 Good morning and welcome to CSIS. I'm Steve Morrison. I direct the Global Health Policy Center here at CSIS. And we're thrilled and honored this morning that we can host Congresswoman Betty McCollum, Democrat from Minnesota, to return to CSIS and speak here. Again, we've had the honor of hosting her several times here and on the Hill to speak on issues that are the ones that she's leading on in Congress. Today we'll be hearing her vision of how to move forward an agenda on maternal and child health. There's an important piece of legislation that she has introduced. We'll hear more about that. I expect to provide assistance, HR 1410, to provide assistance to improve the health of newborns, children, and mothers in developing countries. Now has 73 co-sponsors in the House of Representatives. Betty is a member of the Labor Health and Services and Education Appropriations Subcommittee where she's championed on the domestic front health care access and improving health services issues that are front and center today. In April of 2007 she authored legislation to make health care a right for all Americans and voted to reauthorize the S-CHIP, the legislation that in January 2009 expanding health care to 4 million children. She's also a member of the Appropriations Subcommittee on the State Department and Foreign Operations, a critical position from which she has used her leadership to advance U.S. approaches on HIV-AIDS and has been at the forefront of pressing for new approaches on global food security. She was one of the original co-sponsors of the Global Food Security Act of 2009 and I might add in looking at what happened at the GA summit in Italy last week and the follow-on by President Obama's follow-on visit to Ghana, enormous breakthroughs on the global food security agenda with U.S. leadership as a critical element and I think much of that energy and enthusiasm and confidence is based on the awareness that there's a strong bipartisan support within Congress for moving ahead in this area, this critically neglected area of re-engaging and reinvesting in rural development and changing the practices of foreign emergency food relief, but taking a long-term approach at trying to rebuild the productive base in Africa and elsewhere centered within agriculture. She's also been at the forefront of trying to get the House of Representatives focused around an array of global health issues and she founded the Congressional Global Health Caucus. We had the honor just 10 days back to hold an event there on the H1N1 swine flu epidemic thanks to Congresswoman McCollum's volunteering to host us and organize this event. This was with Drs. Fauci and Fineberg which was timely and a very powerful event. She recently introduced the International Protecting Girls by Preventing Child Marriage Act of 2009 which is past the House and awaits action in the Senate which I believe it's Senator Durbin is carrying this legislative initiative on the Senate side. Very promising. So you can see that Betty has moved forward in her position in the House on the Appropriations Subcommittee in her other committee assignments as an innovator, as a leader across a spectrum of issues. And so today we've asked her to come and speak around the maternal and child health agenda which is also something that the President highlighted during his visit to Ghana, his speech to the Parliament. So thank you very much Betty and thank you for your leadership. Well good morning. And it is a beautiful summer day in Washington, D.C. I cannot believe our luck. It's actually been cooler here sometimes than it's been back in Minnesota. Go figure that one, huh? Well I'm really excited to be here with you this morning and I appreciate the opportunity to be here at CSIS to speak about global health and specifically about the needs of the women and children in the world's poorest countries. But let me start by thanking and congratulating CSIS and Steve Morrison for the ongoing commitment to elevate the importance of global health. The work you're doing here to help really focus an examination on U.S. foreign policy and the health investments our country is making is truly critical and it's impressive and I can't stress how really important it is to me to help me in my role and function not only with trying to come forward with ideas and solutions but also with oversight. Now many of you are here today because you're working on basic health care for women and children across the developing world. And I want to thank you for all that you're doing. Your work is to help prevent needless deaths or in a more positive way to create opportunities for tens of millions to achieve basic life quality. And to do that in places where people are living in extreme poverty and hunger, facing disease, it is quite an undertaking. But it's all very important work and I need you to keep fighting and so do those mom and dads all around the world. So I'm going to start my remarks here with a single sentence from last week's GA Global Health Experts Report. These are the experts now. So listen carefully to what they've told us. Women and children are among the most vulnerable groups and progress towards the MDGs related to maternal newborn and child health remains too slow. Let me stress again what the experts alerted us to. Progress towards the MDGs related to maternal newborn and child health remains too slow. Well let's put this in another light. Because sometimes people like numbers, right? 25,000 newborns and children under 5 died yesterday. They're dying today and 25,000 will die tomorrow. On into the foreseeable future. 1,500 mothers will die during pregnancy or after delivery today. 