 Folks, we're going to get started. I'm Dan Rundy. I hold the Shrier Chair at CSIS. We have a program today called 50 Years in USAids, Stories from the Frontlines. It's based on a book that's been published recently about a year ago that was edited by Janet Ballantyne, who's here with us today, compiling stories from the history of AID. And I think I see many familiar faces in the room. And so it's really great to have all of you here. I think you had a really very interesting panel with a significant amount of experience that they're going to share with us. My view has been that we haven't gotten enough of these stories out there. And so I think the fact that the turnout has been good for this event I think speaks to the fact that many people agree with me. I'm going to ask my friend and mentor, the former USAID administrator, Andrew Natsios, to make some opening remarks. Andrew, please come on up. Thank you, Dan. And thanks for inviting me. This is a remarkable book, actually, Janet. I only started, I'm embarrassed to say, I only started reading after you gave it to me when we had our coffee last time, last month. And it is a jewel. And I just want to thank you for doing this. I have two interests up here. One is, obviously, I'm devoted to AID, but I'm also now an academic running a small institute at the Skollcroft Center at the Bush School. The Bush School was started by President Bush 41, 17, 16 years ago, are now ranked in the upper 13% of the 265 schools of public policy in the United States. And we are moving up almost each year in the rankings. And we have a very large endowment that President Bush and other people have created. We have 300 master's degree students and we are preparing people for federal service in AID, the State Department, the DOD, and the CIA. So it is geared, it's a master's program, professional program, we don't have a PhD program. And I went there a year and a half ago, don't regret it at all. We're getting more and more competitive to get in, but we have an institute, the Skollcroft Institute, in last September I was made director of that in addition to teaching. Now, the reason I mention that is we have more and more money to use. And one of the things I think I'd like to invest in, but we have to find a partner who's willing to do some of the legwork because we're in Central Texas, 90 miles north of Dallas, we're not exactly here in Washington yet. So the reason I mention this is I think this book needs to lead to a series of scholarly books. Each story told here has a parallel in much more depth, a case study that has not been recorded in the literature from an academic standpoint and from a historical standpoint. A lot of other institutions have taken credit for things that AID actually was central in creating. For example, it is widely believed for some reason that the World Bank is principally responsible for the miracle in South Korea and Taiwan. That is simply not true. In fact, the USAID role is only now coming out because of declassified CIA cables. Every cabinet meeting that was held, the AID mission director was in the meeting. And the mission director would actually tell President Park, you need to fire this person, they're corrupt or incompetent. And I didn't realize there were 5,000 or 6,000 aid workers from AID in both countries, Taiwan and South Korea. They are huge success stories. The aid role now because aid officers want local ownership, we won't take credit for anything. I mean, that's self-destructive ultimately for AID. It may be nice from a development standpoint, but what Janet has done in this book by soliciting these stories is now, I didn't know half this stuff. I thought I knew a lot about AID, but the stories, there's so many stories. It's so rich a history that this needs to not be the end. It needs to be the platform that we build a whole series of additional books and monograms maybe from an academic standpoint that can be permanently in the literature so that when master students, because we have a development program at AID, I mean at AID, at Bush School now with several prominent economists who would use this. And I'm gonna put this on the required reading list if we can get electronically ability easier to make my kids read it for my class in development theory and practice. So the other thing I wanted to say is some of what we do because of the nature of the federal bureaucracy, they want for every dollar we invest, they want a dollar in return. This is this law that was passed in 1993 that requires all federal agencies to document this. AID, if you read this and you read other stuff that's been written is more like a venture capital fund which is to say we'll invest in five things, four of them don't work that well, maybe not permanently, but one is a sterling success. I did not know John Blackton's story here about early on airlines in Afghanistan, which still exists. Most people don't know, Eiffus was started by Peter McPherson and Amy Simmons really didn't start but she was the designer of this seed trust that exists that we're protecting two million seed varieties for food stuffs in the world. There's a large endowment behind it and for the people who were at the beginning when she is the one that thought this through, she told me what to do and I basically did what she told me to do but there are other stories beyond this. Now I see my friend Lane Smith, he's not in this book but I did not know to what degree AID introduced the internet to Africa. I mean literally in a physical sense, just into the legal systems and cell phone technology