NEAL CONAN, host:
Next week, the United Nations Development Programme hosts an international donors' conference in New York with a focus on Haiti. The government in Port-au-Prince believes it needs $11 billion to rebuild. One of the key U.S. delegates will be Rajiv Shah, the new administrator of the U.S. Agency for International Development, who took office just five days before the earthquake presented him with a major challenge. And that is just part of Shah's portfolio. His job is to revitalize an agency that's lost half its staff over the past 15 years and always faces skeptical questions about why we should send money overseas when so many need help here at home.
If you have questions for Rajiv Shah about the U.S. role in Haiti or about the priorities of U.S. foreign aid, give us a call: 800-989-8255. Email us: firstname.lastname@example.org. You can also join the conversation on our Web site at npr.org, click on TALK OF THE NATION. Rajiv Shah joins us now from the National Press Club here in Washington. Nice to have you on TALK OF THE NATION today.
Dr. RAJIV SHAH (Administrator, USAID): Thank you, Neal. It's nice to be here.
CONAN: And baptism by fire with the Haiti earthquake just a few days after you came to office, what is your sense of the needs of Haiti right now?
Dr. SHAH: Well, you know, it has been a baptism by fire, and it's been a great opportunity for me to see how our entire government really worked in an aggressive and swift way based on the president's guidance to us. And, you know, it is worth reflecting on a fact that this earthquake was far and away the most significant natural disaster to hit Haiti in hundreds of years, and that it destroyed infrastructure in Port-au-Prince, and many of the government building, and so many people from the even the United Nations were lost in this terrible tragedy.
So the normal mechanisms of public response in organization didn't did not exist in that immediate aftermath. I'm very proud of what the United States government has been able to do together with our military partners and with support from across, all of the federal agencies, we were able to go in, open the airport, get access again via the seaport and help more than 30 countries flow in a significant amount of assistance that ultimately provided food, water, shelter and a range of other basic needs to nearly 4 million patients.
So that's a great accomplishment, but we're also very, very focused on and very concerned about the upcoming priorities and challenges because the rainy season is soon upon us and there continue to be hundreds of thousands of vulnerable displaced persons in Port-au-Prince and elsewhere throughout Haiti. And so we're in an all-out rush to work with our international partners and with the government of Haiti to really protect and provide for those individuals in advance of what we believe will be a difficult situation.
CONAN: And that's the medium-term. And of course, the long-term, that's the reconstruction effort. But so many people are concerned about the competence and the integrity of the government of Haiti.
Dr. SHAH: Well, you know, we work very closely with the government of Haiti. I had the chance to join Secretary Clinton on the third day after the earthquake. And to be down there and visiting with President Preval, with other members of the Haitian leadership. And from that moment on, we made a determination that we would do our work in partnership with the government of Haiti.
So we take their direction on identifying areas of work, identifying immediate priorities. We're currently working with them to identify safe sites where we could help move certain displaced families to safer positions so that when it rains, they are protected. We're working with them to help identify canals and drainage systems that we could aggressively clear, so that the rains are managed effectively and don't lead to a significant outbreak of disease.
And we're working with them to really preposition medicines and health support, so that in an effect of a disease outbreak, the international and humanitarian communities prepared to provide for the Haitian people. But in every step along the way, we continue to work with, and need to work with the government of Haiti, which ultimately bears the responsibility for its people.
CONAN: And of the 11 billion Haiti says it needs to rebuild, how much is the United States prepared to provide?
Dr. SHAH: Well, you know, we've made a significant commitment already to Haiti. The President Obama announced the - immediately that we would be releasing $100 million. We've, in fact, over the last few months, have spent nearly $700 million in the overall relief effort, providing for a broad range of services and basic needs. Going forward, we will be announcing a pledge at the upcoming donors' conference, and we're working with the government of Haiti and a range of international partners to determine how to move forward with that.
CONAN: Let's get some listeners in on the conversation. Our guest is Rajiv Shah, administrator of USAID. 800-989-8255. Email: email@example.com. Gary's with us from Memphis.
GARY (Caller): Great show, Neal.
CONAN: Thank you.
GARY: My question for your guest is, if you can give us a little bit of a history lesson before the earthquake, I understand that Bill Clinton was the envoy to Haiti for many years. And it is my understanding that before the earthquake, our country donated or gave lots of, you know, money, taxpayer money to Haiti. And my question is how much was it over a course of several years, and whatever became of that investment?