1,500 will die tomorrow and every day into the foreseeable future. So do we need to say the progress is moving too slowly? Do we need to say that we're not doing enough? We know that. And we did need a GA report to tell us that. What the GA should be asking is the mothers and fathers of the more than 9 million children who died last year is if progress has been too slow. Or they could ask an orphan child whose mother is one of the more than half a million women who die every year from pregnancy related death if the world is moving too slow for help for those children. So what I want to do is kind of have us look at the question of what to do a little differently. What do we do to pick up the speed? We're the richest nation and there are other donor nations. And are we doing enough to sufficiently reduce child and maternal mortality? Are we doing enough to invest in sustainable health systems? Well in my opinion not enough and I know from hearing from many of you in the room not enough too. And that's why taking on the challenge of MDG-4 to reduce child mortality by two thirds and MDG-5 to reduce maternal mortality by three quarters is something that we know needs to be done and we know how to do it. The goals are all doable. We know that. But the fate of millions of women and children cannot just be a talking point in my speech today. Or it just can't be a summit declaration about we need to do more. It needs to be converted into action. With regards to maternal and child health we need inspiring action. And that I believe is our biggest challenge. The ministries in Sub-Saharan Africa and South Asia understand that women and children in their country are dying in mass numbers and they're dying needlessly. The development and global health communities understand the problem. Everyone in this room understands the situation. And we all know we don't need to wait for a miracle drug or a great technologically breakthrough to deliver what in essence is a package of sustainable interventions if we put our mind to it. And that we can by delivering these interventions literally save the lives of millions of children and hundreds of thousands of women. We're delivering those interventions right now today. It's being done all across the world. We know what needs to be done. It needs to be scaled up and it needs to be sustained. We know that skilled birth attendants are needed at all births and we know how to recruit and train them. And we know expanding access to family planning, child spacing improves the health of women and their children. And we know exclusive breast feeding and immunizations from measles and vitamin A and bed nets combined to save millions of lives all around the world. And we know that the U.S. A.I.D. has been making major contributions to maternal child health as well as reproductive health for decades. Tons of millions of people are alive today because of child health programs implemented by U.S. A.I.D. and paid for by the American people over the past 40 years. And we need to celebrate that with the help of the U.S. A.I.D. and the U.S. A.I.D. And we need to celebrate those tremendous successes. We really do. And all of you here today know every statistic there is to know. Every fact about the lack of maternal child health. Every medical consequence, the human cost. The lack of data is not a problem. And I'm carrying it with me. We don't need to study it anymore. So let's look at child health as I said from a different perspective. What we don't know. That's the harder question. Something must be missing if we know how to solve such a problem. Such a serious problem. How to save lives. And yet we still know moms and children are dying needlessly. So let me throw out a few questions. And as a teacher this is a very dangerous thing to do while I'm still speaking. But I want you to help me with the answers. Because I think collectively we need to figure out how to inspire people to action. So where is the urgency to save the lives of children and mothers? Where is the political will to invest in the lives of children and mothers? And does anybody know or care to even know the names, know the faces of the babies and the women who are dying at this very moment while I'm speaking? These are the questions we need to ask and answer if we're going to translate these endless reports that I held up, all the policy papers, all the strategic plans into advocacy, into inspiration, into investments and into action to save lives. Now I'm looking for the answers. I know you're looking for the answers so I'm looking for you to work together with me to find them. As you know I'm in the House of Representatives and there's 435 other voices and votes as well. Is this level a priority issue for Congress? Well we know it should be, but I have to tell you I don't feel that it's a priority in Congress. Imagine the possibility of a terrorist attack in which 5 million children were at risk. We know how to prevent the attack. We know it would cost 5 billion dollars to save those lives. Would Congress spend the money? Of course we would. Even the blue dogs and the compassionate conservatives would spend the money. But unfortunately that terror strikes millions of parents who watch their children die for malnutrition or malaria. But that's not the same kind of terror that inspires Congress for action. A real sense of urgency may need to start beyond Washington in the very countries in which women and children are dying on acceptable rates. For example, India and Pakistan have billions of dollars to spend on advancing military hardware including nuclear arsenals. Yet tens of millions of their children live in abject misery and die for no other reason than the fact that they're poor. Nigeria, a petroleum exporter, leads African continent in the numbers of mothers dying each