U.S.-NORWAY RELATIONS

Map:  Norway.  Credit:  CIA World Factbook.

FROM: U.S. DEPARTMENT OF STATE
The United States established diplomatic relations with Norway in 1905, following Norway's separation from its union with Sweden. The United States and Norway enjoy a long tradition of friendly relations based on democratic values and mutual respect. The bilateral Global Issues Dialogue is a forum through which the two countries coordinate and expand cooperation on issues of mutual interest in the promotion of human rights, civilian security, and democracy. The United States and Norway share a commitment to promoting universal human rights and economic development, respect for the United Nations, and peaceful resolution of disputes around the globe. The two work closely together as North Atlantic Treaty Organization allies. There is a strong shared interest in addressing the problems posed by climate change, particularly with respect to the Arctic and in building cooperation in the region through the Arctic Council. The United States and Norway benefit from cultural exchanges, both officially and privately.

U.S. Assistance to Norway
The United States provides no development assistance to Norway.

Bilateral Economic Relations
The United States is one of Norway's principal trading partners. The growth of Norway's petroleum sector has contributed significantly to its economic vitality. Many U.S. companies participate actively in the petroleum sector. U.S. exports to Norway include aircraft, machinery, optic and medical instruments, and inorganic chemicals. U.S. imports from Norway include mineral fuel and oil, machinery, nickel and nickel products, and Atlantic salmon. Reported U.S. direct investment in Norway is led by the mining and manufacturing sectors. Software and IT services, coal, oil and natural gas, and metals, account for the top three sectors in Norway's reported direct investment in the United States.

Norway's Membership in International Organizations
Norway and the United States belong to a number of the same international organizations, including the United Nations, Arctic Council, North Atlantic Treaty Organization, Euro-Atlantic Partnership Council, Organization for Security and Cooperation in Europe, Organization for Economic Cooperation and Development, International Monetary Fund, World Bank, and World Trade Organization. Norway also is an observer to the Organization of American States.




Norway Locator Map.  Credit:  CIA World Factbook. 

ADDITIONAL INFORMATION FROM CIA WORLD FACTBOOK

Two centuries of Viking raids into Europe tapered off following the adoption of Christianity by King Olav TRYGGVASON in 994. Conversion of the Norwegian kingdom occurred over the next several decades. In 1397, Norway was absorbed into a union with Denmark that lasted more than four centuries. In 1814, Norwegians resisted the cession of their country to Sweden and adopted a new constitution. Sweden then invaded Norway but agreed to let Norway keep its constitution in return for accepting the union under a Swedish king. Rising nationalism throughout the 19th century led to a 1905 referendum granting Norway independence. Although Norway remained neutral in World War I, it suffered heavy losses to its shipping. Norway proclaimed its neutrality at the outset of World War II, but was nonetheless occupied for five years by Nazi Germany (1940-45). In 1949, neutrality was abandoned and Norway became a member of NATO. Discovery of oil and gas in adjacent waters in the late 1960s boosted Norway's economic fortunes. In referenda held in 1972 and 1994, Norway rejected joining the EU. Key domestic issues include immigration and integration of ethnic minorities, maintaining the country's extensive social safety net with an aging population, and preserving economic competitiveness.

U.S. DEFENSE SECRETARY PANETTA HOSTS NOREGIAN MINISTER OF DEFENSE COUNTERPART ANNE-GRETE STROM-ERICHSEN

Secretary of Defense Leon E. Panetta hosts an honor cordon welcoming Norwegian Minister of Defense Anne-Grete Strom-Erichsen to the Pentagon, Dec. 17, 2012. DOD photo by U.S. Navy Petty Officer 1st Class Chad J. McNeeley

FROM: U.S. DEFENSE DEPARTMENT

Panetta Thanks Norwegian Minister for Support in Afghanistan
American Forces Press Service

WASHINGTON, Dec. 18, 2012 - In a meeting with his Norwegian counterpart yesterday, Defense Secretary Leon E. Panetta thanked Norway for its support in Afghanistan and its "steadfast commitment" to the NATO alliance, Pentagon Press Secretary George Little said.

During his meeting with Norwegian Defense Minister Anne-Grete Strom-Erichsen, the secretary underscored the importance of Norway's involvement in alliance operations and praised Norway for expediting its acquisition of the F-35 joint strike fighter, Little said.

"The secretary highlighted the importance of defense spending and developing future alliance interoperability through the NATO Response Force," the press secretary said. "Having both recently returned from visiting Turkey, the leaders discussed the upcoming NATO deployment of Patriot batteries and strong support for our ally," he added. "They also discussed the strategic importance of access to the Arctic."

PROFILE OF NORWAY

FROM:  U.S. STATE DEPARTMENT
PROFILE Geography
Area (including the island territories of Svalbard and Jan Mayen): 385,199 sq. km. (148,726 sq. miles); approximately the same size as New Mexico.
Cities (January 2011 est.): Capital--Oslo (pop. 599,230). Other cities--Bergen (260,392), Trondheim (173,486), Stavanger (126,021).
Terrain: Rugged with high plateaus, steep fjords, mountains, and fertile valleys.
Climate: Temperate along the coast, colder inland.

