Good morning. Thank you. That’s very kind of you, and it’s wonderful to see you, to be here and experience your energy and commitment, and to have the opportunity to spend this morning with you. Thank you for everything you do as part of this awesome coalition that is making a huge difference in every part of our world. Thank you for your efforts. I want to acknowledge Joanne for her leadership.
Joanne, you’ve been a great leader and someone who is willing to take on the mantle of change and the need for us to constantly improve the way we work, so that we can assure you that when you’re advocating for more resource, more focus, more effort to fight against the consequences of extreme poverty, that those of us tasked with the responsibility of ensuring that those resources deliver results are holding our own feet to the fire every single day. That’s what I’d like to talk to you a little about today. I’m thrilled that my friend Seth Berkley and my other friend Jim Kim are all speaking with you this morning about what’s possible, because what’s now possible is genuinely extraordinary.
This is a photo of a mother in Kenya in a GAVI supported health clinic. No one in this room needs further convincing that the effort to get every child on this planet safe and effective vaccines to save their lives is amongst the most cost-effective things we can do to make the world a better place. Your efforts in this RESULTS conference comes at the start of, for us, child survival week. It’s an incredibly exciting week for us, as Joanne just noted, as we outline a new approach to our work.
Some big goals that we hope to achieve lie just ahead, and for us to be successful, you have to lead this effort. When others are cynical, you have to see possibility. When others believe that our politics are incapable, you have to force people to work together. And when others want to slow down and wait until the next election to get things done or to put resources into saving children’s lives, you have to insist on performance right now.
And I have faith in you, because in the 1980s your efforts secured tens of millions of dollars for the universal child immunization act, getting more than 10 million children vaccines and saving 125,000 lives.
In the 1990s, you organized more than a million people to hold a candlelight vigil across 75 different countries, helping to create the first UN World Summit for Children that created the foundation for the millennium development goals and gave us confidence that the world could come together around those big, grand aspirations.
And over the past decade, even at times of great fiscal constraint, you’ve garnered significant support for, as Joanne noted, high-impact interventions that expand access to things that work, from Vitamin A to low-cost vaccines, to malaria bed-nets, so that more children survive even if they are poor. And for these efforts, you’ve earned a reputation of strong bipartisan support, speaking truth to power, insisting on results, and on making sure that your elected leaders continue to actually lead.
And so, as you go into what I believe is something on the order of 300 meetings on Capitol Hill, I want to encourage you to play the role that you’ve played when David Obey was Chairman of the Appropriations Committee and created the first ever child survival fund; to play the role that you played when Nancy Pelosi first created funding for an international HIV/AIDS effort; and to play the role that you played in bringing together Senator Leahy and Senator Coburn to successfully lobby for an increase in malaria funding for the first time in a long time just a few years ago.
Those are important wins, and you have a moment right now to build on that legacy of success and performance. Thanks to you, for the first time in history—truly the first time in history—we can envision a world without child death and mothers dying in childbirth on a large scale. It’s an extraordinary reality, and when you understand, as you do, what that actually means in the lives of families all around the world, you know that that will create a more stable, more just, more secure world in every part of the planet.
This next slide is of a mother and a child at a hand-washing and sanitation program in Burma. In the past, we have too often focused on specific initiatives in specific areas and failed to bring them all together to explain to the world what’s possible when we bring together our all too fragmented community.
Instead of lobbying for a single disease or a single intervention or a single solution, when we come together around a major millennium goal, when we come together to do something as grand and as important as ending preventable child death, we can get that done. We now know that there are proven solutions that have been around for decades – Vitamin A, oral rehydration, Zinc—for diarrhea that can reach children and help us save more lives at dollars or pennies per dose.
We know that in the critical window of a 1,000 days, we can provide the nutrition so children have the basic immune strength to protect themselves from simple diseases against which they would otherwise die, and we know that simply trying to address diseases without also making sure these children are well nourished simply won’t achieve the outcome we seek. And we know that healthy behavior such as the one being promoted in this photograph are essential to success, even if we have enough resources for the commodities, the drugs, the diagnostics that are often what we talk about in price. It’s ultimately the way people behave that determines whether or not our goal, our shared aspiration of ending child death, is actually possible.
