 Hello, everybody. Welcome. It is very nice to have you with us this afternoon. I'm Susan Collins, the Joan and Sanford Wildein here at the Gerald R. Ford School of Public Policy, and we are extremely pleased to see you here for our lecture this afternoon. I wanted to thank our co-sponsor, which is the Ford School's International Policy Center, and in particular Alan Stam, our new director for that center for their support in both planning the events for today, but also in co-sponsoring the lecture. As those of you who are interested in international policy issues may know, there are a wide variety of new initiatives and activities that the IPC is sponsoring and initiating, and I hope that you will follow those and perhaps become involved in some of those as well. Al, I'd also like to thank for helping to field questions in the afternoon discussion part of the session, along with one of our students, Andrew Ridgewell, so we will get to that part later on in our session today. Today's event is our annual City Group Foundation lecture, and this series is one that the school is particularly proud of because it enables us to bring some of the most impactful policy leaders to campus and to the Ford School to interact with our students and our faculty and to share their perspectives. It is also a personal pleasure for me to be able to welcome our speaker today. We are delighted to be hosting Helene Gale, who was, as many of you know, recently recognized by foreign policy as one of the world's top global thinkers. Dr. Gale, of course, is the President and CEO of CareUSA, which is one of the world's both largest and oldest humanitarian organizations, humanitarian aid organizations, and I encourage you to look at the longer bio of her that we have in our program, but you will see that she has held a number of key positions both within the private sector and in public service. And just to highlight a couple of things, she directed the HIV, TB, and reproductive health program at the Bill and Melinda Gates Foundation, and she chaired President Obama's Advisory Council on HIV AIDS. The impact of her work has been both global but also personal and in so many places throughout the world where poverty and disease threaten lives. The work that the care organization does, and Dr. Gale leads over 11,000 care employees to really move forward their unshakable commitment to improving the lives and to strengthening human dignity throughout the world. So I am particularly pleased as well to recognize that she spent quite a bit of time talking to our undergraduates this morning and a number of our graduate students this afternoon as well as having a discussion with a number of faculty. Dr. Gale, we really enjoyed all of those conversations. We appreciate your time and your perspective both in the small groups, but also look forward to hearing what you will be sharing with us this afternoon. So welcome to the Ford School and the University of Michigan. We have structured today's event as a conversation, and it will essentially be an interview with two of my Ford School colleagues and Dr. Gale. And so I would briefly like to introduce those two faculty colleagues to you. First, Professor Marina Whitman. Marina is a renowned international economist who has a particular expertise on global corporate responsibility. She, among a number of other involvements in both the public and the private sector, served as a member of President Nixon's Council of Economic Advisers. And so we very much look forward to your part in the conversation. We are also delighted to have our faculty member Sharon Messini, who will be joining us in the conversation as well. Sharon is a health economist and has taught courses at the Ford School in public health as well as in microeconomics. And so her research has centered on econometric evaluation of public health policies in developing countries. And Sharon, we're delighted that you were part of our conversation as well. Marina and Sharon have come up with a series of questions that we think reflect some of the most important challenges that confront both care and humanitarian aid more generally. We do want to make sure to leave time for questions from the audience. And so our staff will be collecting the cards, which we invite you to write your questions on at around 440. And you can also tweet whether you are here in the room or you are watching us through the online streaming. And the hashtag is policy talks. So again, we invite your questions, whether through the handwritten card or through a tweet to the policy talks hashtag. And as I mentioned, Professor Alstam will select questions along with our student. And I should have mentioned a former CEO intern, Andrew Richwell. So with no further ado, I am now extremely pleased to turn the floor over to Dr. Gale and Marina Whitman and Sharon Messini. Well, let me just echo again how really pleased we are to have you here. And to have these many interactions that you've been having with our community. It's been a full day. Yeah, I gather. I'm quite sure that everyone in the room knows that CARE is a worldwide philanthropic organization. But partly because CARE's mandate is so broad, I think that people would like to know. You know, how CARE started out and how its mission and its focus or foci have evolved over time. Great. Well, good. Thanks. And again, I just want to say how pleased I am to be here. It's been a really great day and not being somebody who is in the university setting on a daily basis. It's always wonderful to be among students and faculty and people who are grappling with so many interesting issues. So I've had a really great day and I really appreciate the opportunity to be here. So CARE, we've been around for about 70, almost 70 years. CARE started right after World War II. It started as actually a cooperative of several different NGOs that came together as part of the effort to rebuild Europe after World War II. So we started out by giving food and basic essentials to people in Europe who had been devastated by that war. And a lot of people don't know that CARE packages actually derive from our roots and our origins. We gave out CARE packages. I spent a little time on the origins because I think it really speaks in many ways to our legacy as an organization. It was an opportunity for Americans who at one point, the day before were on one side of the equation and the next day were able to say, you know, the war is over. We forget that. And the people who some of the countries that were our enemies today are our friends. It really saw this as a way of building peace. And so, you know, our real roots are using our outreach to communities around the world as not only just a way of providing basic resources and basic needs to people, but actually hopefully being part of a broader effort to build a more peaceful and stable world. Obviously, Europe was rebuilt and CARE then used the organization to really start focusing on helping communities around the world that were facing poverty more