People
Nationality: Noun and adjective--Norwegian(s).
Population (October 2011): 4,973,029.
Annual population growth rate (2010): 1.3%.
Density (2010): 16 per sq. km. (excluding inland water).
Ethnic groups: Norwegian (Nordic, Alpine, Baltic); Sami, a racial-cultural minority; foreign nationals from Nordic and other countries.
Membership in nationally registered religions (2010): Church of Norway (Lutheran) 78%; Roman Catholic 1.3%; Pentecostal Christian 0.8%; other Christian 3.5%; Muslim 2.0%; other, none, or unknown 14.4%, including a Jewish community of approximately 1,500 people, 819 of whom are registered with the Jewish community.
Languages: Bokmal Norwegian (official), Nynorsk Norwegian (official), small Sami- and Finnish-speaking minorities (Sami is official in six municipalities). English is widely spoken.
Education: Years compulsory--10. Literacy--100%.
Health: Infant mortality rate (2010)--3.1 deaths/1,000. Life expectancy (2010 est.)--men 78.6 years; women 83.1 years.
Work force (2011, 3.6 million): Legislators, senior officials, and managers 6%; professionals 13%; technicians and associate professionals 25.3%; clerks 6.8%; service workers and market sales workers 24%; agricultural, forestry, and fishery workers 2.2%; craft and related trades workers 10.2%; plant and machine operators and assemblers 7.1%; other occupations and unspecified 5.2%.

Government
Type: Hereditary constitutional monarchy.
Independence: 1905.
Constitution: May 17, 1814.
Branches: Executive--king (chief of state), prime minister (head of government), Council of Ministers (cabinet). The Council is appointed by the monarch in accordance with the will of the Storting, to which the Council is responsible. Legislative--modified unicameral parliament (Storting, 169 members, elected for 4 years by universal adult suffrage). Judicial--Supreme Court, appellate courts, city and county courts. There are 19 Supreme Court judges, with one Chief Justice.
Political parties represented in the parliament: Center Party; Christian People’s Party; Conservative Party; Labor Party; Liberal Party; Progress Party; Socialist Left Party.
Suffrage: Universal over 18.
Administrative subdivisions: 19 fylker (counties) and 429 municipalities, and Svalbard.

Economy
GDP (2011): $479.3 billion.
Annual growth rate (2011): 1.7%.
Per capita GDP (2011, purchasing power parity): $53,300.
Natural resources: Petroleum, natural gas, iron ore, copper, lead, zinc, titanium, pyrites, nickel, fish, timber, hydropower.
Arable land: 2.7%.
Agriculture: Products--dairy, livestock, grain (barley, oats, wheat), potatoes and other vegetables, fruits and berries, furs, wool, pork, beef, veal, fish.
Industry: Types--petroleum and gas, food processing, shipbuilding, pulp and paper products, aluminum, ferroalloys, iron and steel, nickel, zinc, nitrogen, fertilizers, petrochemicals, hydroelectric power, refinery products, timber, mining, textiles, fishing, transport equipment, electronics.
GDP by activity (2010): Oil and gas 20%; general government 16%; manufacturing, mining, electricity, building and construction 15%; value added tax (VAT), etc. 11%; commodities, vehicle repairs, etc. 7%; communication and transport 4%; agriculture, forestry, and fishing 2%; other services (commercial, housing, financial, private health/education, hotel and catering, etc.) 25%.
Trade (2010): Exports (f.o.b.)--$178 billion. Major markets--U.K. 27%, Netherlands 12%, Germany 11%, Sweden 7%, France 6%, U.S. 5%. Imports (f.o.b.)--$122 billion. Major suppliers--Sweden 14%, Germany 12.3%, China 8.4%, Denmark 6.1%, U.K. 5.9%, U.S. 5.2%.

GEOGRAPHY
Norway’s northern regions lie within the Arctic Circle, where there are borders with Finland and Russia, while much of the long border with Sweden runs through the Scandinavian mountains. This range, sloping to the south-east, is 1,530 km in length and has its highest areas in the south of Norway, where Galdhopiggen, Norway’s highest point, reaches a peak of 2,469 m (8,100 ft). Almost all of Norway is high ground; in the north the country becomes narrower, with mountains overlooking the fjords and the islands along the coast, and in the center and south the mountains form a high plateau, where there are permanent ice fields. The only area of low ground is around the Oslo fjord and along the coast to Stavanger. The principal rivers are the Glomma, the Lagen, and Tanaelv. Some 6% of Norway’s area is inland water--mostly long, thin lakes. Two-thirds of the country is tundra, rock, or snowfields, and one-quarter is forested, so good agricultural land is rare. Less than 3% of Norway is cultivated, and these areas are in the south-east and in the river valleys. The mountains of Norway are rich in minerals; there are deposits of iron ore, copper, titanium, coal, zinc, lead, nickel, and pyrites, and large offshore reserves of petroleum and natural gas.

