Sécurité Sanitaire Mondiale: Financements, activités et évaluations de l’USAID et des CDC relatifs aux capacités des pays à faire face aux menaces des maladies infectieuses avant l’apparition du COVID-19

This is the French language highlights associated with GAO-21-359.

Constats du GAO

Au 31 mars 2020, l’Agence des États-Unis pour le développement international (USAID) et les Centres des États-Unis pour le contrôle et la prévention des maladies (CDC) ensemble avaient alloué un total de plus de 1,2 milliard de dollars et avaient décaissé environ 1 milliard pour financer des activités de sécurité sanitaire mondiale (global health security – GHS), sur des fonds affectés durant les années fiscales 2015 à 2019. L’USAID et les CDC ont soutenu des activités de renforcement des capacités des pays dans 11 domaines techniques en rapport avec la lutte contre les maladies infectieuses. Les fonds engagés ont soutenu des activités de GHS dans pas moins de 34 pays, dont 25 étaient partenaires du Programme d’action pour la sécurité sanitaire mondiale (Global Health Security Agenda – GHSA).

Activités soutenues par les États-Unis en Éthiopie pour renforcer la sécurité sanitaire mondiale

Les évaluations de responsables officiels des États-Unis portant sur les capacités de 17 pays partenaires du GHSA à faire face aux menaces des maladies infectieuses révèlent qu’à la fin de l’année fiscale 2019, la plupart de ces pays avaient des capacités dans chacun des 11 domaines techniques retenus mais connaissaient diverses difficultés. Les équipes-pays interinstitutionnelles américaines réalisent des évaluations de capacités bisannuelles dont le personnel du siège de l’USAID et des CDC se sert pour assurer un suivi des progrès des pays. Selon les évaluations de l’année fiscale 2019, 14 pays avaient développé ou démontré des capacités dans la plupart des domaines techniques. Les rapports ont démontré par ailleurs que la plupart des capacités de ces pays étaient restées stables ou avaient augmenté par rapport à 2016 et 2017. C’est dans le domaine technique de la résistance aux antimicrobiens qu’ont été enregistrées les plus fortes augmentations de capacités, par exemple dans la mise en place de systèmes de surveillance. Dans son analyse des rapports, le GAO a constaté que les difficultés les plus fréquentes en matière de renforcement des capacités de GHS étaient les faiblesses des institutions de l’État et le manque de ressources et de capital humain. Selon des responsables officiels, certaines de ces difficultés peuvent être résolues par plus de financement, d’assistance technique ou d’efforts diplomatiques des États-Unis, mais beaucoup d’autres restent en dehors du control du gouvernement des États-Unis.

Ceci est une version publique d’un rapport confidentiel émis par le GAO en février 2021; les informations jugées sensibles par l’USAID et les CDC en ont été omises.

Pourquoi cette étude du GAO

La survenue de la maladie à coronavirus (COVID-19) en décembre 2019 a démontré que les maladies infectieuses peuvent causer des pertes de vie catastrophiques et infliger des dommages durables à l’économie mondiale. L’USAID et les CDC dirigent les efforts déployés par les États-Unis pour renforcer la sécurité sanitaire mondiale, à savoir la capacité mondiale à se préparer à lutter contre les maladies infectieuses, à les détecter et à y riposter, ainsi qu’à réduire ou à prévenir leur propagation sur le plan international. Ces efforts comprennent des activités liées au GHSA, qui vise à accélérer l’obtention de progrès en matière de respect des règlements et autres accords mondiaux relatifs à la santé.

Le rapport 114-693 de la Chambre des représentants prévoyait un examen, par le Government Accountability Office (GAO), de l’emploi des fonds de GHS. Dans ce rapport, le GAO examine, pour les 5 années fiscales précédant le début de la pandémie de COVID-19 : 1) l’état des financements et des activités de l’USAID et des CDC relatifs à la GHS et 2) des évaluations d’organismes des États -Unis, réalisées à la fin de l’année fiscale 2019, portant sur les capacités des pays partenaires du GHSA à faire face aux menaces des maladies infectieuses et sur les difficultés que ces pays ont dû relever pour renforcer leurs capacités.

Le GAO a analysé des documents d’organismes des États-Unis et d’organismes internationaux. Le GAO a aussi interviewé des responsables officiels à Washington et à Atlanta (Géorgie) ainsi qu’en Ethiopie, en Indonésie, au Sénégal et au Viet Nam. Le GAO a choisi ces pays sur la base de critères tels que la présence de personnel de multiples organismes des États-Unis. Le GAO a également analysé des évaluations interinstitutionnelles des capacités des pays à faire face aux menaces des maladies infectieuses durant l’année fiscale 2019 et les a comparées aux données de référence de 2016 et 2017.

Pour plus d’informations, s’adresser à David Gootnick au (202) 512-3149 ou à gootnickd@gao.gov.

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The facilities vary by geographic location, population served, and level of treatment provided: Geography: About half of the 166 facilities (79) are located in the following five states: California (24), Florida (18), Illinois (15), Texas (13), and Virginia (nine).  Population: Of the 166 eating disorder facilities, over three-quarters provide treatment to both adult (132 facilities) and child and adolescent (132 facilities) populations. Level of Treatment: Most facilities provide inpatient hospitalization programs, which are for serious cases requiring medical stabilization (81 facilities); partial hospitalization, which are day programs providing treatment 5 to 7 days a week (133 facilities); or intensive outpatient programs, which are treatment programs providing therapy 2 to 6 days a week (107 facilities). About one-fifth of the facilities (35) provide residential treatment services, which are living accommodations providing intensive therapy and 24-hour supervision. TRICARE contractors have met with some challenges entering into contracts with eating disorder treatment facilities in certain areas of the country, according to DHA officials and both contractors. However, both contractors told GAO they consider it their responsibility to ensure beneficiaries receive the care they need regardless of the location of the facility. No access-to-care complaints related to eating disorder treatment were reported by TRICARE beneficiaries, according to the most recent DHA data for years 2018 through 2019. Eating disorders are complex conditions affecting millions of Americans and involve dangerous eating behaviors, such as the restriction of food intake. They can have a severe impact on heart, stomach, and brain functionality, and they significantly raise the risk of mortality. Many with eating disorders also experience co-occurring conditions such as depression. Research has yielded a range of estimates of the number of servicemembers with an eating disorder, due to differences in research methods. For example, a 2018 DOD study concluded that servicemembers likely experienced eating disorders at rates that are comparable to rates in the general population, while other survey-based research suggested the number of servicemembers with eating disorders may be higher than those with a medical diagnoses of such disorders. The potential effects that eating disorders can have on the health and combat readiness of servicemembers and their dependents underscores the importance of screening and treating this population. GAO was asked to provide information on eating disorders among servicemembers and their dependents. To describe how DOD screens for eating disorders among servicemembers, GAO reviewed DOD policies related to health screening and interviewed behavioral health specialists from the military branches. To understand approaches and challenges with implementing screening in a military environment, any planned or ongoing DOD-sponsored research related to this topic, and available eating disorder treatment, GAO interviewed representatives from the Eating Disorder Coalition, Uniformed Services University of Health Sciences, and the University of Kansas. To describe how DOD provides eating disorder treatment to servicemembers and their dependents, GAO interviewed DHA officials and TRICARE contractors and reviewed the TRICARE policy manual to identify the types of eating disorder diagnoses and treatments that are covered through direct and purchased care. GAO received data from the two TRICARE contractors related to the availability of eating disorder treatment services as of spring 2020. For more information, contact Sharon Silas at (202) 512-7114 or Silass@gao.gov.
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