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USAID’s Battleground: Expanding Access and Strengthening Health Systems

Administrator Shah: “Our experience with GHI has made it clear: our largest opportunities to improve human health do not lie in optimizing services to the 20% of people in the developing world currently reached by health systems; they lie in extending our reach to the 80% who lack access to health facilities. That is where the success of everything I’ve discussed today will be determined.  That is our battleground.  And I am proud to say: that is where USAID will lead the fight.”

Today, in a packed auditorium at NIH, Administrator Shah outlined a global health agenda around five transformational goals.  Dr. Shah believes that we can achieve the following by 2016: save the lives of over 3 million children; prevent more than 12 million HIV infections, avert 700,000 malaria deaths, ensure nearly 200,000 pregnant women can safely give birth, prevent 54 million unintended pregnancies, and cure 2.4 million people infected with TB.  To achieve these ambitious goals, he emphasized the need to strengthen health systems by empowering community health workers and midwives by equipping them with better diagnostics and treatments.

As part of the President’s Global Health Initiative, USAID helps countries integrate their health systems across WHO’s six health system “building blocks” (human resources; medical supplies, vaccines, and technology; health financing; information; leadership and governance; and service delivery) and within their national infrastructure.  Recent activities included: strengthening health care financing in Armenia, Azerbaijan, Georgia, and Senegal through the use of national health accounts; helping nine countries implement human resource information systems; and instituting performance assessments to raise standards for HIV services in six Central American countries.

USAID in the News

February 8, 2011: In an editorial, Voice of America writes that 50 years after USAID was created, the agency still remains a vital actor in U.S. global presence. VOA also notes that USAID “has become a quiet force for progress: preventing disease and disasters, stabilizing societies and expanding free markets, and changing with the times to best serve the people of the developing world.”

February 11, 2011: Voice of America reports that private businesses are being encouraged to assume a greater role in development efforts as part of the Obama administration’s agricultural development initiative. In an interview with Voice of America, USAID’s Greg Gottlieb, head of the food security bureau, stated that the agency is looking towards economic growth as a way to increase development. “We want to work more with the private sector than we have in the past.”

USAID in the News

Weekly Briefing (1/31/2011–2/4/2011)

January 31 Reuters reports that at the World Economic Forum in Davos, Switzerland, the world’s preeminent companies announced a major plan to invest in agriculture projects in Tanzania and Vietnam. USAID Administrator Dr. Rajiv Shah championed the plan, stating “we believe it is smarter and more efficient to support agriculture than to prevent the more costly famines, food riots and failed states that we will face if we do not make these investments.”

January 31 The Washington Post reports that new contracts from USAID have been awarded to Cardno Emerging Markets of Arlington and Chemonics of DC for professional, administrative, and management support services.

February 2 Foreign Policy’s “The Cable” blog reports that Senator Lindsey Graham, who is expected to be named the ranking Republican on Senate Appropriations’ State and Foreign Operations subcommittee, plans to “use his position…to increase State Department and USAID funding for Afghanistan, Pakistan, and Iraq and increase the civilian side of various military-civilian partnerships.” Senator Graham noted that the State Department and USAID “help win this struggle against radical Islam.”

February 3 In an editorial, Voice of America reports on USAID’s new approach to development and cites USAID Administrator Dr. Rajiv Shah’s recent speech at the Center for Global Development. During his speech, Dr. Shah said that, thanks to a series of reforms called USAID Forward, “our agency is fundamentally changing, becoming more efficient, more effective and more businesslike.” He added, “We are seeking to build something greater: a modern development enterprise.”

February 3 In a blog posted on The Huffington Post, President of the Kraft Foods Foundation Perry Yeatman supports USAID’s new reform efforts and describes how “inspired” she was by USAID Administrator Dr. Rajiv Shah and his perspective on U.S. foreign assistance. Speaking at Davos, Dr. Shah said that USAID’s work is not just “from the American people” but actually “for the American people.”

February 4 The Washington Post reports that U.S. Senator Lindsey Graham could soon be in a leadership position to support USAID. Final decisions have yet to be made, but if Graham is named the ranking Republican on the Senate Appropriations subcommittee on state and foreign operations he will be in a key position to make the case that US national security considerations
“require a fully financed diplomatic and development effort.”

From the Field

In Kenya, partnering with Pact Kenya we will hold a Trauma Healing and Social Reconciliation Workshop to develop a team of trainers/experts in the region to enhance the sustainability of people to people/social reconciliation processes.  By helping individuals deal with trauma, we hope to improve relationships between communities in the area and create environments more receptive to peace-building interventions.