Although Norway crosses the Arctic Circle, the climate is not as cold as might be expected, since the North Atlantic Drift brings warm, damp air to the whole country. The geographical conditions give rise to great climatic variation: it is cooler inland and to the north, where winters are long and dark with much snow, but where the sun shines day and night for part of the summer. It is wetter on the west coast, where about 2,000 mm (78.7 inches) of rain falls annually on Bergen; the mean annual rainfall in the capital, Oslo, is 730 mm, most of which falls during the summer. Temperatures in Oslo are highest in July, when the average is 17.3°C (64°F), and lowest in January, when the average falls to −4.7°C (24°F).

PEOPLE
Ethnic Norwegians speak a Germanic language. Northern Norway is also the traditional home of communities of Sami people who speak a non-Indo-European language. In recent years, Norway has become home to increasing numbers of immigrants, foreign workers, and asylum-seekers from various parts of the world. As of January 2011, there were 600,900 immigrants and 100,000 Norwegian-born persons with immigrant parents living in Norway. The majority of immigrants are from Poland, Sweden, Germany, and Iraq. Thirty-four percent of immigrants have Norwegian citizenship. Immigrants now make up about 12.2% of Norway’s population, but the percentage in Oslo is nearly double that.

The constitution provides for freedom of religion, and other laws and policies contribute to the generally free practice of religion in Norway. The Evangelical Lutheran Church of Norway, the state church, enjoys some benefits not available to other religious groups. Education is free through the university level and is compulsory from ages 6 to 16. At least 12 months of military service and training are required of every eligible male; approximately 40% are exempted from service for health or other reasons annually. Norway's health system includes free hospital care, physicians’ compensation, cash benefits during illness and pregnancy, and other medical and dental plans. There is a public pension system.

Norway is in the top rank of nations in the number of books printed per capita. Norway's most famous writer is the dramatist Henrik Ibsen. Artists Edvard Munch and Christian Krogh were Ibsen's contemporaries. Munch drew part of his inspiration from Europe and in turn exercised a strong influence on later European expressionists. Sculptor Gustav Vigeland has a permanent exhibition in the Vigeland Sculpture Park in Oslo. Musical development in Norway since Edvard Grieg has followed either native folk themes or, more recently, international trends.

HISTORY
The Viking period (9th to 11th centuries) was one of national unification and expansion. The unification of Viking settlements along the Norwegian coast was well advanced by the time of St. Olav’s death in 1030. He is credited with overseeing the population’s conversion to Christianity. A period of civil war ended in the 13th century when Norway expanded its control overseas to parts of the British Isles, Iceland, and Greenland. Norwegian territorial power peaked in 1265, and the following year the Isle of Man and the Hebrides were ceded to Scotland. Competition from the Hanseatic League and the spread of the Black Death weakened the country. The Norwegian royal line died out in 1387, as the country underwent a period of union with Denmark under King Olaf; union with Sweden followed in 1397. Attempts to keep all three countries united failed, with Sweden finally breaking away in 1521. By 1586, Norway had become part of the Danish Kingdom. In 1814, as a result of the Napoleonic wars, Norway was separated from Denmark and combined with Sweden again.

The Napoleonic War saw Denmark side with France in 1807, following the British attack on Copenhagen. With Sweden joining the coalition against Napoleon in 1813, the Treaty of Kiel in 1814 transferred Norway to the Swedish King following Denmark’s defeat. The Norwegians ignored this international agreement and chose the Danish Prince as their king and adopted the liberal Eidsvoll Constitution on May 17, 1814 (May 17 later became Norway’s national holiday). After a few months a Swedish-Norwegian union was agreed under the Swedish crown, with Norway being granted its own parliament (Storting) and government. However, the Swedish King attempted unsuccessfully to revise this constitution in the 1820s and 1830s and parliamentary control over the executive was only obtained following a struggle during the 1870s and 1880s. Norwegian nationalism was associated with the creation of a national standard for written Norwegian based on dialects, rather than the Danish-based official language. There were numerous disputes between the Norwegian Government and Sweden, notably over requests for a Norwegian consular service to reflect the importance of Norway’s expanding merchant fleet. In 1905 the union between the two countries was dissolved following two plebiscites in Norway, one opting for independence and one for a constitutional monarchy. Danish Prince Carl was unanimously elected as King by the Storting in 1905 and took the name of Haakon VII (after the kings of independent Norway) on his arrival in Norway. Haakon died in 1957 and was succeeded by his son, Olav V, who died in January 1991. Upon Olav's death, his son Harald was crowned as King Harald V.

Norway was a nonbelligerent during World War I, but as a result of the German invasion and occupation during World War II, Norwegians generally became skeptical of the concept of neutrality and turned instead to collective security. During the period of Nazi German occupation, over 742 of Norway’s Jews were killed. More than 900 Jews survived mass deportation by hiding and escaping, many of them by crossing the border into Sweden. Norway was one of the signers of the North Atlantic Treaty in 1949 and was a founding member of the United Nations. The first UN Secretary General, Trygve Lie, was a Norwegian. Under the terms of the will of Alfred Nobel, the Storting (parliament) elects the five members of the Norwegian Nobel Committee who award the Nobel Peace Prize each year on December 10 to those who have "done the most or best work for fraternity between nations, the abolition or reduction of standing armies and for the holding and promotion of peace congresses." Norway held referenda on seeking entry into the European Union (EU) and its predecessor the European Community in 1972 and 1994, with the population rejecting membership both times. Today, a majority remains opposed to EU membership.