This week, we will launch a child survival report and initiative, based on two years of work since the child survival Call to Action here in Washington in June 2012. And what has happened since then? At that meeting, more than 80 countries, members of the faith community, members of the private sector, came together and said, “It’s possible to end preventable child death by 2030 or 2035.”
Since then, more than 176 countries have signed the pledge to lead this fight. What that means is that nations like India and Ethiopia, both of whom are represented here this week, created report cards, moved resources from middle class and upper class communities to reach the very poor, moved resources from things where we couldn’t count the impact of the investment, to reaching children with proven interventions that save lives—in India’s case, in 132 target districts where children were dying at too high rates relative to the rest of the nation. Countries across the board— I went to Yemen, on a visit that wasn’t supposed to be about health, and when I got there, President Hadi told me, “You know, I’ve got a health minister and a whole team that were at some meeting you hosted. They’re inspired. They want you to sit down with them so they can show you their child survival plan in Yemen. We want to show the world that even though we’re going through a difficult political crisis right now, we can lead on behalf of our children, our women, our families in our part of the world.” That’s the kind of country leadership that you’ve inspired, and that’s the kind of country leadership that can help us all achieve this goal.
So the next question is, what have we done as donors, as partners, as initiative leaders, to do our part to help these countries that are now committed, that now have plans, that now measure and report on results, that now bring their private sector into the system to co-lead these efforts with them? The answer, we will reveal on Wednesday. We had a review conducted by a Blue Ribbon Panel, headed by Ray Chambers, the UN Special Envoy for Secretary General Ban Ki Moon, as well as a panel that includes distinguished private sector leaders such as John Megrue and Jeff Walker, former members of congress such as Senator Bill Frist and Senator Harris Wofford, health and development experts such as our favorite people Paul Farmer and Helene Gayle.
We narrowed our effort. We said, “We’re going to focus.” We shut down health spending on maternal-child health in twenty plus countries around the world, in order to focus on those 24 that account for more than 70 percent of all maternal and child deaths, because if we‘re going to spend our money, we want to spend it where it will deliver the biggest impact and the biggest amount of lives saved. Because we learned we can deliver better results in partnership with the private sector, we’ve embarked on hundreds of new public-private partnerships, some new ones I will announce on Wednesday, to bring big companies and small local entrepreneurs into the tent of people fighting against preventable child death, and doing it with a focus on logistics, on operational excellence, and on reaching those hard to reach children that are very, very far from where there are health services that can help them save their lives.
And later this week, we will announce an additional $500 million award to help make sure that the technical expertise and the measurement systems exist so that when America leads in efforts to end child death, we have data and results to show for it. Those are important efforts to help us ensure, as our report will illustrate, that the expanded investment we intend to make over the next 18 months will save a significant number of additional lives, and it will be the first time, and I think this is important for you as you are up on the Hill and as you’re talking to potential supporters, it will be the first time in a while that the United States of America will be able to say that for every dollar we spend on child survival, we can measure the attributed amount of children whose lives we are saving, and that we are maximizing against that number because we reviewed more than 260 grants and contracts and will be reallocating billions of dollars from things that did not allow us to guarantee results to things that will allow us to quantify the number of lives saved.
That is a little bit technical, and folks don’t want me to get into too much detail, but I now that that means a lot to you, and I know that you need to be able to go onto Capitol Hill and say, “America can lead this fight for the next 15 years because we’re putting in place a management system and a technical capacity to lead it with absolutely results oriented excellence.”
Here is what that then looks like when we’re successful. This is a chart that just shows you the pace at which child mortality could come down between now and 2020. When we’re successful, when we come together, these results can be remarkable. You look at that chart, you will notice the lines kind of get steeper at this point in time, right now, because that’s when we are reallocating resources. That reflects an almost 40 percent increase in spending on maternal and child survival under President Obama then in the past, if you look at the past four years compared to the four years previously. That reflects the new technologies and the new business orientation towards saving children’s lives that we are now, as a global community, capable of.