into Egypt, this is again, this is wetting the appetite of anybody interested from an academic but also the last point I wanna make is this is gonna be lost because there's a massive change because it's going on across the federal government in fact it's going on in the states of senior career civil retiring and a new generation coming up and there's this time gap because we didn't hire in the 90s and so I was told that 60% of the workforce at AID now direct hires have less than five years experience in the agency. I was at a conference recently and I was talking with them and I was telling them stories about, they didn't even know who I was which I am getting old but I said who are you? And I said, I mentioned my name and he said did you used to work at AID? I said yeah I did work at AID at one point, yes. So, but they have no history unless they're required to read this they're not gonna get a sense of the enormous depth and power of the agency over the last 50 years. I think we played a much larger role in winning the Cold War than is widely understood. I have made a connection in some of the writing I'm doing between the Green Revolution which is in here and Dr. Borlaug told me a dinner sitting next to him when he was still alive. I said well I understand Dr. Borlaug I was the Rockefeller Foundation, the World Bank and AID that helped Jim, he said don't ever, I'm not gonna be critical of other institutions. He said without AID there'd be no Green Revolution, Andrew. Whenever I went there and asked for help there was help, in fact it was the aid administrator that created the term or invented the term the Green Revolution. The reason I bring it up is because the Chinese famine was going on which killed 45 million people, it's the worst famine in the history of the world. Orchestrated by Mao because of this crazy economic scheme he had, the Great Leap Forward that killed an enormous number of people. Now what's the message? Norman Borlaug and AID are saving with the World Bank, he was slightly critical of the bank. Going to any depth I will not use the language he used. He was yelling at me actually at dinner when I started saying we all shared with you. He said no that's not true Andrew and he was yelling when he said it. He said AID was there in the front lines from the beginning with us so and the Rockefeller Fund was certainly central to this but what was the message in the Cold War? This was we were saving at least 300 million people's lives upwards of a billion people's lives because famine ended in Asia as a result of the Green Revolution. Except for North Korea and a famine in Bangladesh in 1974. Those are the only examples and that's because the Green Revolution didn't get to North Korea because of the regime. So what's the message? Our system works, you're dying in China. So now other people want to integrate us, the development committee into the state of the other D's, the big defense D and the diplomatic D and the mistake of that is this. Dr. Borlaug's project took 30 years to implement. Now I'm not being critical, I was a diplomat but I'll have enormous respect for our ambassadors and for the State Department. I do, I don't like the criticism made of the State Department often. Their timeline is six months, a year, two years. There's nothing in the State Department, nothing. About 30 year programs or projects. The program to match that is in this book, the university engineering, 10 or 11 engineering schools with 10 or 11 institutes of technology in India that we helped create. That was a 20 year project from 1951 to 1971, it actually predates AID. It's a 20 year project. Do we have 20 year project institution building projects now? No, you know why? Because the technology, technocracy now requires us to produce quarterly measurements of outputs. If we had quarterly outcome measurements, this book wouldn't exist because we wouldn't been able to do have this stuff. Why? It can't be done in a year or two. The timelines are completely off. The timelines of the Defense Department and the State Department, because of the nature of their work, are not 20 or 30 years. And if you wanna do this successfully, which we have proven from this book and other work that's been done, it takes a long time to do it. And sometimes at the end, if you read the evaluation which I did at the end of 1971 on this project in India, this linkages project between these American, one of them, the leading Indian IT Institute was matched with MIT for 20 years. Guess where the center of the revolution in IT is in India, at that school. What's apparent now from this, and then the democracy and governance evaluation we did 20 year retrospective from 1985 to 2005, that I don't see Jerry here today, but Jerry was the one that pushed me to do it, is the head of the office, G&G office. But what it shows is that there is a time lag between the time you finish a project and the time it begins to show results. And they show this over a 20 year period and this was by the way not AID doing the evaluation, it was done by Vanderbilt and by Carnegie Mellon and it was done with the American Academy of Science and what it showed in the correlations that were done because they correlated these programs, the D&G programs with the democracy index at Freedom House and they showed a moderately robust relationship between the investment of money in these programs, but what they showed is a delay. It took a few years after the 10 years we're up of the program, we used to run 10 year programs, to have it mature and then we noticed after there was no money