broadly. And a lot of our roots were in emergency relief and we continued to do emergency relief, but eventually emerged from and evolved from primarily focusing on short-term immediate and emergent needs to really how can we work with poor communities around the world to do what we can to eliminate extreme poverty. So our focus really now is broadly working to, in the effort to eliminate extreme poverty, working with the poorest communities around the world to build their capacity and to also put in place the kinds of policies that support that. So we work very much on programs and the whole range of things that reflect people's basic needs, whether it's health, education, access to income and financial services, improving agricultural output, access to clean and safe drinking water, all the things that we know are so critical for people's basic survival. But how do you do that in a way that actually builds capacity along the way and also helps to look at the underlying issues of inequity, poor governance, lack of citizens' abilities to exercise their rights, and doing this in a way that really hopefully creates long-term, sustainable social change and not just short-term fixes for immediate needs. So we try to work on both, as I think about it, the consequences of poverty, but also the underlying causes. Let me just say before we move on to the next question that I don't know how many of you have ever talked about sending a care package to a child away from home or whatever. And that phrase comes from the fact. And I still remember my parents came here from Hungary before World War II. We sent care packages back to relatives in Europe after World War II. And just as Kleenex has come to stand for tissue, so a care package has come to stand for any package that is sent to someone or to people, which includes things that they would find helpful, useful, and enjoyable. So it's really entered our vocabulary. So one of the focuses of care that I'm particularly interested in is this sort of idea of empowering girls and women as a way to kind of encourage sustainable social change. And I'm just wondering if you can talk a little bit more about the sort of genesis of that, the reasoning behind that. Maybe give a couple examples of how you operationalize that on the ground in particular programs. Yes, good point. In our mission to eliminate extreme poverty over the years, we really have increasingly put a focus on empowering girls and women. And so if you read our literature, we will talk about how important it is to make sure that we have that focus on girls and women throughout our work. Two reasons. First of all, girls and women bear the greatest brunt of poverty. And so if you look at the people who have least access to education, two-thirds of those who are illiterate are women or two-thirds of children who don't have access to school or don't complete school are girls. If you look at health indices and the unacceptable rates of maternal mortality, for instance, or the fact that girls are less likely to get access to health services when they're sick, et cetera. So if you look at any measure income, women work most of the work hours but get only 10% of world income, do more than 50% of agricultural productivity but only 1% of the farmland, whatever, whatever. You can keep looking at the statistics, but clearly girls and women bear the brunt of poverty around the world and make up over 60% of those who live in extreme poverty, less than $1, $1.25 a day. Flipside of that is that if you have an impact on the life of a girl or woman, you have an impact that is really catalytic and you really are able to make intergenerational change. So a girl who is educated, more likely to marry later, have fewer children, send her children to school, and you can really create that virtuous cycle of change. So we know that if you can have an impact on the life of a girl or woman, she will put that into her family. Her family's outcome will change. And ultimately you bring greater benefits for whole societies because you can't keep 50% of a population behind and expect that that same population is going to have the same progress. I was just in Benin, West Africa a couple of weeks ago talking to the president and he was saying how for him this issue of empowering girls and women just makes sense because he recognizes as a country that is living in extreme poverty, if you're keeping back 50% of those who could be productive, you're not helping the whole society. So any way you slice it numerically or if you look at what happens when you change the life of a girl or woman, you have a huge impact on families. And one of the programs that we put a lot of focus on is microsavings and lending. And we have a program that really help women pool resources together save resources so that they can then make small loans and help them start businesses. And you will hear over and over what a $2 loan can do for a woman who then is able to start a business now has the ability to access clean water so send her children to school. The children don't get diarrheal diseases so they stay in school and finish school. She has an income that allows them to, as a family, have a greater outcome. Her husband respects her more because she's no longer a burden. She's actually contributing. It decreases gender-based violence. So there's this whole cycle of change that happens as you put this focus on girls and women. And we know even in our own society now there's evidence that you probably know this from your corporate board engagement. If you have three or more women on board, the outcome of that corporation is improved. And that's their profit indices. So we know that this value of including women, whether it's in poor communities or in our own country, has this impact that has been far too long not utilized. There's clearly an infinite portfolio of problems and issues you care could tackle. How does care select the programs and the projects that it will, in fact, engage in? And also how does it deal with the unintended consequences that are bound to accompany any project? Well, yeah. For any organization that lives off of other people's money, there is always a dance between what resources are available and what the greatest needs are. And I think we try to make sure that we're doing as much as we can to harmonize those. So when we work in a country, and we're in over 80 countries around the world in Africa, Asia, Latin America, the Caribbean, Middle East, et cetera, so, you know, and we've had longstanding roots in most of the countries in which we work. So we've been there for decades, and oftentimes we'll come into a country because of an emergency, but then stay long-term so that we're really helping to build capacity and build past just that emergency situation, but look at how do we develop long-term sustainable change. In that, we work with communities to look at what are their greatest needs, what are their highest priorities, what are their other organizations, and then look at where are their