 Okay, well, fabulous panel, and we're now going to move on to talk to the people who have the responsibility to make sure that GHI actually delivers. And so I'm very pleased to have Amy Batson from USAID, Kevin Dacock from CDC, and Gavigan from the Office of Global AIDS Coordinator, and Lois Kwam, who has been introduced before from the State Department and now head of GHI. There's a lot riding on this, and as everyone knows, when we look at whether it's PEPFAR or PBI, global health programs that the U.S. has been involved in over years, there's a real great foundation to build on. But I think what we want from GHI is to really look at where we started, from what we're building on, and doing this in a different way. So I'd like to hear from all of you, and maybe start with Amy. What are you expecting GHI is going to be able to produce, and how, from your perspective, do you see that coming together? Thank you, thank you, Elaine, and thanks to CSIS for setting this up. I think there's some serious challenges that we sometimes forget, we're so caught up on our health that we sometimes forget the environment in which the health sector has to operate. The fact that these countries have incredibly weak infrastructures, the roads, the electricity, the safe water that impede access, that health facilities are so understaffed by doctors and nurses, and that these are some of the rarest human commodities in the country. The kind of financing, these uncertain tax revenues, uncertain donor funding, that a country like Malawi has $17 per capita for their total government health expenditures, and then the policy and the capacity issues in the country. So we're operating in that kind of constrained, resource constrained environment. As we're looking, GHI has brought in a possibility for reform. It's building on the tremendous successes of what we've seen, PEPFAR, PMI, all of the other programs we've been doing in health. But it's also recognizing that by approaching each of those diseases separately, we actually created some challenges as well because we were a bit fragmented in our approach. So what GHI is, is the reform of how we do that business. How do we support and bring together all these separate lines of delivery, which were focused on diseases, to be treating the patient, the woman, much more holistically, so we ensure her needs are met? So we're seeing some big advances. We're seeing things like smart integration, that bringing these services together is proving to be not only better for the patient in terms of meeting their needs, but cheaper. In Kenya, where we worked with PEPFAR to couple HIV AIDS treatment with paternal and child health services, what we found is that we could expand the reach of our reproductive health services from just two to all eight regions at no additional cost. In Mali, which has a very weak health system and people have been using campaigns as a way to distribute some of the health interventions, we've been able to bring together these five separate campaigns on NTDs and nutrition in other areas in a way that we've actually boosted coverage and halved the cost. So big gains, and not only the gains in cost, but actually improving what we're doing. We're also seeing a better focus on local ownership and mutual accountability. GHI has reinforced this core belief that country ownership, local investment, is key to delivering sustainable health results. So our investments are being increasingly designed to allow local governments, thriving civil societies, and vibrant private sectors to take over more and more of the responsibilities of their health programs. The eight GHI plus health strategies embody that. After showing a way forward within each of these different unique country contexts, how do we move away from parallel programming and move towards building on the country health system? How do we increase the funding to NGOs, civil society, faith-based organizations, who are the basis on which these programs continue? The last area I'd call out that I think is exciting with GHI is in which pulls in all of these principles that your great show pointed out, is more of an evidence-based community care approach. What we've learned in every one of our GHI plus countries is that the most important gains in saving lives is not going to come from optimizing services to the part of the population that's already being served. It's going to come by extending reach of our capabilities into those communities who are currently underserved. And that is what GHI is focusing on. So that when a woman gives birth and dies in a village, it's our failing. How do we go beyond a fixed health infrastructure to be able to reach those women wherever they are? By focusing on the kind of training for health workers and midwives, and by focusing on the simpler, more foolproof drugs, diagnostics, vaccines that allow them to deliver a quality intervention wherever they may be. And so we're seeing in over half of the strategies, there's a real focus on that community health worker. It's on the people that your film was pointing out. And how do we really reach beyond and are able to reach and expand our services? So I think this is laying the platform. And GHI is showing real efficiency and effectiveness gains in terms of how the U.S. government can work. How we're using the expertise that exists within our agencies, across our agencies, and with the various partners that we are involved with, whether it be Gavi with vaccines, the Global Fund, other bilateral donors, other NGOs and CSOs, to be able to deliver. And I think that platform is what's critical to launch us into the progress of what is the real GHI promise, which is life-saved. And we have a tremendous potential to build on the base that we have and go far beyond it. And I would just point out that this kind of potential comes from tools that the U.S. is bigger investors in, like vaccines. So the miracle of vaccines that my daughter can go to a state-of-the-art pediatric clinic in Bethesda and a Senegalese mother can bring her daughter to a health hut in