being spent, the indicators kept improving. So there's a delayed reaction, which I don't think has studied very well in the literature, I've been trying to find evidence of this kind of phenomenon going on in other areas and we know from our own experience that this is the case, but it is not studied and therefore it's not recorded and it's gonna get lost. So I'm hoping what this conference will do in these stories and this book will do is launch an effort to document in much more depth with scholarly research for posterity what the role has been in the United States as part of our foreign policy, but separate and distinct from the two other Ds because to the extent that we are absorbed into the other two Ds, we cannot do this stuff successfully because the business systems are completely different. The more we get trapped into the diplomatic cloak, you know what happens to the programs. They get compromised, which we all know that from our personal experience. So thank you for doing this, Dan and thank you for doing this, Janet. Thank you, Andrew. Thanks very much. Thank you very much, Andrew. I'm gonna now turn the floor over to my friend Janet Ballentine who was one of the editors of the book that you have in front of you to give us a further perspective about the book and also about the work of AID over the last 50 years. Janet. Thank you, Dan, and thank you, Andrew. I think one of the more intimidating things that one has to go through in life is being the person who follows Andrew Nazio's when in the public speak. Andrew, I have had the great privilege of working with Andrew very closely for several years and I don't know if anybody who is more passionate about the work that AID does. So I really thank him for taking the time from a very busy schedule to come and present that wonderful introduction. You know, looking back over my 30 something years with AID, I think maybe the most interesting was when I had the opportunity of putting together this book. It allowed me to look over a far wider range of AID activities and a far larger range of years than one has the opportunity when one is in a specific place in a specific time. I, for much of my career, I was very much aware of the fact that running a program, a day-to-day program, you're missing a lot if you don't look to the past. Over the last 10 or 15 years, I found a great deal going to the oral histories which are at the Library of Congress and also at the Association for Diplomatic Training and Studies. When I was in Nepal back in, that was the Deanderthal period or the Jurassic period, I think the most, where I learned the most was going and reading Ellsworth Bunker's oral history about when he was in Vietnam and his wife was the ambassador to Nepal, Carol Lays. And he was running the most complex program in the world in Vietnam. But for R&R, he would go to Nepal and kind of hang out in that sleepy little kingdom where he picked up more knowledge and more understanding than many people who lived there for years and years. Putting together the book was really a lot of fun. You, those of you who got copies, there are about 125 stories. And I wish I could tell you these were selected by a very scientific manner. We cast our nets as wide as we could through the Alumni Association, through all the aid websites, through a lot of twist in the arms. Basically, these were the people who respond. There were maybe 150 that came in altogether and some were simply of no general use. I'd really look at this as the first step. Aid, the legislation, the Federal Government legislation requires that most agencies have an historian. Aid is under that ceiling and by law, there should be an historian sitting there. When I took on this job, I decided that I would be the historian. So I actually put a historian on my card and felt like this was another Walter Mittie experience that I had. But it made me understand that an organization like Aid because what is done in the here and now is so important for the future, really should have an historian. And I know there are others who are trying to make that case at higher levels than I am. I would love to see a volume two and a volume three and a volume of four. I've offered to work with any organization that would like to do that. I'd be glad to, in my semi-retirement, I'd be glad to put in my time, having done it once, I might be able to do it again. There is at least one member of the audience who is a contributor to this book. I see other aid people who should have been because everybody has a story. And some of the stories really show such imagination, such dedication and such real courage in the way that the aid programs are carried out. So you're going to be hearing from three of the contributors, each of whom has an interesting, distinct story. But I urge all of you with your aid experience out there to be thinking about what your story would be. I would love to see that every aid person who retires has to leave behind at least a three-page description of something that he or she did during one's tenure with aid. I think this would add to what Andrew talks about, you know, a growing history that begins, and I just say begins to tell the story of the amazing change for the good. The USAID has done over its 50-some years of existence. So thank you for coming today. Some of you were able to do snag a copy of the book. The book is available online from ADST, which is the Association for Diplomatic Training and Studies. ADST.org, go under the publications. You can get the book with postage, but I think it's for $15, which is a