resources and how do we put those together. But it really is by trying to make sure that we're doing what makes the greatest difference for those communities and that there's real engagement in those communities around the programs in which we work. Oftentimes that means, you know, a somewhat long process and sometimes, you know, the work takes a while to get to that point, because if we are able to get communities engaged and really feel ownership of the programs and the priorities, then they're going to have a much longer-term impact than if we're coming in with some cookie-cutter approach and saying, you know, here are the programs we want to do. So, you know, I think that's how we try to work, and, you know, again, it's a dance between what resources are available and where the needs are greatest, how do you put those together, in a way that really can have the greatest impact? And the other half was how do you try to minimize the unintended consequences that come out of any project that brings about any kind of change? Yeah, it's a good, you know, it's a good question. And, you know, back to the point about empowering girls and women, one of the questions I get asked all the time is, so what happens to the men and boys if you're focused on girls and women? And, you know, we believe strongly that empowerment of girls and women can't happen if you're not also having change occur in boys and men because you can't change the way women feel about themselves and then have them back in a situation where men and boys' ideas about women haven't changed. So I think the way we try to have minimize unintended consequences of any change is working on both sides, making sure that as we're empowering communities, we're also working with governments to recognize their responsibility so you can't teach citizens their rights without helping to make sure that governments understand their responsibility. So I think we try to make sure that whatever we're doing on one side, we're also working on the other side of the equation so that as progress occurs, it's happening together. So you've mentioned that Cairn vests in sort of a bunch of health-specific programs and then also a bunch of economic programs like microfinance programs. And I'm just wondering if you can comment on the sort of lots of evidence on the dual relationship between health and wealth and the sort of two-way link between those two and it seems to, that seems to compliment your sort of dual focus as well and I'm wondering if you could comment on that. Yeah, so, you know, I think we try to look at less about, think of our work less in terms of sectors, health and economic development or water or agriculture and more looking at how do you have a comprehensive whole that allows communities to develop. So, you know, we might have a program that starts with microfinance but then links that to being able to access health services that as people are able to develop income streams pooling those together, for instance I was in a program not too long ago where the village savings and loan program that's our microfinance savings program village savings program also while they make loans to individuals they also pool resources so that they have the ability to send women to the hospital when they are in labor and if they have a complicated pregnancy they aren't stuck in the village without a means of transport to the regional health center. So, we really look at holistically how do you make sure that we're building on programs so that's not just a project at a time but really looking what is it what are the comprehensive needs of a community how are we going to have an overall long-term impact and not looking at it as health or economic development but it's really community development some of the things that you need to do that really make that a comprehensive picture and not a sector focused program. One thing that one hears from a number of development experts is the importance of a rigorous evaluation process for projects in order to allocate funds efficiently and how do you decide how much of your funding should go into such an evaluation process as opposed to actually funding programs? Well, again, some of that is dictated by donors and funders themselves and for many programs that we have there is a certain amount that's allocated for program evaluation and I think evaluating individual programs is oftentimes not as much of a challenge as really being able to look longer term at what kind of impact you're having because funding of impact first of all impact measurement is difficult looking at how are you having an impact on something as complex as poverty is not simple. Secondly, again, I think while a lot of donors want impact measurement there aren't a lot of donors who are funding impact and so I think for us we've tried to look at how do you take the resources that you have and put together different pieces of information that will give you some understanding of the kind of impact that you're having more than just short term projects because again, I think for so long the aid industry was based on being able to do projects that you're paid for by a donor that provides short term success after two or three years but it's not looking at long term are you actually creating change that's a lot more difficult to do and it's also a lot more difficult to measure we like so many other organizations are just grappling with that I'm really trying to look at how do you get some proxy measures for what will really end up being long term true long term impact we'd love to do something with the Ford School on impact measurement so it's a good area I think it is a very much an evolving area Switching gears a bit there's been increasing involvement of PPPs these sort of public-private partnerships particularly in global health the ones I'm most familiar with but I'm wondering this would come up earlier in some of our sessions of sort of thinking about ways that the public sector and private sector can coordinate and be very useful in terms of various aid projects and I'm wondering if you can talk about that in the context of the ways in which care works with the private sector I think it's actually a very hopeful trend that has happened a lot recently I think there was a time when there was the public sector and the private sector and neither the two never met in between and I think nowadays the distinction between what's public and private is blurring a little bit more I think there's a lot more that we're learning as a not-for-profit from the for-profit world I think there's a lot more that for-profits are learning and taking away from the way not-for-profits work and I think there's a lot of opportunity for much greater collaboration we've really in the last few years developed some very very strong partnerships with some of the large multinational corporations they recognize that the very communities that we work with are going to be their future markets so there's a business incentive they also realize that from a