Mr. SHAH: Well, thank you, Gary, for those questions. And we've been looking carefully at our history of both investment and partnership in Haiti to identify how we should move forward, and to use the learnings from those lessons to re-craft a strategy and approach that would allow us to be accountable for every precious U.S. taxpayer dollar that we commit to Haiti.
You're right to point out that the United States government has had a longstanding commitment to Haiti, and that President Clinton has played a unique role, both as president and in different capacities with the United Nations, to serve and protect the people of Haiti.
But our pre-earthquake investment was depending on how you count between three and $500 million a year in terms of...
GARY: Was there any result, any fruit borne from that investment?
Mr. SHAH: Well, absolutely. Look, there are areas where things could have been done much better, and we're focused on how to make - use those lessons going forward. But take, for example, our work in the health sector. Much of the capacity of the health sector, broadly at hospitals and surgical facilities in its ability to treat and control the prevalence of HIV/AIDS and its ability to provide services to children, pregnant and lactating women and women of child-bearing age, are all due in part to significant U.S. investments and U.S. partnerships, and in many cases, partnerships with private and public U.S. institutions like the University of Miami or Harvard University and others.
And so we've been part of helping to provide for kind of skills and knowledge, transfer that kind of capacity. And at the end of the day, that installed capacity, plus some of the disaster assistance relief we provided allowed the Haitian health system to see more than 80,000 patients after the earthquake. That's a tremendous achievement.
Our own people that went down, surgeons and doctors, performed hundreds of surgeries, but all of that didn't happen overnight. That was because of years of real focus and strategic investment. But you're right to point out that we can do better. And going forward, we will focus our investment in areas where we can identify and set clear metrics and milestones, and we will report on the dollars that we spend so that we can make sure they're being spent effectively in creating really sustained services for the people of Haiti and sustained growth for the Haitian economy.
CONAN: Is there one lesson you can point to where mistakes were made, an area you could do better?
Mr. SHAH: Sure. I think when you look across the portfolio, the primary lesson - because the needs are so great in Haiti, nearly half of all children, just as one example, are malnourished, and that leads to really drastic consequences. Children who reach age two in a state of chronic malnourishment will have limited ability to achieve their potential in terms of their brain growth and their capacity over time. So, you could - that's just one example, but the problems really are much broader than that. And if we've made any mistake in the past, it's perhaps trying to take on a broader range of problems than we have the capacity to do effectively and efficiently.
And so going forward, what we're really trying to do is say, okay. There's some areas where we think we can aggregate and concentrate our focus and our investment in agriculture and health and a few other areas. But there are other sectors where we're going to really rely on other donors to come in, or local partners, and rely on their leadership. And we might do less specifically in that sector, but only because we think others can do it better and more effectively and our resources would be more efficiently spent having more size and scale in a particular area, like health or agriculture.
CONAN: Gary, thanks very much for the call.
GARY: Thank you, Mr. Shah, and thank you, Neal.
CONAN: Bye-bye. You come from - your background, you previously worked at the Gates Foundation. We were lucky enough to have Bill Gates on the show a couple of months ago, and he was talking about their - the approach the Gates Foundation has used - results-oriented. You really want to find things that produce quantifiable gains. Are you bringing that approach to USAID?
Mr. SHAH: Well, I am absolutely trying to. I think our primary mission at USAID is to show that we can be accountable for every dollar we spend and generate results, as you point out, in a quantified way. So we can look at a health sector investments and say, okay, if we're spending $400 million a year in Ethiopian health, how can we restructure that investment and how can we prioritize the things that will get us the most health gain for the dollars we spend? Are we investing in things like vaccines, in providing skilled attendance at birth, in working to develop a sustainable health system that prioritizes the biggest bang-for-buck type of interventions?
And as I use that framework to really review our programs, I do believe there are great opportunities for us to squeeze more results and more impact out for every dollar we put in. And so that's the basic approach we're taking, is going country by country and sector by sector and identifying: How can we do things better in order to get more results for what we're putting in? And a lot of times, that's about identifying the quantified outcomes you want. It might be lives saved or children who have attained an effective education, and then working backwards to say: What are most efficient ways to spend money to achieve those quantifiable and identifiable and reportable outcomes?
CONAN: Rajiv Shah, administrator of the U.S. Agency for International Development. You're listening to TALK OF THE NATION, coming to you from NPR News.
And let's go next to Jessica, Jessica calling us from Atlanta.
JESSICA (Caller): Yes, hi. Thanks for taking the call.
JESSICA: You partially answered one of my questions, which was the criteria that you use - you've answered that. But, really, how do you determine when to quit? I understand there's needs - there's acute needs. There's chronic needs. But at what point do you say: Well, this is enough for now. These funds are better used, maybe, for programs that are more local, more United States-oriented, versus...