year. They're ashamed for such an African power. Where is the urgency in India and Pakistan to invest in its own citizens' lives? And if they aren't willing to make the commitment for their own children, for their own future to make that a priority, how do I convince my constituents to make their children a priority? Now this administration's leadership on this issue is essential. And the President's speech in Ghana about transparency and corruption in maternal child health and asking for partnership is essential. And it's going to be essential that we prove that in order to go to Congress to ask for any increased investments in maternal child health in 2011. But the President also has some work to do here at home to show that it's an urgency. He needs to appoint someone to head our international development efforts. And I know the vetting is going well and I know no one's probably more frustrated than President Obama but we need someone at the helm of USAID and we needed them yesterday. So I'm sending the President a lot of well wishes that he is able to make that announcement shortly. So let's say we get that in place. How do we still move forward to inspire the political will in the United States and around the world to do something about maternal child health advocacy and we need to think long and hard about it collectively. Together. This is an area where policy, politics and pressure need to come together. Unless there's a new model of grassroots advocacy, political engagement, lobbying Congress and the White House and real pressure from Americans all across this country, from school groups to civic organizations, I'm afraid maternal child health will stagnate as an issue and we will not be successful in appropriating the increased dollars we need to do. And that's a shame because it also diminishes an opportunity to build a sustainable global health platform in those communities. So the reality we're facing is that the political and policy success of the global HIV AIDS community has put a real squeeze on other global health accounts. That's a fact. The White House in 2010 state and foreign operations appropriations invested 7.8 billion dollars for global health with 7 out of every 10 dollars going to HIV prevention, treatment or care. 7 out of 10 dollars to HIV. That's a fact. PEPFAR has created a global health entitlement program. That means a person who needs lifetime treatment for HIV AIDS will take priority over other investments like child and maternal health. Unless we plus up child and maternal health and have that out there transparent where we're pushing for the sustainability and the growth in those accounts will consume the dollars. Now I'm not here to badmouth what we're doing in PEPFAR. I voted for the PEPFAR legislation. I had some concerns about it though because I didn't think we as a country, we as a Congress were really understanding the long term commitment we were making with those dollars. I voted for a five year PEPFAR program and I said to Representative Haydn Lantos in committee and I'll paraphrase what I said I'm not making a five year pledge. Once someone starts ARVs I have a lifetime commitment to those individuals so let's not get ourselves here about what we're doing. It was the right thing to do but we didn't look at the whole basket of global health care needs as we move forward and now we find ourselves with tradeoffs. But in those tradeoffs too many lives are being lost. Now Congress is going through its own domestic health care reform and all of my colleagues have heard first-hand stories from countless constituents about their challenges of accessing a quality health care. Their stories and the people who tell them demonstrate a real need for that health care. But who are the mothers and fathers and children who are going to get to be willing to invest our tax dollars, our energies, our ideas to build healthier families and communities in far away places? Unless we can make these lives real to those individuals and less of statistics in a speech, tens of millions of children and mothers will continue to perish. Now last week, Nicholas Kristoff in his New York Times column wrote, Humanitarians are objectively ineffective at selling their cause. And we are. We do have the success stories and we have to hold them up high and I've been to many of them. Whether it be save the children or care or any of the other fantastic NGOs I work with. They do great work on a limited scale based on the resources that are available to them. So we are ineffective at selling our cause at the large ramped up scale. He went on to say quote, I also wonder if our unrementing focus on suffering and unmet needs stirs up a cloud of negative feelings that incline people to avert their eyes and hurry by. Just as some of you have started to do with the speech that I'm giving. He goes on to say, maybe we should emphasize that many humanitarian successes such as falling child mortality rates since 1990. That means 400 children's lives are saved every hour around the clock and we should celebrate that. But we can't take our eye off the prize to quote my civil rights friends. Mr. Kristoff is correct in his assessment when we should be championing success of every toddler who is now a teenager because of access to basic health care, good nutrition and clean water and we need to tell that story at the same time we're asking for help to help more children. Hundreds of thousands of American citizens are contributing. They're contributing to you through their own money to make a difference in the world. Now we know there are many competing development challenges that require resources and I mentioned one of them, HIV AIDS and they kind of lecture but together we need to look