Monica Villanueva is a Foreign Service Officer at USAID and currently coordinates the COVID-19 response for USAID’s Middle East Bureau.
Her work involves liaising in the field with teams across 11 countries, including Jordan, Egypt, and Yemen. Previously, she served in Nepal, Pakistan, and Malawi. MEPC’s Gavin Moulton discusses the impact of American Rescue Plan Act funds for international relief and the Biden administration’s newly announced vaccine donations with Ms. Villanueva virtually from a short-term assignment in Jordan.
How has USAID structured its response to COVID-19 in MENA and how has it evolved over the course of the pandemic?
Soon after USAID started hearing reports of COVID-19 in January, USAID leadership pulled together a COVID-19 Technical Working Group, and soon thereafter a COVID-19 Task Force to focus on the response. The purpose of the Task Force was to be a coordinating body, ensuring that the Agency responding nimbly and quickly to needs in the field. At that time, movement restrictions in various countries and rapidly rising cases signaled that the pandemic’s impact was going to be very detrimental, and also affect the advances made under other development goals.
In March, under the CARES Act, USAID received funding specifically to combat COVID-19. One of the roles of the Task Force and Technical Working Group was to prioritize and allocate funding to address the needs in places facing notable increases in cases and deaths. Since the onset of the pandemic, USAID has continued to respond globally in support of partner government’s national COVID-19 response plans and national vaccine deployment plans.
How is past CARES Act funding making a difference on the ground and what do you expect to undertake with the additional $5 billion under the American Rescue Plan allocated to USAID for coronavirus and global health work?
For the MENA region, we've been able to work with our implementing partners—primarily WHO and UNICEF—to procure needed equipment and supplies. For example, PCR tests, PPE, and laboratory equipment. Within countries’ COVID-19 nationa response plans, we were able to align our support to WHO’s nine COVID-19 response pillars. Specifically, we've been able to support multilaterals through funding responses around risk communication, community engagement, infection prevention, and control, laboratory strengthening, and coordination to aid governments. These efforts have made a major impact in terms of mitigating transmission and helping with vaccine deployment.
At the facility level, USAID tried to ensure that there was sufficient training and equipment to stop transmission. We also worked on risk communication and community engagement; particularly now, we're planning to use funds under the America Rescue Plan Act to support countries in the implementation of national vaccination plans.
The US and G7 partners pledged in June to donate 2 billion vaccines by the end of 2022. However, in MENA, Chinese vaccines, both bought and donated, have greatly outpaced those from the US. Is the current US effort enough to combat the pandemic in the next six months as new variants proliferate?
Absolutely. In fact, we are the largest donor to COVAX through a $2 billion contribution and 1.5 million doses from the domestic supply. Additionally, we’re about to contribute an addition 500 million doses of Pfizer doses. Across the globe, USG support on the vaccine front is making a difference.
Has the US government’s response to the pandemic strengthened ties with regional health partners for the long term?
I do think so. The MENA region is not a major area of USAID’s health programming outside of humanitarian response. Part of the reason is of the 10 countries where USAID has missions, plus Algeria—where we've been able to allocate some funding for the COVID-19 response—we track what's happening at the national level across various sectors (education, health, etc.) and there really isn't a big need for non-humanitarian health funding.
USAID gets appropriations from Congress for health, usually to combat maternal and child mortality, HIV, and malaria. In the MENA region, those indicators compared to other regions, such as Africa and Asia, are pretty strong. These countries have been very successful in the last 10 or 20 years in improving public health. Advances have decreased maternal and child mortality and reduced infectious diseases. The main issue in our region at the moment is non-communicable diseases. We currently have health programming in Yemen, Jordan, and Egypt.
Prior to COVID, there was not a major health presence. For example, in Tunisia and Morocco if you mentioned USAID, the common association would be with economic development, democracy, and governance programming. But now if you were to go to those countries, given all of the support on COVID-19, there is a new recognition that USAID can support national health systems.
USAID supports both health and social services across MENA. As COVID has disrupted education, has USAID engaged in the transition to remote education?
Yes, Jordan, Egypt, and Morocco have very strong education programs and receive basic and higher education funding. The government, when they give us our annual appropriations, earmarks some of that funding for basic and higher education. The Middle East is a major recipient of this type of funding. For programs like Morocco that have provided extensive support to the ministry of education, they were already moving in the direction of supporting and thinking through implementation of virtual systems to increase access to and quality of education. These discussions had already been taking place in the year prior to COVID-19 and the pandemic enabled governments like Morocco to pivot very quickly.