social good perspective they have a lot to offer as well so I was giving an example earlier of a project that we're involved with with General Mills I was thinking about General Mills who recently bought Haagen-Dazs we're working with them in Madagascar which supplies 80% of the world's vanilla to incorporate the poor small farmers into their global supply chain for vanilla that will end up one day on your grocery store shelf as Haagen-Dazs vanilla ice cream with poor farmers helping them to increase their agricultural productivity better crop higher quality also helping them to have greater access to a larger part of the supply chain so they're actually learning how to do some of the production because a lot of the poor farmers would grow vanilla and then sell it to the processors and the processing part is actually part of the supply chain so we're now helping them to be more productive have a greater portion of the supply chain it helps Haagen-Dazs and General Mills because they have a better a more sustainable less expensive dependable supply of vanilla it helps poor farmers in that country so it can be a really huge economic engine and it's not like a grant that after runs out the project stops this is something that's long-term and sustainable we have another great project I think I was talking about it earlier that I visited earlier this year in Egypt or last year and it's with Denone the milk and yogurt company and it's a project that takes women who may have one cow poor women who have a jack couple of children and a cow and that cow they're taught what are the ways to increase the milk yield of the cow they take it to a community collection center that community collection center was outfitted with all the clean hygienic techniques and that becomes part of their supply chain for Egypt for the country it started out a couple of years ago and it started out producing about 4% of the nations of the Denone needs it went to about 15% in 6 months and now they think that before long it's going to be producing 60% of all of their national needs for the company huge income stream it's a dependable income stream for those women it's a local source of milk supply so those are the kinds of projects that are really encouraging to see where the private sector and the social sector if you will are collaborating in ways that we couldn't have done before you've mentioned several times the importance and sometimes the difficulty of bringing together needs and donor's wishes sort of what what proportion of all the money you get is unrestricted and the other side of it how much of it is restricted to specific purposes so most of our funding is restricted and about 10% is unrestricted so our funding we've really shifted our funding a lot over the last few years so we probably 10, 15 years ago 70 to 80% of our funding would have come from the US government from USAID and then most of the rest of it would have come from individual donors now about 30% of our funding comes from USAID another 25 to 30% from other governments like the DFID, the UK, the European Union and some of our members countries from European and other donor nations Australia, Canada, etc then the rest is from corporations, foundations and individuals individual contributions are what makes up most of our unrestricted funding and that tends to be small donors people who give 10, 20, 25 dollars what have you but the rest of it is the restricted funding for institutional donors so it's a challenge and it's anybody it's the same that universities have the same sort of challenge people will give you funding for specific projects but not to support your infrastructure and I think it's very short-sighted because ultimately it's that maintaining that infrastructure and that platform to be able to do the programs if that's not strong and if that's not sound ultimately we're not going to be able to deliver on those projects so you've mentioned so far a couple of times the importance of long-term sustainability and I imagine a big piece of that is sort of partnership with local governments as well as other NGOs that are on the ground and I also know you've mentioned before I'm not sure if in this conversation or earlier conversations but that a lot of your employees in the countries where you work are local to the area how all of those different factors work in terms of long-term sustainability of the projects that is an important mission for care well, as you mentioned most of our staff we're about 10,000 plus people around the world most of our staff come from the countries in which we work so if you were to go to Ethiopia most of our staff would be Ethiopia if you go to Peru most of them would be Peruvian etc our local they reflect the cultures and the communities in which we work and we think that's very important that's a huge shift too 20 years ago most of our staff would have been European or American but we've really shifted to make sure that we really are increasingly focusing on building the capacity of countries in which we work being relevant making sure that we have people who understand the cultures in which we work I think the challenge of long-term sustainability is both being making a long-term commitment to a country having staff and working with the community so that they feel real ownership of programs but it is also how do you find the resources and looking more for being able to get flexible unrestricted resources so that you can have longer term and not so project related work so I think that is key and it's always a challenge for an organization like ours to be able to have long-term funding and again it's why some of the work with the private sector and creating longer term sustainable projects that are based on actually generating income I think offers a lot of opportunity we now have a part of care that we're a 501C3 and not-for-profit our main organization but we've now developed an organization that's actually a for-profit arm of care so that we can actually do income generating activities that hopefully will lead to new revenue streams that will allow us to have that kind of long-term and more sustainable way of working Looking back over the last 10 years or so what's your assessment of the successes and the disappointments of the Millennium Development goals and also looking forward and taking account of the fact that the economic recession and upheavals of the last few years have cut into economic aid how hopeful are you about the achievement of the 2015 goals? Well I think there's a lot of progress that has been made in the Millennium Development goals and I'm sure most people here know back in 2000 the world through the leadership of UN and at that time Secretary General Kofi Annan put in place the Millennium Development goals with the goals of having poverty by 2015 access to education and some health goals around HIV and malaria and TB maternal health etc and so the whole set of primarily eight core Millennium Development goals and the progress is mixed in some parts of