at that and say how do we collectively use those to contribute to our poor countries healthier, more successful and better prepared to meet their current obligations and future opportunities. Whether it's basic education or agriculture, development, clean water, maternal health, child health we need to make smarter investments that produce results we can show up, hold up and celebrate and then demonstrate to the American people that when we work together real improvements happen. We make a difference in a family, a community and a nation becoming more stable and that means a healthier, more peaceful world for all of our children. So let me conclude by asking for some of your ideas and suggestions in the Q&A about how to mobilize and how to inspire action from the American people as well as from foreign leaders to make maternal child health a global priority. We need to have a dialogue with NGOs, donors and policymakers and we need to have that dialogue saying what are you going to do to help energize what are you going to do to help mobilize and what are you going to do to help communicate more effectively on this issue. Now I do have a bill my name's on it but the credit goes to so many of you in this room. HR 1410 the newborn child and mother survival act which authorizes a U.S. strategy to reduce child and mortality and maternal mortality and to be implemented by USAID but a bill's not good enough. We need a champion. We need a movement in support of the millions of children and women's lives we can save if we only try to mobilize more effectively. We need action in congress and in parliaments and in donor countries and we need action in the developing countries to make this a priority. We need to organize parents here and we need to organize parents in the developing countries. We need to organize children here and we need to order organized children in developing countries to become activists. We need to motivate and mobilize a political movement that will create the support for resources that will allow investments in interventions that we know save lives that we know change communities and we know will transform our future to be a more successful and peaceful and healthier future on this planet. Now I'm committed to making pregnancy and childbirth and newborns start in this world safe and healthy and a joy for every family here at home and around the country but even the poorest families and the poorest of countries turn to the United States and turn to us and look for us for the leadership for us for the accountability look for us for the stabilization look to us for the dollars to make this a reality. So I know we have a lot of work to do but we have a lot of successes to build that work on and so I'm going to ask you as part of the Q&A tell me what you think we need to do to take this book filled with data and statistics this book that has plans put it on the table and say make it happen now we're not waiting another day we're not waiting another year we're not waiting another moment because if countries are going to be healthy if they have a chance of even aspiring to have sustainable governments they need to have a healthy population and that starts with pregnancy and that starts with birth and I know it starts with a lot of the work you do here in the room thank you Thank you very much for that very eloquent powerful statement there has been a significant and in some ways a sort of surprising upsurge of interest in momentum around these issues and the fact that the White House and the President himself are important putting this front and center within the global health initiative making this part of the speech and activities in Ghana getting keeping the G8 focused in this way and we see momentum coming from other directions as well I think the picture this is a moment when it seems to me there is the possibility for moving forward in a significant fashion that you're not starting from scratch you're starting from a moment of a significant upsurge of interest coming from a variety of directions and coming from many sources that are quite important to be able to carry things forward why don't we take three quick comments and questions and then we'll come back to Congresswoman McCollum for discussion and we'll do another round we've got a little bit of time we have microphones I'd like you to just identify yourself and then try to keep your intervention fairly succinct thank you yes thank you I'm doing your luwale from AED thank you very much Congresswoman I'm from one of the countries that you mentioned that women are shamefully dying and yet the resources are in country and I cannot agree with you more that the urgency has to come from within the country and that we need politics as well as Brazil I think like a decade ago there were not too many women in the parliament in my country and in Kenya and in Uganda from the United States from Europe came over to Africa worked with women trained them on how to campaign on how to build self-esteem on how to present their strategies to their constituencies and today I can tell you that it has worked it has paid off there are many women in parliament I think the same strategy can be applied to the issue of maternal newborn and child health let's go out there work with the women let them know the details they do not understand what 1,000 deaths per 100,000 life-baths means it means nothing to them but they understand that every minute one woman is dying and they want to know why we can teach them to communicate with them and work with them on how to present their case to their leadership so that from within we have the politics we have the pressure and then the United States Europe or the countries can respond to it because