Remarks by Administrator Rajiv Shah at the Population-Level Behavior Change Evidence Summit

Monday, June 3, 2013

[Remarks as Prepared]

I’m sorry I missed Ariel’s discussion with Oscar the Grouch yesterday. For decades, Sesame Workshop has helped kids around the world learn to read, to respect other cultures, and understand the importance of good, healthy behaviors—like washing your hands.

It’s a little surprising that kids learn these lessons from someone who lives in trashcan, but it works.

Today’s discussion is one of the most important we can have—bringing the world’s experts together in a room to ask, “What don’t we know?” “Why” and “What can we do about it?”

These evidence summits were started more than two years ago. At the time, we had just recently rebuilt our Agency’s policy capacity—and we envisioned these summits as opportunities for scholars and development professionals to put their heads together to ensure that state-of-the-art research and evaluations informed our work every day.

Since then, we’ve hosted summits on effective approaches to counter-insurgency, broad-based economic growth, the role of technology in agriculture, and reimagining the field of microenterprise.

Last year, our Global Health team, alone, hosted three separate summits—and today continues that important example.

In fact, this is an especially important moment to be holding this summit. One year ago, here in Washington, DC, the global community came together at the Call to Action in Child Survival to rally behind the goal of ending preventable child death. It was a significant event—as disparate communities came together behind a single, comprehensive, results-oriented goal.

Most importantly, it was a goal that was led by developing countries themselves. Today, local leaders in nations like Nigeria, Ethiopia, India, Yemen, and Burma have mobilized their communities around evidence-based plans of action and clear report carts to track progress.

Ultimately, of course, our aspirations must translate into real results on the ground. And as you have been discussing over the past two days, social and behavior change lies at the very core of this effort.

This past January, I had the chance to see this for myself when I visited Nigeria—where 756,000 children die every year before turning five. While Nigeria only accounts for 2 percent of the world’s population, it contributes about 10 percent of global maternal, infant, and child deaths.

Last summer, when the Nigeria Ministry of Health conducted evidence-based modeling on child mortality in the country, they discovered that diarrhea was killing many more children than anyone had realized. When they looked deeper, they found that oral rehydration solution and zinc—a treatment that’s been around for decades—was reaching less than 2 percent of Nigeria children.

Nigeria isn’t alone. Across the world, life-saving interventions are not reaching the lives they need to save.

Worldwide, only 39 percent of infants are exclusively breastfed.

Only 31 percent of children with suspected pneumonia receive inexpensive antibiotics.

And only 35 percent of children with diarrhea receive oral rehydration therapy.

This is an unacceptable reality—especially because we know that simply by scaling up a dozen proven interventions—like oral rehydration and zinc—we could prevent 1.8 million child deaths every year.

Now, this doesn’t just mean addressing the supply side.

It also means addressing the demand side—ensuring that parents know about and take advantage of simple steps and tools to protect their children.

We’ve seen very good evidence that it can work: In Tanzania, we saw overall under-five mortality drop 45 percent in a single decade in large part due to the scale-up of malaria control interventions, like bed-nets.

Power to Change

We also know the potential for new social norms to transform child survival across the world—even in the toughest places, like Yemen and Somalia.

In our generation alone, we’ve seen seismic shifts in behavior around child marriage, girls’ education, vaccination, and smoking. Today, we have within our grasp the power to affect real change.

We can use mobile technologies to educate and empower women in the most remote corners of the world.

Today, through our Mobile Alliance for Maternal Action—MAMA—women receive timely, customized information throughout their pregnancy.

As a result, expectant mothers remember to take their vitamins;

New fathers understand the importance of breastfeeding;

And infants sleep under bednets every single night.

Before you know it, an entire generation of healthy children has grown past the age of five.

That’s the challenge before us—not to rest on old assumptions but to devise new approaches that bend the curve of development to dramatically accelerate progress.

As you’ve been discussing the last two days, behavior change research can and should be on par with medical research. I know it is a complex prospect, with real hurdles when it comes to measurement and attributing success to specific interventions.

But regardless of its complexity, we can use clear methodology and scientific rigor to understand exactly what works and how we can scale it up.

It’s true we live in a world of tighter budgets—but even in this world, we can identify efficiencies that deliver incredible gains.

In fact, that is precisely the discussion that is taking place today around food aid. By shaping a more agile, cost-effective program that harness the new tools in the fight against malnutrition and hunger, we can modernize our program in a way that saves millions more lives without asking for more money.

For example, we know that chronic malnutrition accounts for over 35 percent of preventable child death—and that high-quality, high-nutrition foods during the first 1,000 days of life can make all the difference.

In fact, over the last year, we have reached 12 million children through nutrition programs that have reduced anemia, supported community gardens, and treated acute malnutrition.

And we are developing the next generation of American food commodities to meet the diverse needs of an entire population, from a nursing mother to a malnourished child.

Ending Extreme Poverty

It is this vision—of a world where every child has the nutrition and care they need to thrive—that President Obama set forth in the State of the Union address earlier this year, when he called upon us to join the world in ending extreme poverty in the next two decades.

But we won’t get there by throwing a couple ideas against a wall to see what sticks. We need science, and technology, and rigorous approaches informed by the best evidence and sharpest thinking of our day.

I know I can count on this group to ensure that our scholarship and studies don’t sit on a shelf—but translate into real and lasting impact for millions of people around the world. And I know I can count on this group to continually push the boundaries of our knowledge—to harness new approaches and technologies to affect transformational change in societies.

It isn’t easy—I know. I was in a meeting on Burma recently in the Oval Office, where the President keeps a plaque on his desk that says, “Hard things are hard.”

Ending preventable child death is hard. And ending extreme poverty is harder still. But like most things in life, the hardest challenges deliver the greatest dividends—for our children and generations to come.

I look forward to hearing in greater detail the outcomes of your discussions over the past two days.

Thank you.

Last updated: November 19, 2014

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