Main

In July, the US government released its long-awaited strategy for meeting the MDGs. Beyond words, what actions have you taken?

Credit: AFP Photo/Rod Lamkey Jr

This administration has really been aggressive about putting in place major initiatives to achieve the MDGs, especially in those areas where the trend line has not been as effective as we would like overall. For example, there is an MDG around food and hunger, but over the last several years we've actually seen an increase in the number of people who go to bed hungry every night. And so we've launched the “Feed the Future” initiative, which is structured to mobilize $3.5 billion of our resources and also up to $22 billion of resources from donors and partners around the world to support countries to sustain and improve their agriculture, food production and ability to support nutrition. We've also launched a $63 billion global health initiative, which is our effort to really say, “we want to save the most lives as we possibly can in the most sustainable way. And we want to do it with a real preferential focus on women and children, and re-invest in maternal health, in child health, in family planning and in nutrition.”

Given your background in agriculture, how do you see food security and nutrition as key elements to tackling disease?

We know the links are very strong—actually, the links are strong in both directions. People who have better nutrition are less likely to be suffering from mortality or morbidity related to diseases. In fact, up to 65% of child mortality is caused by kids not having the nutrition to mount an effective immune response and to protect themselves from infections and other preventable diseases. So, we know that if we can get better micronutrients and get better total nutrition into kids in particular, we know that we can save many, many, many lives, and we know that we can do that in a more cost-effective way. Similarly, we know having healthier populations can contribute to food production and improved economic outcomes that then lead to improved nutrition. So it works in both directions, and we're committed to making that link a productive one.

What lessons do you bring from your seven-year tenure at the Bill & Melinda Gates Foundation?

One thing I really learned there was how to be very cost oriented in spending resources to generate outcomes. The reason we spent so much time and effort and energy on immunizations and vaccine was because you could save a child using vaccination as a strategy for somewhere between $15 and $80 per year of life. That's an incredibly affordable way to buy improved health outcomes. And while we don't always want to talk in those terms, we need to be able to justify how we spend every tax dollar. Bringing that rigor around results and around cost analysis has been something that I've been excited to do here at USAID.

How do you plan to move science and technology forward at USAID?

When you look at areas where progress is too slow to achieve the MDGs by 2015, you recognize right away that simply doing more of what we've been doing is not going to get you there. So, we've already launched an office of science and technology, and we're supporting a range of grand challenges in global development to support more innovation in science and technology and the appropriate use of those innovations in resource-poor settings. We want to help local entrepreneurs and local public sector leaders—local doctors, local nurses, local agricultural workers—really expand the use of these types of breakthroughs so people are ultimately benefiting. At the end of the day, the last thing we want to do is create a lot of new innovative technologies or approaches that end up sitting on the shelf. We want to get these things used to scale so we can reach tens of millions of people.

What have you learned from your experiences in Haiti?

A lot of people told me when I joined USAID that the agency moves slowly and is not often able to do things outside of the box in a very innovative way, but Haiti taught me the exact opposite. I saw an agency just stand up and solve problem after problem. And I'll give just you one example: when we were trying to get safe drinking water to the people of Port-au-Prince, we wrote some innovative contracts that asked truckers to also distribute chlorine tablets. As a result, more people have access to clean drinking water in Port-au-Prince today, and the rate of diarrheal illness in Port-au-Prince is 12% lower than it was pre-earthquake. That's an incredible achievement, and it's an achievement that happened because some members of our team had studied the data and the evidence, and they knew how to change the way we operate in order to innovate and create that outcome. My goal at this agency is to enable all of our people to be that entrepreneurial in getting this work done and, in the process, to use our taxpayer dollars better to generate real results.