rural Senegal and both of our children get a vaccine, the pneumococcal vaccine, for example, and both of our children are equally protected. Doesn't matter that mine's in the state-of-the-art and that hers is in the health hut, it's the power of the vaccines that provide that protection. And that's what we're looking forward to, is that GHI ability to reach out, ensure we have these innovations and ensure we're scaling them up through the kind of savings, investments, efficiencies, and real creative approaches that we're taking there. Great. And coming from the perspective of PEPFAR, probably one of our greatest investments that we have ever had in a health program, what do you see as the potential for GHI and how does it really build on what we've been able to do with PEPFAR? When PEPFAR was announced, it was an emergency program and people went out and through the generosity of the American people, they were able to set up programs to prevent HIV, to provide care and support for orphans and vulnerable children, and to provide treatment. And we're providing treatment to more than 3 million people around the world. And what GHI allows us to do is bring that to the next level. It allows us to continue that delivery of services, but then it also allows us to set up the conditions for sustainability in the future. GHI gives us the common platform of the principles that were mentioned in the video and in our strategies, principles that a lot of our countries have been working on already and we looked at the headquarters level and said, these are things that are working. These are things we want to encourage. These are things that we can draw upon. And now I think if you look at the common platform of those principles, you see USAID, you see CDC, you see the State Department, you see Department of Defense, Peace Corps, other departments of Health and Human Services, all working together with that as a basis. And that gives us a common language not only in the 8 GHI plus countries, but it gives us a common language in the 80 countries where we are implementing GHI. I know that a lot of folks think the principle sounds good, but they don't exactly see how they translate into action because they are very much a mom and apple pie sort of vision of America. And I think if you look at what PEPFAR has done since 2009 when GHI was launched at the same time we were thinking about how we move from the first phase of PEPFAR into a phase that stress capacity building and sustainability at the same time we were thinking about saving lives. We've managed to work those principles in a way in our programs that have then also helped to work together with all of the programs. So with country ownership, we're looking at a country like Nigeria where we developed a partnership framework, a five-year agreement with them where we said here's what the US government commitments are to HIV, here's what the government of Nigeria's commitments are to HIV. And it's not just about providing treatment, it's about the government of Nigeria making a commitment to increase its financing, its own financing of the epidemic from 7% in 2009 to 50% in 2015, Nigeria stepping up. It's about working in countries like Ukraine and Vietnam where the epidemic affects most at-risk populations, populations that are marginalized and stigmatized who may not seek care. And it's about the governments in those countries saying we're going to make sure that our health sector is responsive to the needs of all the people, including those who may not otherwise come for treatment. GHI is about gender, it's about women, it's about girls, it's about making sure that the connections we've made and the platform we have with that PEPFAR program is now making sure that the mother we've saved with HIV is not then going to die in childbirth. And her baby is protected with PMTCT programs and we're able to find more moms who are HIV positive and give them the treatment they need. And it's about taking the PEPFAR investments we've made in countries like Ethiopia and making sure that our investments in PMTCT also help to support the antinatal care overall so that more women, HIV positive and HIV negative, come in to seek services in an environment that is friendly and welcoming and there's increased demand. It's about multilateral partnerships, as Amy had mentioned. We've made an increased commitment to the Global Funds, a multi-year pledge for the first time ever. And this is really about recognizing the fact that the Global Fund and PEPFAR work together on the ground and this is beyond the dollars that we're pledging, it's about joint planning and it's about saying our programs can't be without each other. And once you have a strong Global Fund and a strong PEPFAR, we can accomplish more together than we ever could apart. And then it's about innovation, it's not about just putting forward delivery of services like PMTCT or male circumcision, new innovations that help to save lives, it's about the small things that prove we are trying to be more efficient and more effective. Things like changing our delivery of ARVs from air to ground, which is saving hundreds of millions of dollars and then allowing us to invest that back into more treatment for more people. So these principles and what GHI has brought to PEPFAR is a chance for us to really help define what we're doing in a common way so it's no longer the silo of HIV, it's that person at the country level who's able to say, we're all working on these GHI principles, I bring this PEPFAR program to the table and how can we work together to combine the malaria investments, the maternal child health investments to really achieve these principles on behalf of the people of the country in which we're working. Kevin, say a little bit from CDC's perspective as an implementing organization and part of this, how you see this as added value, what is it going to take to stay the course, what are some of the challenges that are in front of us as we really look at trying to move this program forward. Thanks, Helene, thanks for chairing this and