And while I like the charts and the data and the points at which curves get steeper, what actually matters is that for millions of parents around the world, they will no longer have to endure the unspeakable tragedy of losing children to diseases we know how to prevent. For mothers, it means the confidence to plan for their families and not be afraid as they go into what should be a special moment of giving birth, when in too many parts of our world it’s still a moment of absolute fear and terror. And for children, it means the opportunity to pursue a full life.
You can’t go to school with debilitating illness. You can’t learn if you’re hungry. And you certainly can’t imagine communities being stable and moving out of poverty if too many children die before they ever experience their fifth birthday.
So thank you. Over the past decades, you’ve saved millions of child lives. Alongside our partners, we’ve driven down newborn deaths by more than a third by working together. Each day this year, 17,000 more children will live than 20 years ago because of, in part, your efforts and the movement you started. So as you go into this week, I hope that you will remember that your leadership makes a difference, your voice counts and needs to be heard. We can do everything we can, as public sector managers of resources and as stewards of taxpayer dollars, to make sure we deliver results and outcomes, but we need you to inspire the political leadership that now, not two years from now, not five years from now, not ten years from now, is the year to act to get that inflexion in the curves. It’s the year to act to make sure we have significant additional resources in child survival that can deliver results. It’s the year to act, if we want to achieve the millennium development goal and drive the goal further, so that we genuinely end preventable child death.
Q and A
Liz Berry: My question is on the Scaling Up Nutrition: First 1,000 Days Initiative. Since that has been rolled out, my question is how has AID changed its approach? The next part of the question is where would you like to lead AID and how can results support you?
Amy Bartlett: Thank you Dr. Shah for your inspiring words and your leadership on this portfolio. It’s really amazing to be here to see that. My name is Amy Bartlett. I’m executive director of RESULTS Canada, and I had the privilege of hearing you speak about a month ago at the Maternal, Newborn and Child Health Summit that was in Toronto. At that, we at RESULTS Canada and our citizen advocates in the country worked tirelessly with the government to secure that $3.5 billion commitment for maternal and child health. What advice do you have for us in the room and for the RESULTS network globally to mobilize more funds for child and maternal health, building on that momentum, and advocating for this issue?
Rajiv Shah: Thank you for all those questions. First on nutrition, your efforts to focus in on the first 1,000 days have made a tremendous difference. As you know, at the G8 summit in London, I announced that the U.S. had committed to $1 billion to nutrition-specific interventions across all of our programs, in agriculture, in food security, in efforts to improve access to water and sanitation, and in critically important global health programs.
As we’ve deployed that billion dollars, it was over a three year period, we have focused in on the 1,000 days. So we are reaching more pregnant women with higher quality food products all across the world. And it’s important to recognize that, because the United States is a leader in creating the improved food formulations that we are able to now get to tens of millions of people who need them every year. Some of those are produced locally, which is my preference, because it creates economic opportunities for farmers and food businesses. Some of those are produced right here, and I visited Rhode Island with the entire Rhode Island delegation and saw the pride in the faces of 70 or 80 employees as they saw that the Nutributter-like product that they were developing was getting out into poor communities and helping women be adequately nourished during their pregnancy and their children during the first two years of life. So, I want to encourage you to continue to focus there.
The United States is far and away, in part because the history of our foreign assistance started with food, the leader in getting adequate nutrition to women and young children, and we have a responsibility to continue that leadership as a main driver of the results that I was speaking about when it comes to child survival. In terms of what we can do on the funds, and the Canadian announcement, I was with Prime Minister Harper, and I was very excited about it. I served on his Commission for Maternal and Child Health coming out of the Muskoka Summit at their G8. During our G8 at Camp David, we hosted leaders and reenergized the focus on an integrated approach.