bargain anywhere you can go. So thank you all for coming, and I will turn it back over to Dan. Thanks very much, Jan. Jan, before we do that, can I ask you, I'm gonna just take the privilege as being the moderator. Would you just share with the audience the story you told me, because I think it's very powerful. It's in line with some of the stories Andrew told about you were in Peru, and tell us how your connection to Alejandro Toledo, because I just think it does matter, and it's sort of about the importance of the future and investing for the future. How did Alejandro Toledo become Alejandro Toledo in Peru? How about that? Alejandro Toledo's story, really the real impetus between him being Alejandro, a very poor shoe shine boy in a rural area up in the mountains, and Alejandro, the ex-president of Peru, starts with a Peace Corps. That this young man, one of 13 children at the age of 11 became a shoe shine boy. And the kids in the Peace Corps, the young people in the Peace Corps were so enchanted by this guy with a smile all the time who used to say, oh, your Peace Corps, I'll shine your shoes for free. That they helped him get through high school and they got him an undergraduate fellowship to study at San Francisco State, where he graduated, very high honors, came back to Peru and was selected to go on to get his PhD at Stanford under a USAID scholarship. And I remember I was the head of the Office of Health Education and Nutrition at the time that the Education Officer brought him into my office and said, I'd like you to meet Alejandro Toledo. We're sending him off to Stanford. And here's a guy who's about the size of my son who was about nine at the time. And comes obviously from a very indigenous background. The minute he opened his mouth, I mean he was the sort of person you know that is going to make a huge difference in his country and there's gonna be such a positive force on coming to the United States. He went on, got his PhD from Stanford, went on to become Vice Minister of Education and was the first indigenous person elected to the presidency of Peru. I had the opportunity of seeing him several times while he was president. He would come back and forth to the States. And I was at a symposium at Harvard one time where Lawrence Summers introduced him and talked about the wonderful things that this man had done. And the first thing Alejandro said was, I see Janet Ballantyne here. She's from USAID and they made me who I am today. So there are many, many people like that but that was a real, real thrill for me. Thank you, Janet. Thank you. I'm now gonna turn the floor over to Alex Shekau. He's the former Assistant Mayor, Senator for PPC at USAID and then had a distinguished career at the World Bank. Alex, over to you. Is this on? Yeah, thank you very much. First of all, let me say in connection with what Andrew was saying and what Janet followed up on, that the USAID Alumni Association is trying to collect a bibliography really of all the writings that have been done by former aid staff. I mean, there is no such collection anywhere and that would be at least one step towards doing the kind of thing that you're talking about. So if you go to our website, there will be some, I think there's a reference to it on the website but in any case, if you know of people in aid who've written books and articles that you think should be part of that bibliography, please let us know. It's www, what is it? USAIDAlumni.org, right? Anyway, now, thank you for inviting me to participate today. My talk today, unlike my colleagues here, is not a touching one of human interaction in the field. It is rather a more bureaucratic tale of how we tried to develop aid policy in the 1970s and there's some people here who know that intimately so I have to be very careful about what I say. To set the scene in the early 1970s, the future of foreign aid looked particularly bleak. The aid bill was even defeated in the Senate in 1972. In response to that crisis, the House International Relations Committee developed and Congress passed in 1973 the so-called New Directions Legislation with its focus on meeting basic human needs. Incidentally, the ideas in that legislation were importantly based on aid staffer Ted Owen's book, Development Reconsidered, which shows that there is more than one way to influence congressional policy if you happen to be an aid staff member. This legislation raised a number of challenging problems and its implementation required great innovation by aid staff and our partner countries. PPC, under Deputy Administrator Johnny Murphy's strong guidance, let an agency-wide effort to interpret and implement the new law. Our response and aid's basic approach to development was set out in detail in our 1975 report to Congress. It is remarkable, in my view, how valid this work and its analysis remain today. Several of its key elements include, I'm quoting now, by concentrating our aid in the three key sectors of food and nutrition, population and health, and education and human resources, we seek to help developing countries increase their capacity to meet the basic needs of their people. Projects and programs are especially directed toward reaching the poor majority within the populations of these nations. We urge recipient governments to design policies and programs to assure that the benefits of economic growth accrue to all the people and not just a select few. Influencing LDC institutions, policies and systems are indirect but essential means of assuring that benefits reach the broadest group within the poor