thanks to CSIS for putting this together. The title of this session very appropriately, Moving Ahead in Uncertain Times I think captures the major challenges of the era but I think we should remain optimistic, I mean there are many constraints but these constraints also sort of impose on us a need to think clearly, a certain crunchiness for lack of a better term, a need to prioritize, you know, look for value for money and do the best with what we have, I mean so the challenges of the economic downturn, maintaining the progress we've made for these very specific diseases, HIV, TB, malaria and then expanding from those into GHI and thus addressing the other millennium development goals and from that I think GHI will allow us also to open yet onto a broader vista that I'm going to come back to at the end which is, you know, the new global health and the health challenges we're only just beginning to address. I'm really pleased with the discussion that happened earlier with the congressman and the ambassador about what was said about PEPFAR because I think we don't emphasize enough what a game changer PEPFAR absolutely was from which there's no going back. A game changer, you know, a radical event that fundamentally alters how we do things or how we look at things. We wouldn't be having these discussions if it hadn't been for PEPFAR but we have to remember and I think the ambassador emphasized this, we've got to keep it outcome-oriented and we also shouldn't take it for granted that those wonderful advances in malaria in Zanzibar, for example, it's not the first time that Zanzibar is on the brink of eliminating malaria. They've done it before but they lost it because there wasn't that maintenance. I think we look at GHI in two ways. One, it's an initiative with very specific targets for a number of specific diseases but it's also a framework of principles that have to run through all of the work we do and a lot of what's happened up till now I think have already emphasized those principles. I mean, partnerships, CDC examples, we've had some wonderful partnerships. I mean, as part of the equivalent of the American Ministry of Health, we've had just some wonderful experiences with privileged relationships, with ministries of health around the world and just seeing how modest investments in workforce development can just radically alter the ability to deal with outbreaks, Rift Valley fever in Kenya, for example, cholera, whatever it is. Women and girls-centered approach. We forget how much has already been done and how much we have to build on through PEPFAR, through some of the AID-sponsored work in maternal and child health. Extraordinarily good work done by CDC and colleagues, UNICEF, for example, on sexual violence against girls. The studies in Swaziland leading to policy change, program implementation and real interventions beyond the health sector actually making a difference. So, you know, I think we should be cautiously confident that we can move forward into what GHI is actually offering us. I think the other thing that the other potential, the other demand it makes of us, running through this whole discussion, as Amy said, is the need to strengthen health systems, get away from, you know, disease-specific, mono-disease type approaches. Health system strengthening really demands of us a whole of government approach, because, you know, CDC brings a few things, epidemiology, data, labs, workforce training, research. But that's, there's lots more that's needed that others have to bring, like financing and supply chain management and so on. But all of this, I think, just emphasizes the need for clear-thinking data metrics measurement. That's one thing that CDC, I think, is a data-driven agency. Data tell us also what is beyond even GHI. There's a billion people who still don't have access to clean water. There's one of the strange results of globalization is that there are places in the world where access to cell phones is greater than access to toilets. And as we speak, demographics are shifting. There are three times as many deaths in the world in young and middle-aged adults than there are deaths in children. That's largely a reflection of the extraordinary success we've had. But we now have adults who are dying prematurely from non-communicable diseases, from injuries, etc. And we're going to have to start shining the spotlight on those things. As we all know, there's a high-level meeting at the UN later this year. But all of this is part of the new global health. So I think GHI is the right thing to do. It's the issue of the moment. It's about equity. It's about efficiency. It's about justice. It's about health for all, that old slogan, health for all. Thanks, Kevin. Lois, a lot's riding on you. Just give us your perspective on GHI, where you want to take it. What are some of your early thoughts coming in, building on the words that your colleagues have already talked about? We really are expecting a lot. There's a great foundation. But these are challenging times. So say a little bit about your perspective coming in and how you plan to approach it. Well, thank you so much, Helene. What you see here in my colleagues is the embodiment of the power of the whole of government approach of three very capable organizations that approach the same set of challenges in a different but complementary way. And I think you've seen here in the video today and in our panels the embodiment of the work underway at GHI. Now, some people have asked me, so how could you leave the wonderful weather in Minnesota? How could you move away from your career in business to take on this challenge at GHI? Well, when the Secretary of State calls and asks you to take an assignment, the correct answer is yes. And there is nothing more important to do. This work saves lives in very, very real ways, as Ambassador Green referenced. And it protects our country. It protects our country from the risk of epidemic disease. Diseases don't know boundaries. And I've been to CDC three times with Kevin and his colleagues and see up close the way they