I think this is too long a problem for us to carry thank you we have a hand up here we have one in the back we are only focusing primarily on maternal child health mortality versus morbidity in my day-to-day work I am focused on diseases which certainly don't cause the mortality that HIV and malaria do particularly mothers and children have extremely detrimental results so I am wondering how we can better incorporate diseases that might not have the death statistics cause extreme morbidity to really bring about the effectiveness of our programs in the field thank you, thanks Aaron we have a hand in the back here my name is Karthik Ballas-Bermonian my name is Karthik Ballas-Bermonian I'm with the Boston Consulting Group you're going to need to speak a little louder is the mic working? sure I'm with the Boston Consulting Group and my question is what do you think the prospects are for the U.S. ratification process for the U.N. Convention of the Rights of a Child I'll start with the last one first, I'm not a member of the other August body of the Senate where the treaty ratifications take place I bring this up usually when I'm with other parliament members right away that I know that we're not a signatory on how embarrassed I am we also know in fact not being a signatory the landsmine treaty has also to agriculture and has to child survival as well so I have no idea what the Senate's plans are for bringing that up but I think it's high time I think with now I have two Senators from Minnesota I know who would both be very supportive of that so please I feel like a whole grown-up Senators my family's complete but I really think that we need a champion over in the Senate to be taking leadership on this so I would encourage you to do that and once you find out who that person is let me know I'll adopt him as my third Senator if it isn't one of my two I'm gonna kind of take these in reverse I was in reverse order but then I thought you know I think your question on what do we do about neglected diseases to my sister's question about what do we do to support women and communities around the world I like your idea one of the things that I'm trying to do is try to put together a codel and it doesn't necessarily just have to be women I think because we need some of our brothers to talk to our other brothers just but focus on maternal child health showing what we can do and what happens when we have sustainability brought into the problem not having sustainability built into some of these is a huge problem and the only way we're gonna have sustainability is for the countries to be engaged and we did that rather successfully actually with parliamentarians of World Bank sponsored some things on HIV AIDS to get international parliamentarians and some of the recipient countries to sit under the tree and to talk about AIDS and to be more open about how it's transmitted and that people need to be tested we can do the same thing I like your idea of me being more thoughtful with some of the other donor parliamentarians I know to be more engaged with DFID and the rest about how do we really make this person to person what it should be and empower those parliamentarian leaders to action how to empower women to action but we know women are carrying the water they're attending the children they're in the fields but I meet the most amazing women wherever I go they always have time for their children and they always have time to support one another so I think this is totally doable even in their busy lives if they're given some tools in which to help organize so thank you for your suggestion when we build sustainability into these programs and when we look at maternal child health what do we mean when we look at maternal child health yeah we're talking about birth attendants we're talking about vaccines but if a child is going to grow up to be healthy that child needs what food and water this is how do we build an integrated system in which sustainability is part of it so I don't see that what the president is doing in agriculture is being in any kind of competition in what we're doing on child survival I pushed for and I was part of a panel here at CSIS to talk about the 3Ds Defense Development and Diplomacy and wanted us to have a real strong leg, a three-legged stool with someone heading up development I don't think we're going to see a secretary development I think we'll see one in my lifetime I'm going to be positive but I don't think I'm going to see one in the next two or three years but we really need to have a development strategy which integrates all these things that you were talking about so that we create a ladder up and quite often we create a step stool and we forget to put the other rings on the stool so people can move up or after people are in the top of the step stool we go oh we're going over here now and we're not making sure that your government has something you know in partnership to keep the sustainable and we pull the step stool away and we can't afford to do that anymore we have to be so much smarter we are smarter than that now we just have to have the will to do something about it we have a couple of, we have hands up there's one in the back this side of the room is a lot more awake than the other side Maurice Congresswoman thank you for your speech and for being such an incredible champion of health I want to make three suggestions one is a direct appeal to the president and to Mrs. Obama they just came back from the child and reproductive health a hospital in Ghana and it would seem to be a propitious moment to make a direct appeal to them to extend the president's commitment to maternal and child health we were a little disappointed in the budget that we put forward this