GOVERNMENT
The functions of the king are mainly ceremonial, but he has influence as the symbol of national unity. Although the 1814 constitution grants important executive powers to the king, these are almost always exercised by the Council of Ministers in the name of the king (King's Council). The Council of Ministers consists of a prime minister--chosen by the political parties represented in the Storting--and other ministers.

The 169 members of the Storting are elected from 19 fylker (counties) for 4-year terms according to a complex system of proportional representation.

The special High Court of the Realm hears impeachment cases; the regular courts include the Supreme Court (18 permanent judges and a Chief Justice), courts of appeal, city and county courts, the labor court, and conciliation councils. Judges attached to regular courts are appointed by the king in council after nomination by the Ministry of Justice.

Each fylke (county) is headed by a governor appointed by the king in council, with one governor exercising authority in both Oslo and the adjacent county of Akershus.

POLITICAL CONDITIONS
Until the 1981 election, Norway had been governed by majority Labor Party governments since 1935, except for three periods (1963, 1965-71, and 1972-73). The Labor Party lost its majority in the Storting in the 1981 elections.

From 1981 to 2005, governments alternated between Labor minority governments and Conservative-led coalition governments. In the run-up to the 2005 election, Labor Party leader Jens Stoltenberg reached out to the Socialist Left (SV) party and agrarian Center party to form a "Red-Green" coalition government that commanded a majority of seats in parliament. Stoltenberg’s government was the first majority government in Norway in over 20 years, but the governing coalition has had to bridge substantial policy differences to build this majority. The 2005 election was historic because it was the first time the Labor Party was in a coalition government since the 1940s, the first time SV was ever in the national government, and the first time the Center Party joined with the socialist parties as opposed to the right-of-center parties. On September 14, 2009, the "Red-Green" coalition won reelection for 4 more years after winning 86 of the 169 seats in parliament.

The Stoltenberg-led coalition government that took office in October 2005 and was reelected in 2009 continued the northern policy laid down by the government led by Kjell Magne Bondevik (of the Christian Democratic Party) in 2003. This "High North" strategy has remained one of the constant themes of this government and encompasses many of the government’s highest priorities, including environmental protection, responsible development of energy resources, maintaining a security presence in the Arctic, and developing Norway’s relations with Russia. In 2010, Norway concluded bilateral agreements with Russia resolving the two countries’ long-disputed maritime boundary in the Barents Sea and Arctic Ocean and facilitating travel for border residents. Upon ratification, the maritime boundary agreement entered into force in 2011.
Norway maintains an embassy in the United States at 2720 34th Street NW, Washington, DC 20008 (tel. 202-333-6000) and consulates in Houston, New York, and San Francisco. Norway closed its consulate in Minneapolis in 2008 but maintains an honorary consulate with Gary Gandrud as honorary consul general. There are honorary consuls in Alabama, Alaska, Arizona, Arkansas, Bahamas, Bermuda, California (2), Colorado, Florida (3), Georgia, Hawaii, Illinois, Iowa, Kansas, Louisiana, Massachusetts, Michigan, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Puerto Rico (2), South Carolina, South Dakota, Texas, Utah, Virginia, Washington, and Wisconsin.

ECONOMY
Norway is one of the world's richest countries in per capita terms. It has an important stake in promoting a liberal environment for foreign trade. Its large shipping fleet is one of the most modern among maritime nations. Metals, pulp and paper products, chemicals, shipbuilding, and fishing are the most significant traditional industries.

Norway's emergence as a major oil and gas producer in the mid-1970s transformed the economy. Large sums of investment capital poured into the offshore oil sector, leading to greater increases in Norwegian production costs and wages than in the rest of Western Europe up to the time of the global recovery of the mid-1980s. The influx of oil revenue also permitted Norway to expand an already extensive social welfare system. Norway established a petroleum fund (the Government Pension Fund Global) to save and invest the state’s oil and gas earnings. The fund was valued at over 3 trillion kroner (over $500 billion) at the end of 2011. Thanks in part to prudent financial regulation and to high prices in world markets for its energy and fisheries exports, the global financial crisis has had only a limited impact on Norway. Norway’s unemployment rate stood at 3.4% at the end of November 2011. In recent years, labor costs have increased faster than in its major trading partners, eroding industrial competitiveness. Though the impact of international economic turmoil is uncertain, Norway is expected to experience moderate growth in 2012.

Norway twice voted against joining the European Union, but, with the exception of the agricultural and fisheries sectors, Norway enjoys free trade with the EU under the framework of the European Economic Area. This agreement aims to apply the four freedoms of the EU's internal market (goods, persons, services, and capital) to Norway. As a result, Norway normally adopts and implements most EU directives. Norwegian monetary policy is aimed at maintaining a stable exchange rate for the krone against European currencies, of which the euro is a key operating parameter. Norway does not have a fixed exchange rate. Its principal trading partners are the EU, the United States, and China.