CONAN: Or more successful.
JESSICA: ...global. Pardon me?
CONAN: Or for programs that are more successful.
CONAN: Yeah. Rajiv Shah?
Mr. SHAH: Well, thank you, Jessica, for that question. Let me address it in two ways. First, I do believe that - and this administration is committed to the idea that the investments we make in development to provide and allow for health and education and opportunity for real economic growth and development in many poor parts of the world touch hundreds of millions, if not billions, of people, and really do represent the best values of our country and represent those values around the world.
We do this work because it fundamentally makes us safer and more secure. When you provide an education to children in rural Pakistan, they then have an alternative to then going into madrassas or other environments where they would be subjected to a different form of education. When you provide women with the ability to protect for their children and the safety and the health of their child's lives, you not only reduce misery, but you create the basis for a sustainable economic development and a tremendous amount of goodwill towards the United States from grateful communities.
And I've had the chance to visit those communities all around the world, and I can assure you that that is a very real issue.
JESSICA: Yes. I...
Mr. SHAH: The second part of the question, though, is about being accountable for how we spend dollars. And I completely agree with you that we need to find - there are times when we should stop funding things. We have done that in a few specific instances. As part of this president's global health initiative, we're actually looking at how we spend money within the health sector and trying to redirect resources from things that are a more costly way to achieve improvement in population health, to things that are less expensive and more sustainable and more appropriate in some of the countries we work in, things like vaccination and maternal health.
In agriculture, we're moving away from investing in higher-end agricultural development with large farms and from urban economic development efforts and moving towards supporting small farmers who tend to be women and who tend to be disproportionately vulnerable to food insecurity and hunger. And as a result, actually, for the first time in decades, we've seen the total number of people who are hungry go up in the past few years.
Mr. SHAH: So it's these strategic redirections of resources that we hope will make our portfolio of work more efficient and more accountable, is what my real focus is as in leading the agency.
JESSICA: I have one more question, please.
CONAN: I - we're running out of time. I wanted to give somebody else a chance, Jessica.
JESSICA: Okay. Go right ahead.
CONAN: But thank you very much for the call. Appreciate your patience.
Let's see if we can go next to - this is Wellington(ph), Wellington calling from Philadelphia.
WELLINGTON (Caller): Oh, thank you, Neal. Longtime listener, first-time caller. I love your show, by the way.
CONAN: Thank you.
WELLINGTON: I just have a question and a comment. I know historically, U.S. aid to Africa has not been as much as other part of the world. So I was wondering, is that going to change under the Obama administration? And the second part of my question is that given that when even though aid goes to Africa, it does not tend to reach the general populace. Is there anything that this agency's going to do to make sure that there's more accountability this time around?
CONAN: Accountability, again, a place that has been plagued with corruption.
WELLINGTON: Accountability, mostly, on the part of the government, making sure that aid is...
CONAN: Indeed, Wellington.
Mr. SHAH: Yeah.
CONAN: Let's give Mr. Shah a chance to answer.
Mr. SHAH: Well, those are great questions. It is absolutely true that most of sub-Saharan Africa is lagging in performance against global health and hunger reduction-type of goals. These are called the millennium development goals, and they track countries' performance against a series of human development indicators. As a result, this administration is redirecting resources through two major initiatives, our global health initiative and our food security initiative, really designed to improve health outcomes and reduce hunger and starvation and suffering. And those will result in significant redirections of investment to Africa and to sub-Saharan Africa and some of the most vulnerable populations within sub-Saharan Africa.
That said, I agree that I think it's incredibly important that we target our resources to those populations that are most vulnerable, and that we help those populations hold their governments to account. And we're doing that in our food security initiative. We're asking countries who participate to make their own commitment to significantly increase - in many case double - their own public investment against agriculture and food security goals.
We're also going to be tracking our outcomes very specifically. We will talk to the women that we serve, and we will track what has happened to their incomes, what has happened to their ability to provide for their children and their ability to feed their families. And we'll have that data from the household level that will be a new way of really looking at the outcomes and will allow us to make strategic redirections within that.
CONAN: I'm afraid we're going to have to end it there. Wellington, thank you very much for the call. Rajiv Shah, thank you so much for your time today.
Mr. SHAH: Thank you very much.
CONAN: Rajiv Shah, administrator for USAID, with us from the National Press Club here in Washington,
D.C. This is TALK OF THE NATION from NPR News. I'm Neal Conan, in Washington.
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