protect the earth. And we also know that when conflicts erupt, when huge, huge challenges are unleashed in the way of disease. And I've had the opportunity, when I visited with Amy and her colleagues at USAID, to see the role USAID has played over and over again and plays today around the world in expected and sudden ways, as we see now in the Tunisian border, to protect all of us. So this is really important work. And I like a challenge. I like taking on something that's really hard. And as I have been with Ann and Ambassador Goosby and others at PEPFAR and look at the kind of challenge that they took on against really tremendous odds. And as Keith Ellison, my friend from Minnesota, said, we've accomplished things that we would have expected were impossible. And we're doing the right thing in GHI. We're taking the principles that we all know are correct. And we're applying them in country to a set of very ambitious targets. And in doing that, we're projecting American values around the world. We're doing the right thing. And we're protecting our country. And we're doing it in a way that increases the efficiency and effectiveness of American resources, of our taxpayer dollars, of our incredibly talented and goodwill people, and of the organizational alliances that we have, whether it's through GAVI and the Global Fund or our relationships with the governments of Norway and Britain and so many around the world. And in doing so, we're going to in GHI tell the stories to the American people that allow us to draw on what has been support for this work in global health that goes back generations. And it's support from Americans across all walks of life across the whole country. I'm meeting tomorrow with a group of leaders in the religious community who have been doing this work for generations. So we need to update and tell this story to the challenges of our time. CSI has played an important role in this for me. Your report, which you co-chaired with Admiral Fallin and your members are here, really laid out the groundwork for the kind of work that we now do in GHI. And I'm really grateful for the report on Kenya that you released today. I'm in Kenya later this week, and I look forward to building on the insights that you made. And I want you to know that we especially appreciate the report's really care in offering suggestions for us as to how we can build GHI. We accept those. It's so important for the kind of work that we laid out to constantly get feedback and then have the opportunity to adapt what we do. I think we have all recognized we've moved way beyond a setting where we can kind of plan and we get it right and then we just implement. This is a constant back and forth. And in the report, you made some very important elements that I just want to highlight. You spoke to the concerns around resources. We believe that Congress will see the importance of this work. We understand the importance of constantly being able to offer opportunities for members of Congress, particularly new members of Congress, to learn how effective these US investments have been over time. And the President and his budget, as you noted, has, of course, continued to recommend enhancements and investments in this area. Secondly, you make very important points about the challenges in adopting the whole government approach, the challenges of working across agencies. And that's why the State Department, in putting forward the role that I'm now in, has really provided the leadership to work with these capable agencies to represent the US government as a whole. We're doing that on the ground in places like Tanzania and elsewhere. And that's really important work. And I take a very strong personal responsibility to make sure that we can do that well and we can do that consistently. You also spoke to the opportunity we have to communicate more and better. And we take that on as a real challenge. We think that's correct. This is a relatively new initiative. We have to make it real to people. We have to make these complex principles simple and powerful. And in your last paragraph, you really, I think, captured all in the report. You talk about the incredible importance of what we're doing in GHI just as you did in the video and the urgency around it. We know in this work delays really hurt. And you correctly put pressure on all of us working in this space, whether we're representing the government, our partners, our stakeholders. We need to get this job done and do it well. So I feel so lucky to join my colleagues here and all of you in this important task. And we're going to get it done. Thanks. Great. That gives you confidence. We're going to open it up shortly to the audience. And we'd love to have questions from the audience as well. But let me just ask, it is so important to get it right. And the next 12 to 24 months, I think, are going to be really pivotal to get it right and to be able to do what our first panel talked about, come back with results, be able to tell the story about how we've been successful. Each of you, say a little bit about what do you think it's going to take to really be successful kind of coming out of the gate. What do we need to do in this first 12 to 24 months to make this GHI actually deliver on the promise? Take three things. One is we need to have our focus here in Washington needs to be out of our countries. That's where the work happens. That's where the outcomes are delivered. And it's how do we really empower our teams to be working better with all of the different country partners, whether it be government, NGOs, FBOs, CSOs, to be going beyond the fixed health infrastructure. It's to be how do we think creatively about reaching to that unreached population, that 80% of the rural population in Ethiopia, for example, who are largely underserved. So how do we start thinking creatively? How do we enable our teams to be thinking about leapfrogging, not recreating what we have, but leapfrogging the technology so that we're not saying, well, all we have to do is build more hospitals. Yes, hospitals are important. We