Energy Resources
Offshore hydrocarbon deposits were discovered in the 1960s, and development began in the 1970s. Production increased significantly in the 1990s as new fields came on stream. The growth of the petroleum sector has contributed significantly to Norwegian economic vitality. Current petroleum production capacity is approximately 2.6 million barrels per day. Production in gas has increased rapidly during the past several years as new fields are opened, with crude oil production in decline. Hydropower provides nearly all of Norway's electricity, and all of the gas and most of the oil produced is exported. The Norwegian continental shelf's total recoverable petroleum resources have been estimated at 12.8 billion standard cubic meters of oil equivalent (scm o.e.), of which 5.5 billion have been recovered.

Norway is the world's seventh-largest oil exporter and second-largest gas exporter (2010). Norway provides much of Western Europe's crude oil and gas requirements. In 2010, Norwegian oil and gas exports accounted for approximately 47% of total exports. In addition, offshore exploration and production have stimulated onshore economic activities. In 2010, 26% of state revenues were generated from the petroleum industry; taxes and direct ownership ensure high revenues. Foreign companies, including many American ones, participate actively in the petroleum sector. The oil industry directly employs roughly 40,000 people in core extraction activities. Over 250,000 are employed in petroleum-related activities.

Petroleum production peaked in the early 2000s, and the pace of discoveries has not been sufficient to reverse that trend. However, innovative use of extraction technologies has extended the lives of fields and major oil and gas discoveries were made on the Norwegian continental shelf in 2011. Declines in petroleum extraction is to some degree offset by increased extraction of natural gas in both new and existing fields, such as Snohvit and Troll. Given the energy industry’s weight in the economy, diversification into other industries is a long-term challenge for Norway.

FOREIGN RELATIONS
Norway supports international cooperation and the peaceful settlement of disputes, and recognizes the need for maintaining national defense through collective security. Accordingly, the cornerstones of Norwegian policy are active membership in the North Atlantic Treaty Organization (NATO) and support for the United Nations and its specialized agencies. Norway also pursues a policy of economic, social, and cultural cooperation with other Nordic countries--Denmark, Sweden, Finland, and Iceland--through the Nordic Council and bilaterally.

In addition to strengthening traditional ties with developed countries, Norway seeks to build friendly relations with developing countries and has undertaken humanitarian and development aid efforts with selected African, Asian, and Latin American nations. Norway also is dedicated to encouraging democracy, assisting refugees, promoting a global response to climate change, and protecting human rights throughout the world.

U.S.-NORWAY RELATIONS
The United States and Norway enjoy a long tradition of friendly relations, strengthened by the millions of Norwegian-Americans in the United States and by about 30,000 U.S. citizens who reside in Norway. The transatlantic relationship is based on democratic values and mutual respect. In 2010 the United States accounted for 5% of Norway's exports and more than 5% of Norway’s imports. The two countries benefit from an annual $15 billion two-way goods and services trade relationship as well as from active cultural exchange, both officially and privately. The United States and Norway share a commitment to promoting universal human rights and economic development, respect for the United Nations, and peaceful resolution of disputes around the globe. The two countries work closely together as NATO allies, including in Afghanistan. There is a strong shared interest in addressing the problems posed by climate change, particularly with respect to the Arctic and in building cooperation in the region through the Arctic Council. The United States and Norway launched a Global Issues Dialogue in Washington, DC on May 6, 2010

　

SEC. CLINTON IN NORWAY SPEAKS OF NEW PATH IN GLOBAL HEALTH

 FROM:  U.S. NAVY.  Members of the Indonesian army board the Military Sealift Command hospital ship USNS Mercy (T-AH 19). Mercy is participating in Pacific Partnership, an annual U.S. Pacific Fleet humanitarian and civic assistance mission now in its seventh year that brings together U.S. military personnel, host and partner nations, non-government organizations and international agencies to build stronger relationships and develop disaster response capabilities throughout the Asia-Pacific region. U.S. Navy photo by Kristopher Radder (Released) 120531-O-ZZ999-007 
FROM:  U.S. STATE DEPARTMENT

A World in Transition: Charting a New Path in Global Health
Remarks Hillary Rodham Clinton
Secretary of State Oslo, Norway
June 1, 2012
Well, that is quite a compliment. And whatever it takes to accept, I do. Your Majesty, Your Royal Highness, Mayor, my dear friend and colleague, your excellent foreign minister, also let me recognize Ingrid Schulerud, wife of the prime minister who, along with her husband, just hosted me and my delegation for a wonderful luncheon, and to everyone who has organized this extraordinary conference, which I think does come at a historical turning point.

It’s no surprise that we would be meeting here in Norway, one of the most generous nations on earth when it comes not only to global health but so much more, and that we would have gathered here the panel and others who bring such broad and deep experience, and also have the opportunity to elevate an issue that is connected to so much else.

I often think about issues like maternal health from a personal perspective because I am privileged to have known what it meant to me to have had the great good fortune and gift of my daughter. And I think about what it would have been like that cold February day in 1980 if I didn’t know that the facility was available. Or were it available, I didn’t really know for sure if it would be open. And I couldn’t count on a doctor or a midwife or a nurse being present. Or if they were, if something went wrong, that they would have the equipment and the expertise to handle whatever the emergency might be. But indeed, as we have just heard described by the minister from Sierra Leone, that is the experience of many millions of women every single day throughout the world.