year as you know a second suggestion would be to have the Institute of Medicine report that came out that report came out that has a very important recommendation makes it clear that it's in the U.S. interest to make these investments but there hasn't been much action in response to that report and my third suggestion would be to have a report card on health performance if we do an annual report card on human rights this seems to, there is such a body of law and of treaties around health that there ought to be a public report card whether emanated from civil society or from government that scores governments and whether or not they are living up to their commitments I think that's a really good idea I like the idea of the annual report on health and I don't think we have to reinvent the wheel to do that the World Bank collects a lot of those statistics and so I'm going to follow up and talk to the World Bank and see if they can help us kind of start maybe launching something up because if we wait to build a bureaucracy to do a report, remember I said we have all the statistics we need and they have what's going on with the governments by economy by economy there maybe I can work with them to see if they'll do a course to the poor annual report and kind of look back a couple years so we kind of have a base to work off of. I like that idea and working then we can show the women in the village and the parliamentarians in a very transparent fashion we're willing to do this is a partnership this is not about a handout I can't think of anything more disappointing than to have a handout when you want to help your family you want a partnership I wanted to be a partner with my children's schools I want to be to the best of my ability a partner with my children's health care providers when they were young I wanted to be a partner with my community in making the playgrounds in the neighborhood safe and that's how we have to look at this we have to look at this as a partnership because if we do it in that way I truly believe people in the recipient countries will become more excited about being engaged with us they deserve to have this done in a respectful fashion because I have never met one parent who hasn't wanted to do what's best for their children we've given an opportunity and we have to respect those parents rights to be given an opportunity to have a healthy family and so I like the idea of the report card to have parents within their own governments as well as empower our own government to do what we should be doing we can Bob Gates is with us the Secretary of Defense thinks it's a smart investment of money we should be listening to him on this particular reason for sure let's take a couple of different comments we have a woman in the middle there please and if the microphone is not working it's important for the videotaping that the mics be working is this working? thank you for your comments on integration it's a very difficult thing for many people to grasp this integration and a hard thing to advocate for many times something like AIDS where you can show the statistics and show that people dying quite easily is much easier to advocate for and so I was just wondering what you see as the future for integration across a wide spectrum regardless of the fact whether they're male, female, children mothers and get the health care they need and I just wondered in Congress what you see as the future and if people are in fact getting on board with this, I know that President Obama is and I was just wondering what your thoughts on that were thank you Keith Hansen from the World Bank thank you very much for your leadership comments that was a nice plug I gave you guys very much in line with this comment just to note that I think AIDS has succeeded largely because there is a magic bullet that can be delivered that incontrovertibly saves lives and can be easily counted but can also be delivered largely outside of formal health systems child health and especially maternal health the only way to solve these sustainably is by strengthening systems and I think our message in the World Bank and one I know you're pushing and I think all the agencies need to follow is this next stage where the approach to global health can't rely on magic bullets or quick fixes this is really the time we need to strengthen systems as a whole especially maternal mortality it's an excellent proxy for the overall strength of the system and that's we need to take a longer view and in some sense be impatient with results but patient with the kind of structural work that needs to be done in order to make this last and not be a flash in the pan let's take one more over here in the corner Hi, my name is Mikayla Hennig I'm an intern with Representative Ed Pearlmutter's office I had the opportunity last year to advocate for the Child Marriage Act of 2008 and I'm thrilled to see this passage in this Congress my question and I'd like to thank you for your comment about engaging our brothers in this issue from my limited experience so far as a college student my frustration with family planning, reproductive health and maternal health care and a bronze that were only reaching half of the population so how do we frame this issue not only as a women's issue but also as a people's issue that's really good Earl's are we were having the first congressional ever women's softball game you all want to miss it I don't know where I am in the starting lineup and Earl's been one of our coaches so we used our brothers' expertise to kind of we'll see if the guys are kind of like walking in the field after a while one more plug on that the average age of our competition is 25 and ours is double that okay I was just in Peru and I was going back