means recognizing that health systems are vital not only to achieving health outcomes but also to sustaining them (Mills, 2007; Travis et al., 2004).

Successful models do exist and there are opportunities to learn from these experiences. “Child Health” days, which began as an important approach to reach rural or other marginalized families with polio immunization, have now been expanded in many countries to include other immunizations as well as different interventions, such as deworming, family planning, and health education messages (WHO, 2009b).

Likewise, countries have used a selective set of programs, initially focused on child health, to build a pathway to a more comprehensive health system (Rohde et al., 2008; Sepúlveda et al., 2006). For instance, the Tanzania Essential Health Interventions Project was instituted to test innovations in planning, priority setting, and resource allocation at the district level, in the context of the reform and decentralization of Tanzania’s healthcare system (IDRC, 2009). Improved local health system planning and priority setting, together with modest investments in health services and increased coverage of key child-survival interventions, contributed to significant reductions in infant and child mortality in Tanzania (Bennett, 2007). The most recent demographic and health survey in 2005 showed a 24 percent improvement in child survival, with mortality rates among children younger than 5 down from 147 deaths per 1,000 for 1994-1999 to 112 deaths per 1,000 for 2000-2004 (Masanja et al., 2008).

For the U.S. government, this would mean that even disease- and intervention-specific programs, such as PEPFAR and the President’s Malaria Initiative, should contribute to wider health outcomes by working with countries to incorporate programmatic best practices into health service delivery. The committee commends the language in the 2008 reauthorization of PEPFAR, which calls for expanded efforts to strengthen health systems and human resources and to collaborate with other programs, such as child and maternal health, clean water, food and nutrition, and education (PEPFAR, 2008). Leveraging the successes in implementing PEPFAR to support broader national health priorities would go far in making even greater improvements in health outcomes.

Ultimately, this approach would allow U.S. health investments to go beyond merely treating a patient for a single disease and support the delivery of more comprehensive primary health care. When a woman brings her child with acute malaria to see a health worker for treatment in Zambia, for example, appropriate treatment will usually prolong the child’s life. However, a comprehensive approach to care—by using that same health worker and drug supply chain to provide malaria treatment as well as preventive measures such as oral rehydration salts, deworming, and inoculation against polio and measles—can immeasurably improve the child’s health. Strengthening primary health care to include services for the mother can extend the benefits even further: the mother visiting a health clinic because of her sick child could gain access to cervical cancer screening,