the world particularly in countries that are now middle income countries there's been huge reduction in poverty there's been a lot of progress there's been progress in the water in some of the water goals there's been considerable progress in some of the health goals but it varies a lot and if you look region by region it's been incredibly variable there's a big push now starting April 6 to count down to the last thousand days with a renewed vigor on part of the world community to really see what can we do in the last thousand days to see if we can push towards that but also with the recognition that we're not going to achieve all of the Millennium Development goals and what's the add on how do we what should we be doing post 2015 to look at both making sure that we finish the job that we started and not say okay let's have a whole new set of goals and forget that we didn't accomplish all the others let's have a new set of goal let's make sure that we're cooperating the things that we didn't finish but also look at how the world has changed and the world has changed the issue of climate change for instance is one that wasn't part of the previous Millennium Development goals and people really feel and the current Secretary General particularly that we need to look at climate change goals towards continuing to reduce the impact of climate change but also continuing to reduce the factors that lead to it looking much more at the issue of equitable growth because you know now more poor people live in middle income countries than in the poorest of the poor countries so that means while overall economic conditions may be improving in many countries inequity is becoming more of a problem within countries where where their actual you know kind of overall national economic picture has increases so looking at this notion of equity more as a lens as well as absolute poverty so there are a lot of those sort of things that I think will be part of the dialogue in looking at what's the follow on the add-on to 2015 and a lot of you know a lot of discussion I think the the add-on to post 2015 will be probably a more inclusive process because the Millennium Development goals before were developed kind of quickly so I think you know in the next year or so moving into 2015 there's a lot of discussion around what should these goals look like and making sure that they are inclusive and create a strong dialogue around them but I think the Millennium Development goals have been incredibly useful because we had some goals and I think part of what we have lacked before around these issues is not having targets to actually shoot for and so having those goals I think has been a huge mobilizer of resources and I think there's been such focus on it and such commitment that even in the wake of some of the economic downturn you know there still is a strong commitment to try to see what we can do to reach those goals it's about time to shift questions from the audience I think this is on, yep it's on so I'm Andrew Ridgway I'm a second year MPP and I was an intern at CARE this summer and I'm still actually working part time for CARE thank you well I am looking for jobs so let's begin with the student questions could you describe a specific program that you were especially inspired by or excited about well I named a couple that I often give this example of the projects in Egypt the Danoan project which is I think really spectacular when you literally go to a one room shack and see a woman with her cow and realize that that cow is producing milk that is going to be on the grocery store shelf in that country so some of those I think are really incredible but one of the ones that I really that I have just seen create incredible change for people is our village savings and loans program and it's a pretty, it's a really simple program it started in Niger West Africa about 20 years ago and it really kind of built on a community savings sort of approach where opposed to a lot of the micro finance programs which started with credit where you went and took out a loan from an institution this really started by first saving one's assets and when I think about it simplistically most of us didn't start our banking life by taking out a loan we started by putting pennies in a piggy bank and it got us familiar with money, with savings and first developing our own it was built on that approach and it's sometimes people taking what amounts to a few pennies and collecting that but it's giving people management skills along the way and it's often you know probably 70% of our village savings and loans programs are women and women who didn't have economic power within their family and so they they save, they put the money together they save, they make up the groups usually are about 10 or 15 people they make up their rules how much interest they're going to charge for loans what the repayment schedules are going to be and all the rest of this and then we give them management training what businesses should they go into how can they use their resources most effectively how can it be used for community-wide benefit as well and so looking at what that small amount of money can do to change the lives of families and I give an example of one woman who actually came to a conference that we have every year in Washington woman from Burundi in Central Africa never been out of the country never been out of Africa came and spoke at this at this conference that we have and she told her story of how you know she started out with a $2 loan and how that loan she was able to start a business from that business she then was able to develop a store and she became a merchant within her community and just the ripple effects that that had for her family as she as a woman who had basically been a prisoner in her own home been victim of domestic abuse and how it totally changed her whole life in the life of her family around because of a $2 loan that she was able to then use to start a business develop a shop send her children to school totally changed the dynamic of her and her husband who used to literally beat her saw her as now this is somebody who has some value they became real partners and she talks about just how different her relationship with her husband was you know now saw her as an equal partner and they talked about their children's life and their future together so it's you know these things that as small and as simple as they may seem can really start a whole ripple effective change and we see that over and over again of how these simple things can make such a huge difference in people's lives next question how does care work with governments that are not as transparent and or struggling with corruption what are the difficulties and how has care tried to overcome them what effect do these type of situations or partnerships have on long term sustainability yeah it's a great question you know first of all as a non-governmental organization we're not obliged to work with governments or work directly with governments our