be fully ready." Virginia, unfortunately, has had the opportunity to test its response to a real situation but the State is, thankfully, at the leading edge of terrorism preparedness and response. Since coming to Virginia I have often said that my time in Africa was what had prepared me for being Commissioner. Now, I can say that my time in Virginia has been invaluable in preparing me for the task of managing this new Bureau for Global Health within USAID.
Throughout my career, there have been several important tenets that have guided my public health practice. The first is: lasting change occurs best within a cultural context. One of my earliest and most lasting professional lessons was working in a mission hospital in Zaire. Problems that seemed simple proved exceedingly difficult. Inefficiencies, problems and corruption were rampant. Potential solutions were masked by ancient traditions. I learned to watch and listen. Through that I learned that being "quick to listen and slow to speak" was a good starting point for success. I have tried to apply this lesson ever since. In subsequent community development work, listening well allowed me to join my health expertise with the community's cultural experience into unanticipated yet viable solutions. The most successful health programs in our own country and throughout the world have recognized and planned for this, and the most effective health practitioners know that they must meet and serve others on the grounds of understanding and mutual respect.
The need to listen and learn is also true within an agency structure and work setting. I am very thankful that I have had even a short time at USAID to listen and learn, to meet staff, to learn their strengths and the wisdom that, if confirmed, I will need to call on in decision making. People who go into public health, especially those called to address challenging international health issues, tend to be very dedicated. I have already seen that dedication in the Global Health Bureau. Similarly, I look forward to the opportunity to listen carefully and work together with the Foreign Service staff and host country counterparts to understand and address the specific health concerns of each country that USAID works in.
Second, lasting improvement means transforming change in people's choices and behaviors. In the United States, major attention is turning to diet, smoking and exercise as risk factors leading to chronic disease. Internationally, knowledge, opportunity and the desire to change health choices can similarly transform health whether the issue is clean water, vaccinating children, or changing risk behavior to avoid HIV/AIDS. Good data and science are the basis for wise decisions, yet neither science nor data alone will transform health.
For centuries elephantiasis like leprosy, has been a hopeless, stigmatizing disease that is also the second leading cause of disability worldwide. Recently a Brazilian doctor developed a new, simple treatment. But like diabetes management this treatment needs daily lifestyle change. Moving from hopelessness to hope is hard. With patience and partnership the medical understanding was translated into reality. I saw Mr Maurice Antoine go from dependence and immobility to caring for his legs and running his own business in front of the hospital in Leogane, Haiti.
Countless studies have demonstrated that knowledge alone does not necessarily equate to behavioral change. We must take responsibility for transforming and tailoring data into useful, understandable information so that people most at risk can apply it to their lives, then encourage the personal decisions that enhance their prospects for health and prosperity. We need to have good data, analyzed with skill (the science) to turn that data into information, tailor it for those most at risk (health communication and social marketing skills) and bring it to the people (program design) in such a way that it is relevant and transforming (program and outcome evaluation). Doing well in one part of this sequence is good, but only when all the pieces are linked together for each health issue will we really make an impact on the health and wellness of those we serve.
The third tenet is: good stewardship maximizes impact. There is always more need, especially in the health arena, than we have resources for. There are always competing interests within health and outside of health. Even with America's wealth, there are always more good things to do than we have resources to do. Therefore, it is critical that the health resources we have be used where they will have greatest benefit. The American taxpayer deserves to know what his or her money is being invested in and what return he or she gets on that investment.
My commitment to the President, to Administrator Natsios, and to you in Congress is this: I will ensure that resources are deployed efficiently and reflect the values and priorities of the President and Congress, to improve the health and prosperity of people throughout the world. This kind of accountability is difficult in the developing world, but without it we cannot answer such basic questions as: "Do our programs really accomplish what we have said they would?" "Are the stated priorities of the President and Congress measured?"
Let me share a very short version of what was a major management and accountability issue for me. Many government agencies have struggled with the escalating costs of data systems development. I was buried deep in my first frantic legislative session (Virginia has short, very intense legislative sessions), when I discovered that my agency was in trouble with a major information technology development project and very unprepared for Y2K. With concerted attention and some outside help, we moved from bare Y2K compliance to leading edge, web-based data systems development that meets the users' needs and gets information to decision makers. Data systems development at the Virginia Department of Health is now considered the model in Virginia.
I am willing to recognize problems and devote energy to fixing them. I would apply that same willingness to problem solve in USAID. I am very pleased with the strong guidance of USAID's Administrator, Mr. Natsios, both in recognizing that the health issues within USAID need more attention and their own leader but also his emphasis on management and accountability. If confirmed, I look forward to assisting him in making management and accountability real within the Bureau of Global Health.
As has been the case during my tenure in Virginia serving the Governor and Legislature, if confirmed, I will endeavor to serve the President and Congress by fairly and faithfully administering its laws and by providing information and testimony that is timely, complete, and accurate. I believe I have been successful in finding ways to encourage bipartisan support for health initiatives. I see my role as translating your legislative intent into programmatic and policy realities that will have the desired impact on the health and well being of millions of people in the developing world. I am an optimist and believe strongly, even in the face of daunting international challenges, that America's foreign assistance can bring improvements in each country where we work. We represent our nation and all Americans throughout the world through our personal interactions and the services we provide. Therefore, we must always act in good faith and with integrity. I take very seriously the honor and responsibility of the position for which the President has nominated me. If you choose to confirm me, I pledge to you that I will bring my medical and public health expertise together with a strong management style in order to enhance the administration of international health aid through business excellence, efficiency, and accountability in USAID's Bureau for Global Health.
Thank you.
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Last Updated on: January 02, 2009 |