In Tanzania, along with the Ministry of Health and Social Welfare and DFID, we are procuring $10 million in contraceptives to avoid stock-outs.  The event will be used as a platform to advocate for adequate budgeting and disbursement to ensure contraceptive supply in public sector health facilities.  We will also use the event to highlight the positive outcomes from donor partnership and coordination.

In the West Bank, we will hold our biannual press round table to update the local West Bank media of USAID activities in the area.  We will do the same in Jerusalem with Gaza journalists.

USAID In the News (1/24/2011–1/28/2011)

January 24: In an exclusive interview with Foreign Policy’s “The Cable” blog, USAID Administrator Dr. Rajiv Shah responded to calls from Republicans in Congress to cut development and foreign aid, stating it would undermine US national security. Shah explained that it would not only put USAID’s reforms in jeopardy, but have “real and drastic negative implications for American power and the ongoing missions in Afghanistan and Pakistan.”

January 25: The Washington Post published a story on USAID Administrator Dr. Rajiv Shah’s recent speech at the Center for Global Development. The Post reported that Shah outlined a new vision for USAID with the goal of replacing the agency over time by “efficient local governments, by thriving civil societies and by a vibrant private sector.”

January 26: The Huffington Post published an op-ed by USAID Deputy Assistant Administrator for Africa Larry Garber on the recent election held in Southern Sudan. In the piece, Garber underscored the importance of the vote and how significant it is given the challenges the region has overcome in recent years.

January 27: Foreign Policy’s “The Cable” blog presented statements made by State Department’s outgoing Director of Policy Planning Anne-Marie Slaughter arguing for the increase of funding for USAID and the State Department.  She called for budget increases in targeted areas for certain USAID and State programs in order to implement crucial reforms and streamline the system.

‘Modern Development Enterprise’ – A Major Address by Administrator Shah

As featured in the White House Blog

Last week, USAID Administrator Dr. Rajiv Shah gave a major address to over 200 non-governmental organizations, think-tanks, academics, and international development leaders hosted by the Center for Global Development. The text of the speech as prepared for delivery can be found here.  Dr. Shah’s speech on The Modern Development Enterprise addressed the current state of development and formally announced the Agency’s 50th anniversary.

In his speech, Dr. Shah recognized the important role of religious and community groups in providing assistance to those most in need around the world. I thought you’d be especially interested in the excerpts below:

  • American Values:  When we prevent violence in Southern Sudan, we’re not just avoiding future military involvement; we’re also expressing America’s values.  When schoolchildren organize bakesales to pay for anti-malarial bed nets, they are expressing America’s values.  When more American families gave money to the Haiti relief than watched the Super Bowl, they were expressing America’s values.  When church groups across America raise money and volunteer to support children orphaned by AIDS, they are expressing America’s values.
  • Communities of Faith:  I’m proud to know that USAID is one of CRS’s largest supporters.  But I’m also proud to know that we support a wide-range of faith-based organizations, from Samaritan’s Purse to the American Jewish World Service. Organizations of faith not only express the moral values of millions of Americans, they also provide some of the most dependable support systems for millions in the developing world. In Kenya for example, 30% of all healthcare services are provided by Christian Hospitals.  Our success depends on listening to communities of faith, connecting with them deeply, and supporting the vital work they perform around the world.
  • Food Security:  Instead of merely providing food aid in times of emergency, we are helping countries develop their own agricultural sectors, so that they can feed themselves.  We launched Feed the Future – bringing together resources across the federal government and engaging in deeper partnerships to extend the impact of our efforts.  We are now leveraging more investment from countries themselves and from other donors.  Firms ranging from General Mills to local African seed companies are all doing more.  As a result, in just five of our twenty focus countries we will be able to help nearly 6.5 million poor farmers – most of them women – grow enough food to feed their families and break the grip of hunger and poverty for tens of millions of people.
  • Global Health:  In our Global Health Initiative, instead of a scattered approach that fights individual diseases one at a time, we are pursuing an integrated approach that will generate efficiencies and strengthen health systems.  We are now working with partners such as the NIH, CDC and PEPFAR to leverage recent advances in science and technology, especially in high return areas such as vaccinating children, preventing HIV, malaria and TB and focusing on childhood nutrition during pregnancy and the first two years of life.
  • Smart and Transparent Investments:  I want the American taxpayer to know that every dollar they invest in USAID is being invested in the smartest, most efficient, and most transparent way possible.
  • 50th Anniversary:  This year, USAID will celebrate its 50th anniversary. Our legacy is filled with incredible accomplishments. Throughout those fifty years, we have contributed greatly toward ending an incomprehensible measure of human suffering, and I urge you to learn more about our Agency’s rich legacy through our newly launched anniversary Web site, http://50th.usaid.gov.  But if I am lucky enough to live another 50 years, I hope I am also lucky enough not to witness our centennial. Instead, I hope we will be commemorating the success of USAID’s mission.