I think you gotta realize something you already know. The United States is the leader in child survival. We commit nearly two-and-a-half to three billion dollars a year in child survival. So the quality with which we expend those resources is probably the global determinant of large-scale global outcomes. And quite frankly, a few years ago, we were way too distributed and way too distracted, taking on far too many goals and objectives as opposed to integrating our efforts and focusing specifically on driving down the number of child and maternal deaths as aggressively as possible in the places where kids were actually dying, and in the quintiles of population, which are the very poor, that suffer the greatest under five child mortality rates.
That massive restructuring of how America deploys $2.5 billion a year of investment is going to save hundreds of thousands of additional lives, and I’m going to make these announcements on Wednesday, and I hope that you are able to get everyone in Congress to see what we’re doing, to participate as much as they can in our Wednesday conference, and to show up at this reception at 5-7 pm in the Kennedy Caucus Room of the United States Senate, where I think we should have more than 30 members of Congress present to recognize that American leadership will drive success over time. And my aspiration and my advocacy inside our administration and around the world has been to suggest that the US still has room to significantly grow its financial commitment to child and maternal health.
In my annual letter this year, we presented an economic analysis of how much we’ve spent on maternal and child health from 2010 to 2013, and how much was spent in the prior four years, and you see a 40 percent increase in our budgeted commitment. And that’s what you should expect, we should have more of that, we should continue that path because we can lead this effort around the world.
Joanne Carter: Again, remarkable leadership and it’s going to be a great week, and we’re going to get the word out to Congress in advance and after, because this week is just one week, and we don’t go away. I know your time is limited, so there were just two other questions, important ones were submitted that are really on related issues, one around poverty and the other one around education. So Steven Leary, if you could ask your questions and then, we’ll see if we have time for any more.
Steven Leary: Dr. Shah, you mentioned the importance of behavior to child mortality issues, and, of course, education is a major driver of behavior change, and the same places where there are so many kids dying are the places where kids aren’t in school or getting an adequate education. This is one of the reasons that RESULTS has been building support for the Global Partnership for Education. We’ve been supporting a $250 million, two-year pledge to the global partnership as a complement to USAID’s programs in education. So with the replenishment meeting coming up this week we were wondering when the administration was going to make a decision on this.
Rajiv Shah: We are going to announce our pledge at the conference in Brussels. I think it’s on Thursday or Friday, and we will be represented by Eric Postel, our outstanding Deputy Assistant Administrator for Education. I do want to highlight one thing though, and this is sort of the child survival lesson applied to education. You and others have appropriately had a major campaign to raise resources for the Global Partnership for Education, and I applaud you for that. But I also want you to know that the U.S. has an $800 million a year education budget. It’s fixed. It comes to us courtesy of Congresswomen Lowey and Granger and so many other great congressional leaders. What we will have to do, and we will announce an expansion of our commitment to the Global Partnership for Education.
But, because we are advocating and trying to make the case for one specific partnership within that portfolio, I have to make the determination about cutting education programs that currently have kids in school, where we’re measuring outcomes at second and third grade levels using iPads and testing literacy in a way that’s never been done before. But I will have to cut programs in South Sudan, in Afghanistan, in Haiti, and elsewhere, and reduce the scale of these programs to move money to the Global Partnership for Education, which then, and I hope they will do this, and I’m confident that they will, will take the same rigor around results measurement and literacy outcomes and other outcomes of learning attainment that we have been taking over the past several years. That’s not a viable strategy in my book.
We’ll do it this time because it’s the right thing to do to an extent. But what I need you guys to do, is the next time it comes up, which I hope is like next week, fight for the development assistance account. It’s a $2.6 billion account – it hosts all this stuff. You know, I visited some of these schools, and these kids in South Sudan, up in the north, they have nowhere else to go. I call them makeshift schools because they don’t look or feel like the schools I’m used to, but they get a bunch of kids together under a tree or next to a hut, and they have teachers who are trained and somewhat effective, and they do their best - sometimes with radio support to have a viable curriculum. Sometimes we handed out these little Nook e-readers someone donated, I think Amazon, so these kids have learning material.
