The whole effort is only sustainable if local governments take leadership and gradually assume greater burdens. Here, Zambia is fortunate. Its new president, Michael Sata, is a former health minister. Zambia's first lady is a former ob-gyn. Zambia's current health minister worked at the World Health Organization for 20 years. The government's first budget increased health spending by 45 percent in a single year -- a commitment permitted by sustained economic growth and the rising price of copper in Zambian mines.
But much of the progress against malaria here has been made possible by America, particularly through the President's Malaria Initiative (PMI) -- which has provided millions of nets in Zambia, including those distributed by private groups in Mongu. It is an unexpected intervention for a superpower. China, for example, has taken a different approach in Zambia -- providing foreign assistance in exchange for resource concessions. And China out-invests America in Zambia by more than 10-to-1. China's influence is everywhere -- and resolutely self-interested.
The American Embassy, in contrast, is mainly a health care provider. Of the $400 million the United States spends each year on foreign assistance to Zambia, about $370 million goes to fighting AIDS and malaria.
Zambia has issued a recent judgment on the merits of China's transactional, extractive foreign policy. President Sata ran and won on a platform opposed to outsized Chinese influence. Upon taking office, his first diplomatic meeting was with the Chinese ambassador -- whom he publicly excoriated for bad Chinese labor practices. Sata's first public reception honored the Peace Corps and USAID -- America's aid agency.
In much of sub-Saharan Africa, the American image is now defined by the Peace Corps, by PMI and by PEPFAR, the American AIDS relief plan. It is a form of influence that is hard to measure or weigh. But people remember when you help to save their children.