So I greatly appreciated the invitation by the foreign minister to increase and accelerate our mutual efforts as to how together we, and hopefully bringing others with us, can do more to save the lives of mothers during labor and delivery. Now, maternal health has a value in and of itself, I think we would all agree with that, but it is deeply connected to a broader purpose. And our panelists have all very persuasively discussed that.

How do we achieve health systems that will help every country improve life for more of their people? And the key question comes down to, if you really want to know how strongly a country’s health system is, look at the well-being of its mothers. Because when a woman in labor experiences complications, it takes a strong system to keep her alive. It not only takes skilled doctors, midwives, and nurses, it takes reliable transportation, well-equipped clinics and hospitals that are open 24 hours a day. Where these elements are in place, more often than not women will survive childbirth. When they aren’t, more often than not they die or suffer life-changing, traumatic injuries.

When China, Sri Lanka, and Malaysia upgraded and expanded their health systems, their maternal mortality rates dropped dramatically. When Zimbabwe’s system began to crumble, its maternal mortality rates shot up dramatically. That is a powerful, inescapable correlation. And it is why improving maternal health is a priority for the United States.

Through our development agency USAID, we are supporting more skilled midwives and cell phone technology to spread health information. We’re involved in the International Alliance for Reproductive, Maternal, and Newborn Health, a five-year effort to improve donor coordination. We are partnering with Norway and others to support innovative interventions that improve outcomes for pregnant women and newborns. And we are working to ensure access to family planning so that women can choose the spacing and size of their families. Reproductive health services can and do save women’s lives, strengthen their overall health, and improve families’ and communities’ well-being.

And of course, women’s health means more than just maternal health and therefore we must look to improve women’s health more generally, because it is an unfortunate reality that women often face great health disparities. And improving women’s health has dividends for entire societies, from driving down child mortality rates to sparking economic growth. And Norway, as Jonas just pointed out, has been a leader in not only doing that, but recognizing it.

And the comment he made at the end about the difference between Norway’s GDP with oil and gas and with women’s empowerment and involvement is very striking because a recent study that Norway has just completed demonstrated that Norway’s GDP actually do more to the empowerment of women than the discovery of natural resources and their exploitation.

Norway has been a leader in also pointing out the direct links between gender-based violence and health. So for our part, the United States is integrating services throughout our health programs so women and their families have access to the range of care they need. And we are linking our health programs to others that address the legal, social and cultural barriers that inhibit women’s access to care, such as gender-based violence, lack of education, and the low social status of women and girls.

But you can’t impose a health system, and you can’t change some of these attitudes from the outside. We understand that. There has to be encouragement for it to grow from within, the kind of leadership that the minister is discussing about what is happening in Sierra Leone.

That is the principle of what we call country ownership. And I think it’s important to stress the connection between maternal mortality, strong health systems, and country ownership. Because while the global health community has recognized that we have to rigorously think about what works and what doesn’t work, and that we endorsed country ownership at the high-level forum in Paris in 2005 and reaffirmed it in Accra and Busan, it is enshrined in numerous global health agreements.

But few of us have honestly forced ourselves to examine what country ownership means for the day-to-day work of saving lives. Now, for many people, that phrase is freighted with unstated meaning. Some worry that it means donors are supposed to keep money flowing indefinitely while recipients decide how to spend it. Others, particularly in partner countries, are concerned that country ownership means countries are on their own. (Laughter.) Still others fear that country-owned really means government-run, freezing out civil society groups or faith-based organizations that in some places operate as many as 70 percent of all health facilities.

And this is not just a matter of semantics, because if we are not clear about what country ownership means, we cannot know whether we are making progress toward achieving it. And we certainly can’t identify what works and what doesn’t. And what’s more, we will achieve real gains in maternal health and global health more generally only with effective country ownership. Now, one or two programs in isolation are not enough. It takes an integrated, country-owned approach. So let me share with you what our latest thinking about what that means is.

To us, country ownership in health is the end state where a nation’s efforts are led, implemented, and eventually paid for by its government, communities, civil society and private sector. To get there, a country’s political leaders must set priorities and develop national plans to accomplish them in concert with their citizens, which means including women as well as men in the planning process. And these plans must be effectively carried out primarily by the country’s own institutions, and then these groups must be able to hold each other accountable as the women did in front of the parliament in Sierra Leone.

So while nations must ultimately be able to fund more of their own needs, country ownership is about far more than funding. It is principally about building capacity to set priorities, manage resources, develop plans, and carry them out. We are well aware that moving to full country ownership will take considerable time, patience, investment, and persistence. But I think there are grounds for optimism.

Economic growth is making it possible for many developing nations to meet more of their people’s own needs. In 2010, the GDPs of Mozambique, Botswana, and Ethiopia grew more than 8 percent. Nations across sub-Saharan Africa are seeing similar growth. And what we want to be sure of is that countries don’t substitute donor funding for their own, because unfortunately, there are examples – Zimbabwe being one – where an existing health system that was providing basic services to many was allowed to deteriorate while the government chose to put funding elsewhere. We have seen ministries of health lose funding to ministries of defense or ministries of transportation. And so what had been possible only a decade before becomes very difficult going forward.

