As one who is opposed to centralization, I am wary of attempts to turn
a grassroots movement against big government like the Tea Party into an adjunct
of the Republican Party. I find it even more worrisome when I see those
who willingly participated in the most egregious excesses of the most
recent Republican Congress push their way into leadership roles of this
movement without batting an eye -- or changing their policies!
As many frustrated Americans who have joined the Tea Party realize, we
cannot stand against big government at home while supporting it abroad.
We cannot talk about fiscal responsibility while spending trillions on
occupying and bullying the rest of the world. We cannot talk about the
budget deficit and spiraling domestic spending without looking at the
costs of maintaining an American empire of more than 700 military bases
in more than 120 foreign countries. We cannot pat ourselves on the back for
cutting a few thousand dollars from a nature preserve or an inner-city
swimming pool at home while turning a blind eye to a Pentagon budget
that nearly equals those of the rest of the world combined.
foreign policy is based on an illusion: that we are actually paying for
it. What we are doing is borrowing and printing money to maintain our
presence overseas. Americans are seeing the cost of this irresponsible
approach as their own communities crumble and our economic decline
see tremendous opportunities for movements like the Tea Party to
prosper by capitalizing on the Democrats' broken promises to overturn
the George W. Bush administration's civil liberties abuses and end the
disastrous wars in Iraq and Afghanistan. A return to the traditional
U.S. foreign policy of active private engagement but government
noninterventionism is the only alternative that can restore our moral
and fiscal health. I am optimistic, and our numbers are increasing!
Ambassador Jack Chow's recent FP article, China's
Billion-Dollar Aid Appetite, is misleading in its characterization that
multilateral development aid sent to China to address HIV/AIDS, tuberculosis, and
malaria comes at the expense of sub-Saharan countries.Undoubtedly, while China can and should commit more of its own resources
to meeting domestic as well as global public health needs, U.S. development
assistance, whether bilateral or through multilateral mechanisms, should not be
seen as a zero-sum endeavor where one recipient benefits at the expense of
Further, the article overlooks the many ways -- besides
simply financial -- that Global Fund dollars are good for China and the world. Proposed
by former U.N. Secretary-General Kofi Annan in 2001 and established in January
2002, the Global Fund is a performance-based organization that awards grants
based on individual need and the quality of proposals that it receives. It is
also a values-based organization, requiring recipients to have transparent,
accountable, and inclusive governance mechanisms. Grant applications and project
implementation in each nation are overseen by an elected a board of governors,
from government, U.N. and donor agencies, NGOs, businesses, and people living
with the diseases. This board is known as the "Country
Coordinating Mechanism" (CCM).
Ambassador Chow is correct in asserting that China's Ministry
of Health is weak in comparison to other Chinese ministries and that its
initial motivation to apply for international funds was its inability to garner
adequate support from its own bureaucracy. Yet his conclusion is incomplete. It
is precisely for these two reasons, governance and resources, that the role of
the Global Fund is particularly valuable for China, as well as for any country
with a stake in a healthy, stable, and well-governed China.
Global Fund financing, which began to flow to
Beijing in 2004, has helped China rebuild its health system, which failed so
spectacularly during the SARS crisis in 2002-2003. Global Fund resources have
been deployed quickly and efficiently to project sites in nearly 3,000cities and counties throughout China,
bypassing bureaucratic restrictions and political allocation processes that might
have seen funds earmarked for health projects diverted elsewhere, particularly
by local officials.
This relatively streamlined system enables health
officials in China
to demonstrate the value and effectiveness of investments in public health
projects to top officials [KCD1] outside of the public health
stovepipe. It is still true, however -- as Chow rightly points out -- that
other inefficiencies and the sheer scale of China's health-care system present
challenges for governance; there is a growing need for improved oversight.
Fortunately, the Global Fund introduces important regulatory
norms to the Chinese government; particularly the importance of public
participation in policymaking, transparency, accountability and even aspects of
human rights, such as international standards protecting for protecting the
rights of human test subjects. The Global Fund's commitment to governance and
public participation has the potential to make a significant contribution to
Chinese political reform over time. Ambassador Chow is correct that the bulk of
Global Fund grants are channeled to Chinese government departments, while
grassroots organizations working on HIV/AIDS preventions continue to face an
array of restrictions on their activities in China. However, to begin to address
this concern, the Global Fund does require that recipient countries meet
standards for transparency and citizen participation in governing organizations
as well as programs. The Global Fund's
minimum requirements call for 40 percent of the board to come from the private
sector. Non-government stakeholders should elect their own representatives in a
transparent and well documented manner. (In 2005, Burma lost its grants because
it did not meet the Global Fund's governance expectations.)
In 2006, the Chinese Center for Disease Control and
Prevention, under the Ministry of Health organized the election of a civil society representative to the CCM, causing an
uproar amongst some AIDS nonprofit groups in China.
Under pressure from U.N. agencies and the Global Fund secretariat in Geneva, China
eventually permitted civil-society representatives to organize themselves and
hold free elections to determine who would represent them on the committee. This
is the first time that Beijing has allowed non-members of the Communist Party
to organize a national, independent election process. The CCM represents a rare
instance in which government officials sit as equals with civil society on a
decision-making body in China.
To its credit, since the aftermath of the SARS
outbreak in 2003, the health ministry has been outspoken in its support for
"all sectors of society" playing a role in public health efforts; it has even
provided grants to grassroots organizations to implement some AIDS prevention programs. Previously, the government had never provided
significant funding to grassroots groups to carry out public health work, which
had previously been considered the government's exclusive responsibility.
Granted, change has not come overnight. Engaging the
Chinese government and encouraging public participation and democratic
processes must be viewed as a long-term endeavor. Although individual officials,
including many in Beijing, increasingly see the value of involving civil
society in their work, there remains intense government pressure from other
quarters to tightly control civil society.
The Global Fund represents a dialogue between the
Chinese government and international community, not simply a flow of aid money.
The interaction provides a unique opportunity to promote the uptake of such
universal values as transparency, accountability and inclusion through
The United States should continue to support the
Global Fund and its portfolio in China. It is undoubtedly in the U.S. national
interest to contribute to China's capacity to prevent the spread of infectious
disease. With the relentless pace of economic integration and growth of
people-to-people contacts, improving China's health system benefits Americans,
both directly and indirectly.
Finally, the U.S. contribution to the Global Fund
and its continued support for China is an important manifestation of U.S.
intentions toward China. It is particularly important at a time of heightened
tensions in the bilateral relationship -- over maritime sovereignty, human
rights, Taiwan, Tibet and trade -- that the United States signals that it
welcomes China's participation in the international community and seeks its acceptance
and ultimately validation of international norms, such as those espoused by the