work is largely through other NGOs on the ground we do a lot of work implementing our programs with local and national NGOs and so as far as the transparency of our resources that's within our you know essentially within our own management structures and our own control because we work with organizations we work with our money we don't give money directly to the government that said because of the challenges in governments that are corrupt or that are unstable you know we're always working with we're often working with governments where there isn't transparency there may not be capacity within government and government structures and governments are often our partners even though we don't work directly through governments you know the issue of corruption in places that we work is as much an issue for the governments but also just the cultures in which we work where transparency and corruption can be a huge problem so we even within our own staff often have issues related to corruption transparency and it's one of the things that we work with constantly to make sure that our management and our management structures and the standards in which we hold our staff to our standards of transparency and no tolerance for corruption but it is an issue throughout and the instability of governments does mean that oftentimes we're in situations I gave the example earlier of Mali for instance where we have had to shut down our operations in northern Mali because of the instability there or Somalia Sudan lots of places Pakistan Afghanistan we had to close our country office in Iraq because our country office director was kidnapped and killed so we work in very unstable situations throughout the world where the safety of our staff and security has to constantly be an issue that's on our mind From your perspective as CEO of CARE how can the United States be a role model for women and girls abroad and where is the US behind on this issue? I think the fact that if you look around the world the United States is behind in many measures so I think about 16% of our congress are women and in many countries around the world they have mandated that 30 to 50% of parliaments or cabinet positions have to be women you take a country like Rwanda for instance because there's a clear correlation between percent of women in government and peace and stability there are a lot of post-conflict countries that have actually moved to mandate that in fact a certain percentage of their top government leadership actually needs to be women so Rwanda has a higher proportion of their parliament that are women than their cabinet that are women than the United States so I think there's a lot that we could learn from many countries around the world in terms of how do we get better representation of women in key policy positions we know that governments that have more women in policy leadership positions have less corruption have more stability have greater indicators on all range of societal factors there's something where I think we do need to look at how could we do a better job the fact that we've never had a woman president and if you look around developed and developing worlds this is something that now is kind of common place where we're still grappling over is it time yet to have a woman president so I think there are a lot of ways in which the United States could take a page from many developing countries as well as many developed countries with the inclusion of women in policy levels and you know there's a lot of talk about this these days with everything from Cheryl Sandberg's book on Lean In to Ann Marie Slaughter's Can You Have It All article but I think these issues here in this country I think there really is a revitalization of some of these issues around women and women leadership but I think there's a lot to be learned about how we're debuting poverty now and threats the environment and other sustainability challenges. Yeah well we take you know this issue of sustainable development is something that's very very important for us and we're really doing a lot of work with our sister organizations environmental organizations to look at how do you do development work in a way that also looks at sustaining and looking at projects where because many of the communities in which we work in are the same communities that are most affected by climate change, environmental degradation and so you know we really believe that you have to it has to be hand in hand it can't be development or the environment it has to be the two hand in hand and looking at how do you come together with sustainable solutions for the environment but also looking at long-term development income development and economic development and making sure that what we do doesn't have a detrimental impact on the environment and climate. How has care shifted towards or supported aid models that increase country ownership and if you could please speak specifically to Liberia's health sector pool fund. I don't know anything about Liberia's health sector pool fund. What was the first part of it? How has care shifted towards or supported aid models that increase country ownership? The whole issue of country ownership is the way we feel we have to work. So our we look at our work as how do we work ourselves out of the job over the next 10, 20, however many years but really looking how do you develop ownership by the country? How do you make sure that we're building capacity? So most of our work today is not done by care. It is done in partnership with local organizations whose capacity we work to build and working alongside of communities to make sure that whatever we do builds long-lasting capacity in those communities versus care doing the work. So it's just the way that we work and building local capacity and country ownership is just part and parcel of our fabric and the way that we work. I give an example of in Afghanistan about a year or so ago there were a lot of burnings of schools and particularly schools that educated girls. Care's were the only schools that weren't burned down because they had been or one of the few organizations who didn't have any of their schools burned down because we had been working with those communities for so long that they felt that those were their schools. They didn't feel like they were schools that were imposed on them by somebody outside. They felt that those were in fact their schools they had ownership over them. So while a lot of other schools were actually burned down in the communities ours were the ones that were able to be sustained. What if any kind of resistance to assistance has care seen in its work i.e. a local dominant business class, pushback from local authorities, cultural ministries, etc. I'm not sure exactly maybe whoever answered that asked that. Yeah. Any kind of pushback you received from trying to help on the ground but then maybe different I didn't check that what you were trying to do. So for example in Madagascar you mentioned that you had a process that cut out that