So what we are trying to do is to help put in place the essential pieces of strong health systems. That means we are helping to build clinics and labs, to train staff, improve supply chains, make blood supplies safer, set up record-keeping systems; in short, creating platforms upon which partners can eventually launch their own efforts. Now, with this momentum, the question before us is not: Can we achieve country ownership? We think we are in a very good position to begin that process. Instead, we have to ask ourselves: “Are we achieving it? And if we are not, what must each of us do better?”

Well, some countries are. And earlier we heard about Sierra Leone. And I am very excited by what the minister has done to enlist 1,700-plus women as health monitors, responsible for checking up on their local clinics, reporting problems to the health ministry. That’s a wonderful way for ownership to migrate down from the national level to the local level and then come back up as a reporting mechanism.

Or consider Botswana, where the government manages, operates, and pays for HIV treatment programs. With PEPFAR’s support, it is also working with American universities to build a national medical school that will train the nation’s next generation of healthcare workers. And perhaps we can then stop the brain drain, because so many countries train excellent doctors, midwives, and nurses who then leave that country. My birth was assisted by a nurse midwife from Ghana – the birth of my daughter, and I know how wonderful and skilled she was. Now she’s back in Ghana, because she thinks she has opportunities to do her best work in her home country.

If you look at what India has achieved – and I appreciate the minister being here – six years ago, when the government launched its National AIDS Control Program, half the budget came from outside donors. Today, less than one fifth does, and the Indian Government covers the rest. But these are the exceptions, not yet the rule.

In too many countries, if you take a snapshot of all the health efforts, you see donors – that’s all of us – failing to coordinate our work, leaving some diseases underfunded, burying our partners in paperwork that I am convinced hardly anyone ever reads once it’s filled out, paying too little attention to improving systems. You see partner countries committing too few of their own resources and avoiding accountability for delivering results. And you see patients encountering a maze of obstacles that block them from the services they need. So therefore it is up to us – donor and country alike.

There is an old proverb that says: “When a man repeats a promise again and again, he means to fail you.” At the turn of this century, we made a collective promise to cut the maternal mortality ratio by three quarters and achieve universal access to reproductive health services. And yes, we have repeated that promise again and again. And although we do not mean to fail, we risk failing all the same, if we don’t change course.

So what do we need to do? Let me offer a few suggestions. Beginning with donors, governments, foundations, multilateral organizations – and I see a number of familiar faces. First, we do need to move from rhetoric to the reality of making it a priority to strengthen country-led health systems. That means meeting our commitments even in tough economic times. Part of this assistance should include an assessment of country systems, led by the countries themselves, with common international benchmarks so we can compare results across borders. And those are not only national borders but donor borders.

We need, for example, to follow closely the National Heath Accounts supported by USAID that give us an excellent view of the state of a health system’s financing – not to point fingers or cast blame, but to identify gaps and then develop plans to fill them.
Second, we donors have to recognize that supporting country ownership in health requires hard choices. It is often easier to start a new program than to phase out an existing one, even when the existing one is not producing results. But if we are serious about helping our partners plan, implement, and ultimately pay for their own efforts, we have to be willing to make the tough calls.

Third, donors must embrace transparency, even when it brings bad news. For example, when Zambia uncovered corruption in its Global Fund program, some donors responded by punishing them for the corruption, rather than applauding them for uncovering it. Now, we should never turn a blind eye to corruption or throw good money after bad, but it is counterproductive to punish our partners when they root out problems like that. It sends exactly the wrong message: We want you to fight corruption, but if you find any, we might freeze your funding. Instead, we should say find the corruption so that we can help you fix the problems.

And fourth, donors need to solve the coordination curse. Donor coordination has been a theme at health and development conferences for so long, it is a cliché. But there’s a reason it keeps coming up, and that’s because it is critically important and notoriously hard to get right.

When President Obama took office, we recognized that the United States Government needed to do a much better job of coordinating with ourselves to start with, as well as our partners and other donors.
For years, health teams within the U.S. Government operated independently. HIV/AIDS teams under PEPFAR would work with a country to develop one plan; USAID, which was the implementing partner for HIV/AIDS, might very well develop another plan; in would come our malaria team, they would develop a third plan, so on and so on. It was enough to make anybody just dizzy.

So we are trying to integrate our programs. And under our Global Health Initiative, each of our country teams now assess how they fit within a comprehensive vision and program, based upon a health plan established by the country where we are operating. And we have worked with partners to develop these health plans in more than 40 countries.

For donors, tackling all these problems will be essential if we want to get more partners back on the path to helping build sustainable, country-owned systems. And this goes for the emerging economies that recently were recipients of assistance but now are net donors. These countries are playing an increasingly important role, and some have shared technical advice and lessons with their developing nation partners. We want to see that expand.

But at the same time, we look to all emerging powers to recognize that with this growing power comes growing responsibility, and they should consider working whenever possible through existing multilateral channels and ensure that the ultimate aim of their efforts is to put more countries on the path to meeting their own needs, not to – figuratively and literally – pave the way for extracting countries’ natural resources.