to kind of see what was happening with some of our maternal child health projects and I was in a village outside of Cusco where they had integrated the whole community similar to another project I had seen in another part in Ayacucho Peru and it's the engagement of the community engaging the men in it that has helped bring the sustainability in it because the guys don't their dads they want to see their children do well they want their wives to be healthy after the delivery they don't want to be widowers and so the engagement of them is very important and sometimes something that we don't tend to do very well but sometimes we don't tend to engage the village very well from the get-go and that was to my point about respect in the United States we tend to lay on a table if you're not in a water pressurized tub or something delivering your baby we have our tradition of delivering babies so when we roll out our programs that's what we bring with well they found out no one in Peru was coming to the clinics well that's not how they deliver babies so they sat down at the SSID and they worked with the medical school in Cusco and said what do we need to do in these villages because the government of Peru was engaged in changing the outcome now I realize this isn't the poorest of the poor countries but I want to use this as an example of how when you engage people you can have good outcomes so I went and went to this village the women are identified they're given prenatal counseling they have waiting houses where you bring your own chickens and everything else the kids come down to the waiting houses two weeks before they're immunizing the kids there they have people there talking about best practices in farming with the women they're talking about breastfeeding being best all these other kinds of things are going on and the dads come back and forth from the field and then when it's time for the delivery they go across the street in a room that they've been in a couple of times the women sit in a very specialized stool the dad sits in another stool the dads put their arms out the mom has her arms around the dad mom's sitting on a stool to do the delivery and I just the happenstance was everyone one of the babies was delivered they haven't lost a child yet but they're finding something interesting out because now they're able to collect data kids are doing great till six months they're losing weight and they're starting to see children at risk of dying we're able now to track the fact that there's lack of nutrition and so that's the next step in so that's putting the integrated system in together but that's involving fathers we don't do any one part of our life in total isolation our lives are integrated and we have to approach this as integration as well you know that you're going to measure the outcomes differently but we need to start scoring preventive medicine both here at home and abroad and we haven't done a very good job of doing that but if we're going to do that then we have to be serious about building the sustainability and the partnerships and with the governments and that has to be part of any plan moving forward what will this village look like a year five years ten years after we're gone and we're just kind of coming in collecting more data on how to do things more effectively sure so right here in front I'm Andrew Berra the executive director of the U.S. Coalition for Child Survival and I have a, I think what's a difficult question for Betty and that is we have a lot of support for your bill 1410 from the NGO community members of Congress from members of the House Foreign Affairs Committee but how do we get congressman Chairman Berman who is a supporter of Child Survival he talks about it all the time how do we get him to mark up the bill rather than wait for what might be a two or three year process of foreign assistance reform how do we get action now great question thank you Dan right behind and then over to good morning I'm Daniel Singer associate director for global health research and international activities at the Unis Canada Shriver National Institute of Child Health and Human Development don't count that against my time but what's your rank as you know we have a lot of good evidence based interventions where we tend to fail as in the implementation and the delivery of those and my question is that clearly is going to require a reconfiguring of how we do global health how do you see the appropriate relationship between the State Department and also the relationship between those entities and NIH and the other technical agencies that really have the health expertise how should we be organized to be better at getting these things to scale in the field congressman thank you for your leadership and also your staff are always extremely knowledgeable and accessible so we appreciate that I work for an organization led by a proud graduate of the University of Minnesota and we're trying to find a vaccine to prevent tuberculosis which as you know is one of the leading killers of women of child bearing age about a million women a year but when you talk about the focus on HIV and how can we spread that around I think one of the issues is partly Dr. Hanson from the World Bank said they're sort of seen as an easy solution in some ways there but also there are a million Americans living with HIV and half a million Americans who die of AIDS and unfortunately the things we're talking about today Americans don't think affect them so I don't know how to make them do that because it's really an uphill battle but one thing might be 60 minutes to the show a few months ago on Plumpy Nut the feeding for children and maybe there's a way to get 60 minutes interested in kind of a positive