Sao Tome and Principe National Day

Antony J. Blinken, Secretary of State

On behalf of the Government of the United States of America, I congratulate the people of Sao Tome and Principe on the 46th anniversary of your independence.

The United States commends Sao Tome and Principe’s long tradition of democracy and respect for human rights, and we applaud your continuous efforts to develop your economy and protect your territorial waters.

We look forward to further opportunities to grow our relationship and wish your nation continued success and prosperity.

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  • Defense Health Care: Efforts to Ensure Beneficiaries Access Specialty Care and Receive Timely and Effective Care
    In U.S GAO News
    The Department of Defense (DOD) has a general expectation that its health care beneficiaries, upon receiving an urgent referral to see a specialist, will access that specialty care in 3 days or less. GAO's analysis of 16,754 urgent referrals at military treatment facilities (MTF) shows that DOD beneficiaries accessed specialty care services in 3 days or less for more than half of the urgent referrals. About 9 percent of the urgent referrals involved beneficiaries waiting 3 weeks or longer to be seen. According to DOD officials, some beneficiaries may have waited longer than 3 days due to factors such as patient preference, appointment availability, or waiting for lab results. Time to access care varied by specialty, with beneficiaries urgently referred to ophthalmology generally seeing a specialist the fastest, and those urgently referred to mental health and oncology generally waiting the longest. According to DOD officials, MTFs are responsible for monitoring beneficiaries' access to specialty care through urgent referrals. GAO found that the monitoring processes used varied by MTF and specialty care clinic at the five selected MTFs that GAO reviewed. For example, officials from one MTF told GAO they centrally manage all urgent referrals using a daily report to address any delays, while officials from another MTF told GAO that individual specialty care clinics are responsible for managing their own urgent referrals. DOD officials acknowledged such variation and MTFs have been directed to centralize their referral management and monitoring processes—an effort that is currently underway. GAO found that DOD monitors the rates at which beneficiaries receive timely and effective care, in part, through 10 outpatient health care quality measures. These measures allow DOD to make comparisons to civilian health care systems, and they are reviewed by various DOD groups at least quarterly. However, DOD officials told GAO that since October 2017, they have been unable to monitor nine of the 10 measures for MTFs using Military Health System (MHS) Genesis, DOD's new electronic health record system. According to the officials, DOD's current data warehouse—a system that stores some MHS Genesis data and can be used by MTFs to create reports on quality measures—is not capable of producing accurate reports for those measures. DOD officials told GAO they expect to implement a new data warehouse by the end of 2020. DOD officials also said they are importing data related to quality measures into another system used for quality monitoring; however, DOD does not have a targeted date for completing these data imports. Until these actions are fully implemented, groups responsible for monitoring quality care will continue to lack the data needed to offer assurance that the growing number of MTFs using MHS Genesis are providing beneficiaries with timely and effective care that will lead to better health outcomes. A draft of this report recommended that DOD establish a timeline to complete importing the quality measure-related data from MHS Genesis into DOD's system used for quality monitoring. In its review of the draft, DOD concurred with the recommendation and established a timeline for importing the data, to be available in DOD's system no later than May 2021. After reviewing the information DOD provided, GAO removed the recommendation from the final report. DOD is responsible for ensuring that beneficiaries have access to specialty care for conditions that, while not life-threatening, require immediate attention, as well as for ensuring that beneficiaries receive timely and effective care for certain routine or other services. A report accompanying the National Defense Authorization Act for Fiscal Year 2020 included a provision for GAO to review the quality of health care in the MHS. This report examines (1) the timeliness with which beneficiaries access specialty care at MTFs through urgent referrals and DOD's efforts to monitor access, and (2) DOD's use of quality measures to monitor and improve the rates of timely and effective care received by beneficiaries at MTFs. GAO examined relevant policies, national DOD referral data (a total of 16,754 urgent referrals) for a 1-year period ending August 2019, and the most recent available quality measure data (April 2020). GAO interviewed officials from five MTFs, selected for variation in military services, geography, provision of select specialty services, and use of the electronic health record system. For more information, contact Debra A. Draper at (202) 512-7114 or draperd@gao.gov.
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  • Space Acquisitions: DOD Faces Challenges and Opportunities with Acquiring Space Systems in a Changing Environment
    In U.S GAO News
    What GAO Found The Department of Defense (DOD) is making changes to its space-related processes and organization that will present both opportunities and challenges to the way it acquires its space systems. GAO has reported over the past decades on challenges DOD faces in its space acquisitions—including schedule delays, multibillion-dollar cost increases, significant reductions in capabilities, and in some cases cancelation—and made recommendations that have improved program outcomes. For example, DOD took actions to implement a GAO recommendation to use an incremental approach to acquiring space launch services. DOD's modified approach reduced risk by allowing it to incorporate knowledge gained from early launch competitions to inform subsequent competitions. Many of the most troubled programs are nearing completion, and DOD is starting new programs to develop the next generation of capabilities, some of which are being acquired under a streamlined acquisition process known as the middle-tier of acquisition pathway (see table below). Starting new programs is an opportunity to learn from past mistakes and take measures to put programs on successful paths. GAO's work has shown that in many cases, DOD is attempting to do so. Selected New DOD Space Programs and Near-Term Estimated Costs Dollars in billions New program Current estimated costs for 5-year middle-tier effort Evolved Strategic SATCOM (ESS) Protected satellite communications $1.4 Future Operationally Resilient Ground Evolution (FORGE) Ground control for Next Generation Overhead Persistent Infrared satellites $3.0 Next Generation Overhead Persistent Infrared (OPIR) Block 0 Missile warning, infrared intelligence, surveillance, and reconnaissance $8.4 Protected Tactical SATCOM (PTS) Protected satellite communications $1.0 Source: Department of Defense (DOD) data. | GAO-21-520T However, DOD faces challenges because it will be starting these new programs amid significant changes to the acquisition environment. Some of these changes are external to DOD, such as increased threats to on-orbit space systems. But over the past several years, DOD also initiated substantial organizational and acquisition process changes. While the Space Force offers an important opportunity to streamline lines of authority, accountability, and decision-making and avoid duplication of effort, many details will require careful consideration. In addition, adopting leading practices for acquisition, as previously recommended, could help DOD achieve faster delivery of new capabilities, especially if DOD balances new, streamlined acquisition processes with sufficient oversight to help ensure program success. Why GAO Did This Study DOD space systems provide critical capabilities that support military and other government operations. Space systems can be expensive to acquire and field, costing billions of dollars each year. The U.S. Space Force was recently established as the sixth branch of the U.S. military. As planned, the Space Force will consolidate leadership, planning, and management for some DOD space programs, as appropriate and authorized. This statement discusses the challenges and opportunities DOD faces as it acquires space systems amid changes to the acquisition environment. This statement is based on GAO reports issued over the past 10 years on DOD space programs. It also draws on recent work supporting GAO's 2021 annual report on the progress of major defense acquisition programs.
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    In Travel
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  • Former Air Force Contractor Pleads Guilty to Illegally Taking 2,500 Pages of Classified Information
    In Crime News
    A former contractor with the U.S. Air Force pleaded guilty in the U.S. District Court, Southern District of Ohio today to illegally taking approximately 2,500 pages of classified documents.
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