Now, partner countries have challenges to meet as well. First, I challenge our partner countries to invest more in the health of their own people. If you went to Abuja and agreed to put 15 percent of your national budget into health, we need you to deliver on that commitment. That should be a priority – not just for health ministers, but for all political leaders, starting with presidents and prime ministers to finance and defense ministers. Meeting this commitment will pay off many times over, making it possible to expand services to underserved areas and people, develop your workforce, and even expand economic growth.

And there’s a special opportunity here for those nations that have recently discovered new sources of wealth in oil, gas, and other extractive industries. I urge you to follow the examples of two countries that are not often mentioned together in the same sentence: Norway and Botswana. Both discovered large stores of natural resources. Both dedicated a portion of the income to health and education. And in both cases, their investments coming from their own ground, their own natural resources, are saving lives and lifting up communities. And both Norway and Botswana are very generous in being willing to offer advice and technical assistance about how to do this.

Second, partner countries must take on the flip side of donor coordination. While it’s absolutely true we donors need to do a better job of working together, only one player has the authority to speak about a nation’s needs and orchestrate all the different groups working in a county, namely the national government of that country. So we need you to help identify the needs that aren’t being met and to convene the partners to determine who will fill which gaps. I applaud Rwanda and Ethiopia for their exemplary progress along these lines. Now, I know it is very difficult for many countries, but in the end only you have the power. No one else can do it for you.

Third, partner countries must begin bringing down the political barriers to improving health. That means making regulatory changes that allow faster approval of new drugs, procurement reform to ensure that drugs get to clinics on time, setting and delivering a living wage for health workers.

And it also does mean taking on corruption at every level. We’ve had the very sad experience of negotiating to provide antiretroviral drugs for HIV/AIDS in some countries, and it’s very clear that the leadership of the country wants to make sure that they get their hand in the money for those drugs before it is delivered to the people who need it. And we have been very clear you have to take on corruption – local, regional, national – ensuring that drugs don’t get diverted to the black market.

It means repealing laws that stop progress, like the unfortunate treatment of women in so many places, ending gender-based violence and discrimination, creating true health equality for women and men. In some countries, women and girls are considered inherently less valuable than men and boys and are treated that way by custom and law. In many countries, members of the LGBT community are considered very much outside the mainstream and are treated that way, often therefore not being able to access health services that will benefit them and benefit the larger community. A system with built-in bias against any part of the population is not only unjust, but is unstable and unsustainable.

Now, my own country’s views about this global health work is shaped by what we have learned. As I said earlier, we are very proud that PEPFAR helped create platforms that countries can use to tackle a wide range of health problems. But as many observers have pointed out, PEPFAR did not initially set out to strengthen country systems. Instead, it began by creating a parallel network of clinics that were separately managed and paid for.

That’s a fair point. But let’s remember that in 2003, when the world faced an epidemic unlike any we had seen, HIV/AIDS demanded an emergency response, and the United States had the resources to answer the call. And today, we’ve made phenomenal progress with more than 4 million people receiving lifesaving treatment, 600,000 babies having been born HIV-free, and just last year 40 million receiving HIV counseling and testing.

But we know now it is time to shift from that emergency response to a country-owned model built to last. Last year, when I spoke about the goal of an AIDS-free generation, I made it clear that it could only happen by embracing country ownership. And PEPFAR provides us the framework, because there are five-year plans we have made with nearly two dozen countries to identify their most critical needs, to make joint commitments to meet those needs, and outline steps for transitioning responsibility for their HIV/AIDS programs. Our partners are no longer just recipients. They are now managers of their own response to the epidemic. And what we’re doing extends beyond HIV/AIDS. In Nepal, we have a USAID partnership to drive the expansion of family planning, maternal health, and children’s health. Nepal is now on track to achieve Millennium Development Goal five, as are Bangladesh, Egypt, and other countries.

So I am very pleased that the United States will be a part of the Saving Mothers, Giving Life partnership, along with Merck for Mothers, Every Mother Counts, and the American College of Obstetricians and Gynecologists. We’re not focusing on a single intervention, but on strengthening health systems. We are beginning with projects in parts of Uganda and Zambia, learning what works and how we then can spread it. And I want to thank Norway for your extraordinary commitment, and I am pleased to announce the United States is committing $75 million to this partnership.

There are so many forums where matters of global health are discussed. I think every one of us have been to dozens, probably. But we have to do things differently. We have to be open about the obstacles that we confront. We have to be willing to admit what doesn’t work. We have to be ready to applaud those who point out mistakes or corruption. That kind of dialogue can be difficult. There will be times when we don’t see eye to eye. But it is fitting that we meet here in Oslo City Hall, where the world comes together each year to honor historic accomplishments that further the cause of peace, and think about the men and women who have stood here in this city hall being honored – the organizations like the International Red Cross or Doctors Without Borders.

Norway has long understood that the stability of any nation is tied up in the well-being of its people. And every life we save is a step toward that more peaceful, prosperous planet we seek. I think back to that day when I had my daughter and how fortunate I was. But surviving childbirth and growing up healthy should not be a matter of luck or where you live or how much money you have. It should be a fact for every woman everywhere. And I think we can make this happen, and by doing so, bring the world closer to recognizing that working together we not only can save lives, we can help improve them, bring greater peace, prosperity to all.

Thank you very much. (Applause.)