need to train more doctors. We need more nurses. We need more labs. We need all those things. But if we're going to wait in a country until all of those things are established, we're going to be waiting decades. And a lot of people are going to die in the interim. What's exciting is our ability to get to those communities and start thinking creatively. Things like point of care diagnostics so that in 10 minutes, a patient can tell whether they have malaria or not, rather than the tests, the tests being sent to the central city, the lab technicians checking it out, giving a diagnosis, sending it back to the village health worker trying to find that person again, and then starting them on treatment. We need the point of care diagnostics. We need the vaccines. We need the trained health workers with the simple, effective tools that allow them to deliver the kind of health care that is going to save many lives. And what's really exciting is that we have a lot of that science and technology available. It's a question about how do we move faster from the development of the science into turning that into a real adapted product that's produced at scale, that's at an affordable price, and that we are using our programs and our USG platforms to ramp up very rapidly in countries so that it becomes immediately accessible. And frankly, we're not real good at it. It takes decades and decades to get a product from that point of a sparkle in some scientist's eyes to then proof of concept to then another several decades to get it actually launched in a country because change is hard. So I think the best thing we in GHI can be doing is really focusing on that innovation and our capacity to be using all of our country teams, to be driving beyond, to be focusing sort of not on the incremental improvements, but on the major game changing improvements, which is going to save millions and millions of lives. Anne, two things that I hope we accomplish in the next 24 months and that I believe we can accomplish. Number one is really internalizing our work on gender. We've been talking about gender in all of our agencies for a long time, but we've had trouble translating our lofty principles into action, as it were. Making sure that gender is mainstreamed into all of our programs. Making sure that as we're looking at the services we provide, they are friendly to women. They are friendly to girls. They are things that women and girls want to come to. One of the most compelling cases we can make for global health in bringing members of Congress there is taking them to a place where women give birth and asking them, would you want your wife to give birth here? Would you want your mother, your daughter to give birth here? And that's what we can do. We can take that health center and then go beyond and really make sure that we are creating a health system where women are not only the recipients of care, but they are the ones who are helping and have input into the systems of care. The second thing I want to point out, which for some people will be contradictory, is then also increasing the role that governments play and how we work with governments. And I know a lot of people ask the question, well, what if governments don't want to do something around gender or around controversial subjects? But I think we need to change our relationship with governments. We need to come to them and say, we want to be here as partners with you, but we recognize that in the long run, it is going to be your responsibility and it is going to be the demand of your people that you provide a working health system. How do we help you in building that capacity? How do we help you in creating the mechanisms necessary to have a system that works? But it requires a shift, a subtle shift in our relationship with these countries. And I think through GHI and the focus on what's happening in national plans, that's going to be really helpful for us. Kim. I'd offer four or five things. Firstly, the combination of a whole of government and country ownership. I mean, I think we in the United States have to really implement a whole of government approach. And in our country work, we really have to work with the host countries to ensure that what is being done is what the country wants. That's the first thing. Secondly, I think that our guides should be science and pragmatism. The mixture of looking for the innovative but using what's available right now. Readiness to change is appropriate. Science and pragmatism. Thirdly, as has already been said, keep it outcome oriented. I mean, this is a health initiative. We have to show measurable benefit in specific areas. Some are easier than others. I think making progress in child health is certainly doable. Neglected tropical diseases are relatively low-hanging fruit. The toughest one is going to be maternal mortality. Maternal mortality may be the single most important indicator of how we do in global health in general. Because it's such a coalescence of different systems that have to be there to have impact. And finally, as Lois I think has emphasized, communications, one of the earlier panels said, the importance of seeing things on the ground. We've been involved deeply in Haiti. I thought I knew what we were doing. My visit to Haiti a few weeks ago, a couple of months or two ago, changed my views completely. And so seeing is really important. And getting the message out is so important. I think the principles of GHI are really sound. I think we have to think deeply, individually, those principles. How do you actually apply them to specific programs, specific populations, specific health challenges? Lois? I second everything my colleague said and would add three things. The first is I think we're gonna need to demonstrate courage. We can't wait till all the risks are settled. We can't wait till there's consensus on every point. We're gonna need the courage to act and the courage to make a difference. Second, we're gonna need to touch the hearts of the American people who have been so generous in so many ways, who I think