There are programs on the ground, for example in Jordan, to redirect funds and support the government in ensuring the use of different modes of communication with students. For example, working with the Ministry of Education in Jordan to ensure that they could broadcast lessons on public television. However, we still worry about and try to address access to education during the pandemic for internally displaced persons households that might not have ready access to the internet or television. We were thinking of different modalities to reach learners whose education was interrupted, recognizing that not everyone had access to the same technology.
At this stage of the pandemic, what are the most pressing health needs in MENA?
There are three pronged needs. The first and most important is ensuring that countries have access to vaccines to increase coverage as quickly as possible. The second is implementing a response following the WHO’s COVID-19 Response Pillars, continuing to mitigate against transmission, and the third piece is strengthening each country’s global health security system to respond to future public health threats.
How can a global health security system be implemented to more quickly respond to a future pandemic or outbreak?
This is an interesting area that will likely see great growth. The American Rescue Plan Act includes language to address the global health security architecture, an effort that I believe was started under the Bush administration. At that time, there was an intense interest in global health security, a conversation that continued through the Obama administration. From these discussions, a commitment to global health security, emerged. At the same time, there was an international movement as outlined by the Global Health Security Agenda that also gained traction. The goal is to foster strong and resilient public health systems that can detect, prevent, and respond to infectious disease threats.
There was significant traction on this end in MENA, leading to Joint External Evaluations of national health systems. Each evaluation was led by consultants or teams that would issue an assessment of countries’ global health security systems—including how prepared they were to respond to a pandemic—mostly funded by WHO’s Regional Office for the Eastern Mediterranean (WHO EMRO).
The evaluations assessed the health security capacities of countries to identify gaps across 12 technical areas that would help to produce an action plan. Compared to other regions, MENA had the most joint external evaluations completed. However, the action plans were slow to be developed and eventually disbanded once COVID-19 hit. One aspect that was very surprising and a bit alarming during COVID-19, is that historically strong health systems in low-to-middle-income countries like Tunisia, Jordan, and Egypt had weaknesses revealed. In particular, global health security systems, such as surveillance, laboratories, and monitoring at points of entry were weak. Looking forward, we have a chance to build country and regional level systems that contribute to global health security.
Beyond support for COVID-19 responses, how has the pandemic affected USAID's traditional health programs including maternal health, family planning, and refugee health services in the region?
The region is fortunate in that, comparatively, diseases that plague other regions such as TB, malaria and HIV have a limited presence in MENA. However, in protracted crises like Yemen, we still see a great need for health due to demolished health systems and infrastructure. . Getting basic services to refugees, internally displaced person, and the general public is a significant challenge. COVID-19 has exacerbated what was already a challenging health system and posed additional barriers to accessing health services for populations in the middle of war and conflict.
In terms of our response, when it comes to internally displaced persons or refugees, both are managed by our Bureau for Humanitarian Assistance, in cooperation with the Bureau of Population, Refugees and Migration at the State Department. Yemen is one place where we have a USAID health program in a protracted crisis. Most of our work is in the south, ensuring access to health services at the facility level, including immunization, family planning, and nutrition services.
What is the future outlook for USAID’s health programs in MENA?
We will continue to support our existing health programs. In Egypt, we currently have a family planning program. Interestingly enough, we graduated out of Egypt which was one of our oldest and most successful family planning programs. Graduating meaning that the government took ownership of the family planning program and we no longer allocated money or support in that field. However, when the last demographic health survey was completed a couple of years ago, we noticed an increase in the total fertility rate. When we started digging into why, it looked like Egypt had taken steps back both in the focus and rigor in implementing a robust family planning program to ensure women have access to contraceptives. We will definitely continue to work with the government of Egypt to better assess what happened and how we can support them. We'll continue to support Yemen as long as we can.
For Jordan, one of our most robust and comprehensive programs, we'll continue our extensive work. Jordan, is an interesting case study. Normally, our initial programs focus on service delivery, ensuring people can go to a clinic and access medical services. Then, after increasing access at the delivery level, we start focusing on health system strengthening. In Jordan, the government is taking ownership of the services since the capacity has been built.
Over time, rather than us working through NGOs or multilaterals, we’re setting up government to government agreements where the government and USAID agree on parameters of the program. For example, for a specific intervention around neonatal care, we'll transfer funds to the government of Jordan which then manages that money and implements the program to the specifications of the agreement, similar to what we do with NGOs.
The idea is that over time, our money will go directly to the government based on an agreement. During this process there are discussions around benchmarks and deliverables. This is a truly sustainable approach. Over time, the partner government will arrive at a point where it can fund its own assistance which is the ultimate goal for USAID.