aspect of maternal health such as showing how this sort of diver suits that women can wear to prevent hemorrhage can prevent women from bleeding to death during childbirth or some other maybe more positive way because Americans do tend to kind of tune out or look away when something seems too depressing so I don't know if that's something that you all can help kind of reach out to people in the media and say here's a way you can tell a positive story but otherwise I'm afraid Americans will feel like it has nothing to do with them and they won't want to spend money on it. Thanks. Well Americans do spend money through many of the charities and churches and that it's just that we haven't been able to harness collectively to turn those individual movements to expand those and then turn it into a political movement here in this country much as you were pointing out we need to do in Africa and Asia and other parts of the world the the letting people know about successes is really important and it's letting people also know how if we fail to do this how it will have a direct impact on the health economy of the United States and I think each one and one kind of brought that up to light. That's one of the big reasons why I founded I'm the founding grandmother of the Global Health Caucus is because members of Congress and their staff need to have information about what works, what's going on just general education on these issues and so we're always thrilled when CSIS comes and helps and does a briefing in that but in people's day to day lives right now dealing with in Congress dealing with home foreclosures health care, returning wounded soldiers the economy, everything else on unless there is some place where people know they can go get information when they need to get it and that's kind of why we formed the Global Health Caucus and a lot of you provide that information too kind of one stop shopping then if it's not easy to accumulate that data they'll walk away from it but the other part of it is if you're out in your constituency and I have a constituency that talks about these issues greatly if you have a constituency that knows that they're welcome in your office to come talk about it or they need to come to your office and talk about it they will move they will be more moved to action so those of you who are NGOs here it's great that you come see me up on the hill and it's great that you have folks who come with you to Washington every once in a while but you should have people who are checking in two or three times a year in the district office invite the district office person to coffee and a round table with some of your people who are donors or knitting hats for newborn infants and say this is really important to us because I know when I go to a Lutheran church in Minnesota and my mother was Lutheran I'm Catholic or if I go to the archdiocese I know that they have a relationship with a church or a relationship with an orphanage does your member of Congress know that probably not we keep a lot of this very hidden and we need to make it real at a district level so it just isn't so I met with this group in Washington and I signed on to the bill so that they know that there's people back home constantly putting pressure on it and kind of closing with what do we do with Trim and Berman well we're going to love them to death because I do he has really felt like he's been waiting to see what happens at USAID he's been waiting to see where the Obama administration is going to go with its foreign policy he's been kind of waiting to see what's happening with we have the the whole other foreign policy issue in Afghanistan and some of the other complex countries we're in and I'm encouraging him to do what he's waiting I'm encouraging him and I think we should all encourage him to have a day on the hill where some of these bills are just heard doesn't mean that there has to be a vote immediately taken on but so that the committee is informed and there's some real discussion and there's some real action and then after we have that day on the hill where the bills are heard and all that then I think we need then we can say okay so now that you've heard them it's time to herd them into some policy here and I really think having a USAID director is going to help Secretary Clinton is supposed to be giving a major address tomorrow I believe and we're excited to hear what that is but we need the administration also to be putting some pressure on congress to move forward here's our problem in the house in all politics as locals I'll talk about house politics we have sent so many good ideas over to the senate that we're we're kind of just kind of waiting for them to get caught up a little bit before we send them more good ideas but I'm looking forward for the day when the senate starts sending us back some good ideas so I think Chairman Berman I'm encouraging him to hold hearings on the bill I'll tell you the reason why the child marriage language was included in the last big step they did was because of all the work that you folks did and what he was hearing from his district back home on this issue as well as what was starting to happen with some of the media in the press we can do the same thing on foreign assistance, reform and that's a given but until that reform bill happens children still go hungry children still dying mothers are still dying to your point about 60 minutes in celebrating successes let's not forget to celebrate our successes and you do amazing things you really do, you do amazing things every day with your advocacy you make the difference in the life of a child we just want to make a difference in the lives of so many more children thank you very much for inviting me here today