identify so deeply with people all around the world and capture that deep impulse around American values. And thirdly, we're going to need to make sure in all the work that we do, in all this work in building infrastructure, that we protect the American people from epidemic disease. This work is really at the heart of our nation's security. A conflict in one part of the world that will never spread to the United States can release disease that spreads to the United States. We don't know what the changing disease challenges will be in the future, but we know what they've been in the past and they've been very significant. What we're doing in GHI by, as my colleague so correctly said, is building a foundation for the world's health that improves the health of people wherever they're born and improves and protects the American people. Let me ask one more question before I open it up to the audience. Is there an audience, Mike? Oh, yeah, okay, all right, there's several. So people can raise their hand. We've talked a lot about the whole of government approach. I spent 20 years working in government. I know it's not easy. I'd like to just hear just briefly from all of you, why you think this is different? Why do you believe that it is possible to have this kind of more integrated approach and what from your perspective from the different organizations that you work for, are you doing differently as a result of GHI? Now I'll start with you since I've been putting Amy on the spot. Thank you. I think global health today is different from our former understanding of what was called international health, what was called tropical medicine, geographic medicine. It's extremely broad and as was pointed out in the recently released QDDR, the distinction between what is domestic and what is global has sort of eroded. I think that means therefore that just viewing health as something that, or global health as something over there that we over here sort of think about and go and do something about is changed. And we have to bring all of our resources to the table in a much more integrative way. South to south collaboration right now and in the future is gonna be just as important as north to south collaboration. So I think there is strength in the diversity that we bring to this global engagement. And for my own agency, CDC, where we're a limited agency in our capacity, where we do certain things, there are other things we don't do. The same is true for our other partners, AID, the Department of Defense, Peace Corps, the State Department. I just think it's the way to do things today. But it does mean then that it brings certain challenges as well because who's exactly in charge can be more difficult to define. And actually nobody's in charge because nobody can be, but there can be coordination as there is in other spheres of our country's of apparatus like in defense for example. There are many different players but there is very clear coordination and ultimately, of course, the president's in charge as he is of health. I'm fortunate to come from an interagency program where we also have had our challenges but we've also had our successes. And I think one thing that we're hoping through GHIs to take what's worked through PEPFAR now that we've had time to think about it and say how do we apply those things that have worked? How do we learn from what hasn't worked? And then help use that where it is applicable. It's not gonna be applicable in every situation but it will be applicable in some areas. The other thing which really heartens me about the whole of government approach is that I've seen it working on the ground. In the country visits we've done as we've been talking to people about GHI, I've seen country teams start to engage with each other in a way that they hadn't necessarily before. Where there hadn't been an incentive for somebody in a malaria program to necessarily be talking to somebody in a maternal child health program or an HIV program and really say where are the possibilities for linkages? How can we make sure our programs are partnered together in a specific way? How are we working to see what kind of research NIH is doing on the ground? So it really is providing that incentive and teams have been responding. Many of them have been doing this already but it really helps to provide that incentive for it to happen across the board in global health. As Kevin noted health is complex and in fact some of the best ways to achieve health outcomes isn't even through health as it's strictly defined. It's not through the biomedical interventions, it could be through education. It's through agricultural policy and having diverse diet for the population and the impact that has on nutrition. It's through the kind of work that in governance and democracy to ensure that the systems are there to provide good use of resources and good evidence-based decision-making. So health is particularly complex and it takes the expertise of all of the partners that we have that we can bring to bear from the US as well as the various partners that aren't represented here but that are coming from other parts of the government. So we are working with the Department of Agriculture and working with Treasury and HRSA and NIH and a number of others that every single one of them in addition to those of us who are on the stage, everyone brings absolutely critical expertise, knowledge and partnerships that help us achieve what are some very big goals. On the part of US AID, we see this as an enormous opportunity. We can achieve great things, building on the success but going a lot further with some of the new tools and new possibilities that we have. And so we see our job as helping to provide that kind of development platform that allows all of that expertise to really hit its mark to greatest effect and our ability to bring in some of the other sectors so that they can also ensure that they're being contributed to. So we think that health is a special case and that we really can only achieve our goals through this kind of whole government effort. Great. Let