Ari Alexander serves as Deputy Director at the Center for Faith-based & Community Initiatives and the Coordinator of Global Engagement.

USAID’s January Frontlines

FrontLinesRead the latest edition of USAID’s premier publication, FrontLines for these stories:

A farmer in Balochistan, Pakistan, displays wheat affected by wheat stem rust, a disease that can destroy a significant amount of crops. USAID is working in the agriculture sector here and in other parts of Pakistan to prevent the damage caused by the rust. Photo credit: USAID

Read these stories and more in the new issue of FrontLines. If you would like to automatically receive FrontLines every month, you can subscribe here.

In the News (1/18/2011–1/21/2011)

January 18: In a profile piece, The Washington Post highlighted the work of a senior USAID official and his experience in Afghanistan, Pakistan and Burma. The USAID employee stated that he has been “very fortunate to have worked on important foreign policy priorities.”

January 20: In an interview with Reuters, USAID Administrator Shah said he plans to cut millions as the Administration looks to make budget cuts and as the agency seeks to restructure itself. Dr. Shah argued that administrative changes save about $65 million in operating expenses, and added, “We’re actually embarking on perhaps the most aggressive operational reform of a major federal bureaucracy. If we get the support for it, we will save American taxpayers hundreds of millions of dollars over time.”

January 21: UK’s The Guardian newspaper reported that in a major speech given on January 19, USAID Administrator Shah stated that the agency plans on cutting costs and becoming more business-like in an effort to gain public and congressional support for US foreign assistance.

Moving the Business of Development Forward

Guest post from Sara Messer of ONE. Originally posted on The ONE Blog

Sara Messer, ONE’s policy manager for aid effectiveness, had a chance to speak to USAID Administrator Raj Shah about a few new changes at the agency and how ONE members can help. Watch her exclusive interview in the video below.

During an exciting and provocative speech hosted by the Center for Global Development yesterday, (watch the full speech here), USAID Administrator Raj Shah explained how his agency is transforming into a “modern development enterprise.”

Last year, USAID unveiled a slew of reforms, labeled USAID FORWARD, that fundamentally change the way the agency works in order to become “more efficient, more effective and more business-like.” Mr. Shah has already begun implementing many of these reforms, which include a renewed focus on results through stringent evaluations, a change in business and procurement practices to gain efficiency, and a spotlight on science and innovation to create better, more cost-effective development tools.

What is prompting all of these changes? Now more than ever, many realize that development is not just an idealized notion, but “is as critical to our economic prospects and our national security as diplomacy and defense.” At a time when every government agency and program is under scrutiny for their effectiveness and cost savings, Mr. Shah made a compelling case for the continued support of USAID’s mandate. By promoting and supporting economic growth and good governance in developing countries, the US is creating new markets for our exports, strengthening valuable partners in the fight against extremism, and promoting American values of generosity and goodwill. The US cannot afford NOT to lead the way in responsible and accountable global development.

How will this happen? To fulfill this obligation, Mr. Shah announced a number of even newer changes that USAID is making to its workforce, its strategy and its implementation plans.

  • To be accountable to both taxpayers and beneficiaries, USAID is rolling out a new evaluation process conducted by independent evaluators and measured against baseline data with results published within three months on the new USAID Dashboard.
  • To ensure the successful implementation of reforms and signature initiatives like Feed the Future and Global Health, USAID will continue to strengthen its staff and skill-sets, including an increase in mid-level hiring to bring in more qualified technical expertise.
  • To improve efficacy and impact, USAID is making tough decisions on resource allocations, planning to scale back or close missions in countries that are graduating as aid recipients and focusing resources on “critical” regions where needs are greater and impact can be maximized.
  • And finally, to improve efficiency and save costs, USAID is reforming its contract and implementation processes. Administrator Shah was firm in his resolve to demand real accountability from partners and contractors with which USAID works, to increase competitiveness and to fund more local NGOs and entrepreneurs that will ensure sustainability of development investments in the long-term.