I have to reduce the scale of these programs to move money to Global Partnership for Education. It’s literally robbing Peter to pay Paul. So let’s not do that again, let’s fight for the accounts that matter. Seth and I have this conversation on a weekly basis when we’re talking. Seth tells me that we’re going to fight for GAVI, but we’re fighting for GAVI within the context of child survival. America doesn’t win out if we move money to GAVI, and we cut malaria bed-net distribution to do it. That’s not what Seth wants, and that’s not what I want. So I need his voice, because he’s an extraordinarily credible, important leader in this fight. I need his voice fighting for all of child survival. In the same way, I need your voice and Julia Gillard’s voice and everybody else fighting for all of development assistance, and together, we can get there. You know, our accounts, USAID’s accounts, are up twenty percent, sixteen percent relative to the four years before, if you look at my tenure. The reason for that is that people believe we’re delivering results more effectively and more efficiently. So we can raise all boats, and I really do need you guys to be at the vanguard of that effort.
Joanne Carter: And just to say, totally agree with you, and we’ve been some of your strongest advocates to drive up the bilateral funding for education, as well, but also within the context of ‘we need all these pieces.’ And in some ways, the models you’ve done with child survival and GAVI is sort of the model we also seek for GPE, which is both bilateral and also the huge leverage you can have multilaterally.
Larry Reed: Thank you Dr. Shah, and I want to commend you for the focus you’ve taken to the work at USAID and the management and results that you’ve put in there. USAID has also taken on the mission of ending extreme poverty and focusing on the countries where there is extreme poverty. I wanted to ask, getting into the details, what tools are you using to measure whether or not the programs you have are reaching those living in extreme poverty and then measuring whether or not they are having results in terms of people moving out of poverty?
Rajiv Shah: Well, that’s an excellent question. First, I want to highlight something you said, which is we went through a process, and you’re going to see Jim Kim today, and he went through the same process, and we copied his leadership, because I think we’re in a unique point in time where those of us in this space leading these great institutions are genuinely all friends and want each other to succeed and learn from each other. So Jim and I are together a lot. He led an effort to get the World Bank to adopt the mission of ending extreme poverty, and we said that’s exactly right and we’ve done the same thing.
In our case, we had 2,200 staff participate in a 7 month process of redefining our mission, and said what our core mission is about is ending extreme poverty and building resilient democratic societies. That’s what we’re going to represent all around the world, in the National Security Council, in the internal budget meetings, over on Capitol Hill and everywhere else we work. To that end, we have tried to make sure that in our largest areas of spending—health, food and agriculture, education, water and sanitation, and energy—and our core humanitarian investment, which is almost $4 billion a year of dealing with crisis, that we are measuring results against ending extreme poverty and its consequences.
The health work is now focused on ending preventable child death. The food and agriculture is focused on women’s incomes at the household level in rural communities, because we all know that that is the driver of poverty reduction, especially the reduction of extreme poverty. The water and sanitation work is measured in saving lives and in freeing up time for women and girls because again, that’s critical to the path to ending extreme poverty. And our energy work is measured in the number of megawatts of energy we generate, or the projects we close that generate more energy, and the access to those who don’t otherwise have reliable low cost energy sources so kids can read at night in rural communities and small business can grow and not be starved of the basic resources that they need to modernize and employ others. That’s the best we can do right now in terms of those kinds of measures.
I think as we continue in this effort and with your advocacy, the World Bank, USAID, so many of these institutions are increasingly working together, not just to understand how to measure and report on the results that we try to deliver, but on making sure that we’re all collectively focused in those places where people suffer the most. And believe me, as I’m seeing in health, it does require a shift of resources. We’re doing it, the World Bank is doing it, some other institutions are also part of this effort, and we need your continued advocacy, support, friendship, and leadership. Thank you.
Last updated: March 28, 2017