me open it up. Do we have questions from the audience and people raise their hands and bring some mics around? And I think we just have time for a couple of questions. But I know we had a question here in the back and then Tammy, yes. Is it working? Okay, great. Thank you so much for your presentation. While I appreciate the social impacts of this but these various programs that the US has contributed through investment and I'm gonna consider it subsidies, can someone address the implications of the investment to the US commercial sector and in the spirit of making the case that there are benefits that if they're not there yet will come down the line considering also that the United States is in a hard place and I imagine politicians, Congressional people are looking at the budget constraint and why aren't, why isn't the commercial sector activities measured as part of the overall benefits that could come? Anybody want to? Thank you very much for your question. I think that it is important for us to look at the whole contribution of the United States in global health to look at not only the work that the US government does but some of the most remarkable work in global health is done through our universities with both dedicated students and faculties, researchers, some of them funded by the NIH and in the many American companies that provide services or have established important programs around the world whether that be in nutrition or in the medical space. And so I think that we do need to do a better job of working in concert and also a better job of capturing the value and impact of all that that represents for this country because that creates a truer picture in the end. Just to add briefly to that that I think our investments in development are fueling economic growth in these countries and these countries have, this is where the markets are growing and these are going to be many of the markets where US goods will be sold. So in fact, by helping to fuel greater economic growth around the world, we're really serving our own interests and the ability of our own economic sector to find new markets, new partners to play with and have the kind of commercial prosperity that you're talking about. Yeah, and I think in a comment and maybe it was John Hammer earlier talked about I think more and more this whole concept of the double bottom line doing good and doing well is becoming more and more, I think, accepted in business these days. We are in a global world and if we can help health, it will build prosperity and as you said, these are the markets that are going to continue to be the most important for us as well as the rest of the world. So I think the economic argument has to be made and I think we don't do as good a case of doing that as probably we should looking at that issue. Tammy. Despite what seems to be a real beginning in communication and collaboration among agencies, it's still very much as you know, the reality on the ground that hardly anybody knows what anybody else is doing in health or in international assistance in general. So how do you see that changing? What are the tools you need and what are the strategies you're trying to put in place to make a better sense of what's going on so that people can plan more strategically and effectively? Thanks. Oh, thank you very much. One of the ways we're doing that in GHI is of course by the country's teams in health sitting together, planning together, operating together and being a part of joint reports on progress towards our targets. And that over time we expect to make a very strong difference. Secondly, concurrent with this effort, the State Department did a review, a quadrennial review and in that role really clarified the important role that our Chief Admission, the Ambassador does as the leader for our nation in representing the full set of services. And I was speaking to an Ambassador and said, and in Africa recently, and he said, you know, we really are talking about what is the US government bringing and how are we bringing it together versus what may have been at times a bit of an alphabet soup of independent activities? Now I would say these changes don't occur overnight. They require a lot of vigilance and a lot of focus on a target. And that's what we're seeking to bring in all the countries that we're working, working with each of these agencies to do so. I think there is improvement. When I look both within my own agency where I think there's genuine attempts to get a better understanding and then a better presentation of what we actually are all doing out there and what we have. But at the country level, the collaboration and coordination between the US government agencies. So I think there is improvement there. But what is challenging though is all of the international donors who are very different in there. Some of their approaches both ideologically or motivationally. And the choice of where they do their work and so on. And that is considerably more challenging and represents the diversity of donor countries or countries in the world. And I think that's one of the actually, the benefits of GHI is by looking at that country focus and saying how do we build off of what the country is doing, what their national plan is. How do we make sure we bring American government programs in support of that plan? We can then also say and what are the other donors doing around that country's defined plan? And it helps to provide that common framework for everybody to continue working together. So I think the increased focus on partnerships not only with our multilateral partners but with our country partners and our donor partners is something that is helping with some of this coordination. There's still a long way to go but efforts are being made. Great. I think we could go on and you have been a fabulous panel and very thoughtful observations. I've got lots of other questions. I know the audience probably has lots of other questions but in respect for time we will end this panel and thank you very much for being part of it. Thank you.