seemed to be like a middle group that would treat the vanilla beans. Would you ever get a situation where that group of people were upset with the work you were doing and maybe try to grow another operation or something? Yeah, it's a great question. Because I do think when you look at what we're trying to do, which has changed this quote, it does mean that you are in some ways threatening some people's interest and I can't say that situation particularly because it's new, it's evolving but we have had situations where because you are in fact changing the status quote people's interest are threatened and sometimes we have been threatened. Again, although it sounds somewhat simplistic and repetitive, I think the way that we've tried to do that is making sure that we are looking at how do we help mitigate that by working with all the groups that are involved. How do you make sure that everybody feels like they have a stake in poor people winning? How do you make sure that others understand how they can shift what they're doing so that they actually have benefit from it as well? And looking at if in fact the middle person is cut out of the situation how will they also have gained from that because we can give them training to actually allow them to develop some other skills that they may not have had. So really looking at the whole system and how are you making sure that if you have change in one sector you're looking at what the consequences might be so that you can in fact mitigate that. So we try to look at the whole system and look at what might be the consequences and how can you bring everybody into it so that there's solutions that can be found more broadly and not just looking at one piece of the puzzle. Are there corporate relationships that have not varied as well as the outset and what have you learned from these experiences? Well, I think the corporate partnerships that haven't worked well are when there hasn't been an open honest dialogue from the very beginning where the goals weren't clear, where the objectives weren't clear, and where you really didn't have shared value. And I think it's really and shared objectives. I think it's really important just like any partnership that from the very beginning you're really clear and transparent about what each side wants from it but the objectives are clear and the game plan is clear. So we've had situations where for instance we might have a corporation or an organization that provides money for one purpose and we may think, okay well they asked for what they said they want to give us money for is to do project X, but what we really want to do is project Y. Let's see if we can't morph it into what we really want to do. Well that never works because it's not transparent you didn't have the same goals and unless you're really starting from something where you really know what you both want to get out of it, in the end it's going to be disastrous. We've also had problems with corporations particularly and in some corporations the extractive industry is a good example oil and gas sector and the mineral sector where oftentimes there's real challenges because the very nature of their work destroys the environment often time is not as transparent in how the funds are being used there's huge possibilities for corruption and so you know there are sectors that are much more challenging to work with where we have had a real struggle in making sure that we're maintaining our values making sure that the needs of the community that we're working with are being upheld and we have had to in some cases actually dissolve partnerships but I think it's really by being as clear as possible from the very beginning what are your priorities what are your goals making sure that we're being as transparent as possible and there's any partnership knowing when what you want out of it doesn't align and agreeing to disagree and move on so can you tell us about CARES role in combating the spread of tuberculosis worldwide are current measures sufficient to address the spread of drug resistant TB? TB is not a big focus of CARES so it's something from my previous lives that I've worked a lot with but it is not a big focus of the work of CARE I don't think that currently we have enough to treat drug resistant tuberculosis but it just frankly isn't something that I'm as involved in right now in terms of the microfinance slash community savings approach I have noticed especially with Kiva and other lending organizations women are more likely to be trusted with loans does this observation apply in other aid situations are women more likely to receive aid over men and make better use of limited resources? Yeah all the data on lending programs have shown that women have been incredibly good at repaying loans most of the data suggest that women with loans will repay 96 plus percent successfully that said there can be more evidence that also suggest that often that more often than was previously realized that sometimes women are taking out those loans for men and men are then coercing women to repay those loans and oftentimes coercing in sometimes violent ways so I think there's a lot more evidence behind some of those statistics but I think overall studies have shown that women have very very high repayment rates but I think we're starting to look underneath that and looking at you know repayment rates are not the only measure what's happening to the loans how are those loans being used are they being used in ways that actually help to empower women or not is there coercion as a part of that are women actually being able to use the loans in ways that benefit her and her children versus being used as a loan because so many programs are more available for women than men and men are actually using them so there's a lot more to that that I think is becoming coming to light but overall yes there's been a lot of studies that show that women are very very successful in loan repayment what are some of the challenges with changing traditional cultural values and having long term change in communities that care is encountered and how have they been managed sorry the challenges with challenging traditional cultural values and getting them to change over the long term in communities that care has worked with yeah and I'm not sure who it is somebody who's there who asked that if they want to elaborate on a little bit more what exactly they were trying to get at or any specific that was that so having long term cultural change for long term economic change for communities and the fact that some communities have a cultural perception which maybe won't go along that like you just mentioned empowering women but then having cultures where maybe men coerce women or men yeah so I think what we've tried to do in our work is to make sure again in working with communities that we're not just doing programs but we're also looking at how do you shift community norms community standards the way that people think about change you know again a good example is girls