Perhaps most telling was Mr. Shah’s recognition that the business of development is to put itself out of business. He acknowledged that “we must seek to do our work in a way that allows us to be replaced over time by efficient local governments, thriving civil societies and vibrant private sectors.” As USAID celebrates its 50th anniversary this year, we all look forward to a future 50 years from now when the agency will have fulfilled its mandate and is no longer necessary.

Week 9: The Modern Development Enterprise

50th anniversary logo

Today, USAID is fundamentally changing—becoming more efficient, effective, and businesslike—which ultimately helps our investment dollars go further.

Our effort to transform how development is delivered reflects the beliefs of the President and the Secretaries of State, Treasury and Defense: development is as critical to our economic prospects and our national security as diplomacy and defense.

We have an obligation to make sure our reform efforts go beyond building an updated version of an aid agency. We are seeking to build something greater—the world’s first modern development enterprise.

Executing a Clear and Focused Strategy. Like an enterprise, we are developing and executing innovative and focused strategies across our areas of excellence.

We recognize the enormous development progress the world has made in recent decades. But we also realize that more has to be done, and more of the same will not be enough. We must embrace a spirit of innovation to change the way we work.

  • Food Security. Instead of merely providing food aid in times of emergency, we are helping countries develop their own agricultural sectors so they can feed themselves.
  • Global Health. We will transition away from a scattered approach that fights individual diseases one at a time; we are pursuing an integrated approach that will generate efficiencies and strengthen health systems.
  • Disaster and Crisis Response. Based on lessons learned in Haiti and Pakistan, we’re reforming our approach to disaster assistance to speed the time between response, recovery and long-term development.
  • Economic Growth. We are rejecting the traditional assumption that a series of development projects alone will lead to growth and are instead developing partnerships for growth with countries committed to enabling private sector investment.

 

  • Democracy & Governance. Instead of merely paying to hold elections, we are now funding new open government technologies to quickly and significantly increase transparency, so citizens can hold their own governments accountable.

We are bringing a similar spirit of innovation, science, technology and strategic thinking to areas such as education, water, and climate. In each of these core areas, we have already or will soon release comprehensive strategies that detail how we can achieve development gains faster, more sustainably, and at lower cost so more people can benefit.

Measuring and Evaluating Our Work. Like an enterprise, we are relentlessly focused on delivering results and learning from failures. USAID used to be the world leader in development evaluation, but we have fallen from that distinction.

We are working to ensure we’re spending American taxpayer money in the most responsible way possible. To help meet this goal, we’ve introduced an evaluation policy that will set a new standard in development. This policy includes:

  • Independent third-party evaluation of major projects;

 

  • Baseline data collection and study designs to measure our actual impact in the field; and

 

  • Public release of evaluations within three months, whether they indicate success or failure.

Delivering Shareholder Value. Like an enterprise, we are focused on delivering the highest possible value to our shareholders—the American people and the Congressional leaders who represent them.

We have created a suspension and debarment taskforce to monitor, investigate, and respond to suspicious behavior among our contractors and partners.

We will also deliver savings by reducing our footprint in countries where development successes have created the conditions where American assistance is frankly no longer necessary. By 2015, we believe USAID can graduate away from assistance in at least seven countries, starting with Montenegro in 2012.

Serving Our Customers. Like an enterprise, we are listening to and improving the way we serve our customers—in our case, the people of the developing world.

We seek to do our work in a way that allows us to be replaced over time by efficient local governments, thriving civil societies and vibrant private sectors. We have launched aggressive procurement and contracting reforms, and to improve competition, we’ve announced that no contract extensions in excess of $5 million will be non-competitively granted without the personal clearance of the USAID Administrator.

As USAID approaches its 50th anniversary this year, we are reflecting upon about the ultimate benefits we’re delivering. We’re not only helping the people we serve, we’re creating jobs for Americans, helping keep us safe at home, and reflecting our core American values.

We create economic opportunity by helping develop strong trade partnerships in countries that will be the growing markets of tomorrow—relationships that create jobs here at home.

We keep America safe by playing a direct role in national security—working directly with the military to help stabilize volatile regions like Afghanistan and Pakistan, or preventing conflict in Southern Sudan.

And our work reflects our American values—working with students, families and communities of faith to address the needs of the developing world.

Ultimately, creating the modern development enterprise will help advance prosperity and security both in the developing countries that need it most, and within our own borders. This reflects the beliefs of both President Obama and Secretary Clinton—that together we have the power to create the world we seek if we have the courage to embrace the opportunity.

Now is the time to invest in USAID’s capabilities, so we see the day when our assistance is no longer necessary.

If you missed the speech, you can see it here.

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