education in many places around the world girls are not it's not seen as a good investment to send your girl to daughter to school as opposed to your son because girls are expected to marry early have children and education not seen as a benefit we've been most successful in increasing enrollment for girls in school when the communities themselves have been educated where fathers really buy into the notion that if their daughter has an education she'll be more productive she'll be able to have fewer children her life will be better and so I think it really is by working with communities to understand the benefit that you can have that kind of cultural change I was just in mentioned I was in Benin West Africa not long ago a couple weeks ago and we were working with a program that looked at land tenure for women and a law that had been passed not very recently that allowed women to own land in many places around the world as you know women don't have the right to own land they had recently passed a law but the law was not really being enforced because there wasn't really strong community buy in in that program we had paralegals people who weren't lawyers but kind of legal extenders who actually worked with communities to understand the value of women having land ownership giving tangible examples of women in their community who own land and were able to increase their agricultural productivity because it's a very agricultural country and showing the value of that was able to start shifting the thinking about land ownership and land tenure and inheritance rights but it was by working with those communities that in fact that started shifting the cultural norms and so you know it's always this mix between how do you help an individual but then how do you help the society around that individual so that in fact that change takes place and you don't have an individual who's changed but not a society that has changed along with them Some argue that technology is the way to solve many or perhaps even most development challenges Do you agree? Can you give examples where technology has helped and also where it may have gotten in the way of what you were trying to do? I think technology is a huge enabler and has huge benefit for some of the development challenges we face so the mobile phone mobile phone technology has had a huge impact we do a lot of work with mobile banking now so people who live in remote rural areas who never would have had access to banking who used to only have the ability to have small transactions who now are able to actually have interaction with financial institutions our health work has been hugely impacted by the ability for people who are again in remote rural areas to be able to use SMS to either get information to send symptoms so that health people who are in rural areas and village health workers are able to communicate with higher levels of health services and really save lives in a lot of ways so there are a lot of ways the advent of new clean cook stoves that have really been developed that help to cut down on both the environmental degradation that goes along with chopping down trees for fuel but also that helps decrease the environmental pollution that leads to pneumonias in children fire accidents etc so I think those are just a few examples access to clean safe drinking water there are a lot of new technologies both for sanitizing and making drinkable water that people can put we have a project with Procter & Gamble they have a substance a pure packet that you can put into water and change dirty water to clean right in front of your eyes or new filtration techniques and machines that are being used so there's lots of ways in which I think technology has been hugely useful but there are always limits and we had a really good discussion of that earlier today around some of the limits of technology and where technology the people who create some of these solutions are not close enough to the problems to be creating solutions that are actually useful for the people who are trying to have an impact on their lives again with clean cook stoves some of the very early versions of those were done by people who weren't talking to the women who needed to use them and they created cook stoves that once they were tried to be once they were brought into villages and women tried to use them they didn't even meet the needs of the very women that they were trying to serve so I think if we're not linking technology and technological solutions with the people who actually need to use them then we often can create in a vacuum things that don't have the real usefulness that they should so I think technology has huge impact and has had a huge potential but it also needs to be done in a way that looks at the actual needs of the people and making sure that people are part of helping to design some of those solutions so we have one last question you have a very interesting background can you share a bit about how you got to Cares presidency from your initial career path in pediatrics yeah well I started out as a clinical doctor in pediatrics but I went into medicine because I wanted medicine as a way of contributing to positive social change so I always had in my mind that I wanted a career that would allow me to have as great an impact on the largest number of people that I could in the most meaningful way so that's a big goal so but I started with pediatrics and then migrated to public health because it was a way of not looking at individual patients as individuals as your patient but looking at populations and communities as your patients and worked in public health for 20 some years first at the Centers for Disease Control then went to Bill and Melinda Gates foundation but if you look at public health and if you look at the challenges within public health a lot of what leads to poor health are not just health factors and in my years of working in HIV and AIDS which I worked in for many years when I was at CDC the factors that lead to the spread of HIV yes it's a virus but it's also poverty it's inequity discrimination and so many of those sort of things that are not just directly impacted by health and health interventions but are the very sort of things that we work on care it's the underlying causes it's poverty it's inequity it's discrimination stigma etc so for me it was kind of really working coming full circle working on health issues but looking constantly at what are the underlying causes of poor health and unequal distribution of disease and death around the world and that kind of led me to my work at care so well thank you very much so I'd first like to thank all of you for some really excellent questions we would love to continue the conversation in our great hall just outside of the auditorium we have a reception and I hope you will join us and stay for that I'd also like to thank my colleagues Sharon Messini and Marina Whitman for hosting the conversation and then a very special thank you on behalf of the Ford School thank you Dr. Gale