majority. Moreover, while it is slow going, we are emphasizing programs which involve the poor as active participants in the development process itself, avoiding any suggestion of a handout. So while ending a quote there, while elements of this focus had been present in aid programs for some time, what was new was the assertion of the agency's, quote, complete commitment to concentrate our attention on these approaches and to attempt on a broad basis to engage the poor in the development process, close quote. Thus the crucial question asked in every project and program was who benefits. One of the most important tasks was to ensure that an emphasis on meeting basic human needs was not seen as antithetical to an interest in growth. We argued that the two must go together, growth with equity, but this was not a simple concept, still isn't, and many practical issues confronted field staff as they sought to help countries achieve both. PPC, working with our colleagues throughout the agency, developed guidance which spelled out in some detail how to help governments design a program which included an appropriate pattern of growth as a vital component of a basic human needs development strategy. Despite this, and with the benefit of hindsight, we probably still exaggerated then how much anti-poverty measures on their own would bring about sustainable growth. Another task was to set out rough benchmarks used to define the poor majority. We had to counter an extreme view that our focus should be only on the poorest of the poor while at the same time resisting the view of others who urged a very broad definition which would not have changed anything. These examples illustrate several of the issues that arose as we tried to convince an often skeptical agency to fulfill the mandate given to us by the Congress while protecting our strong belief in a balanced approach. Some staff wished to simply carry on with the traditional big investment programs under the new directions rubric. Some staff thought it was just a passing fad. It was not easy to achieve consensus as for many staff, this required a cultural change. As a result, we spent as much time as possible meeting with AIDS Field Regional and Central Bureau staff encouraging them to raise practical operational issues in the many training sessions we organized. In the 1970s, PPC had overall responsibility for developing and recommending to the administrator the complete AID budget. In my view, this is a function that is absolutely critical if the policy bureau is to be really operationally relevant. We were the administrator's eyes and ears and sought to be an objective and unbiased arbiter and all matters, which I think we did pretty well, although no doubt the other bureaus felt differently on occasion. We also built up AIDS evaluation capacity instituting use of the logical framework matrix, the so-called log frame, which I gather again forms the underlying framework for the current focus on results-based aid. I see Bob Berg here who was instrumental in the creation of that. These and other approaches were essential to help us analyze and demonstrate to Congress and others who benefits from AIDS-supported projects and programs. Perhaps most critically, PPC had a strong policy group capable of addressing the broad policy issues of the agency. PPC's team of economists and other social scientists at the time was remarkable and its support for policy-based research by outside scholars was also very influential. This analytical capacity was essential to our ability to develop and explain our approach to the new directions legislation and a variety of other international, economic, and development issues. The interaction with the central bureaus, excuse me, and the regions was not always smooth as difficult questions and challenges were raised. But as a result, PPC had a strong voice in intra and interagency discussions on a broader range of US policies toward developing countries. PPC's force, excuse me, forceful role was crucial in gaining a better balance in AIDS population, family planning, and health programs. For example, more focus on girls' education and social issues and not simply condom delivery. Moreover, the policy group's efforts made the work of PPC's budget group much more credible. In retrospect, however, it must be said that the advent of the new directions basic human needs emphasis prompted a gradual erosion of AIDS sectoral and macroeconomic talent much to the benefit of the World Bank. It is my impression that AIDS relationships with the State Department differed greatly during the Nixon Ford and the Carter administrations. In the former, States views were particularly highly politicized. The Kissinger approach was to use each major speech as a vehicle for significant initiatives, which usually included AID and or PL480 food aid. Indeed, it often seemed to us that Henry Kissinger was the PL480 desk officer. This made PPC's efforts, along with USDA and OMB, to make the very large PL480 Title I food aid programs more developmental, a tough job under any circumstances even more difficult. During the Carter administration, we had a very able and development-oriented partner in Tony Lake, who is head of States Policy Planning Bureau, was very close to Secretary Vance and Deputy Secretary Christopher. The PPC Policy Planning Link and our contacts at senior levels elsewhere in State worked very well during this period, in my judgment, and illustrated how the State-Aid relationship could work in close harmony and with mutual respect. Halfway through the Carter period, another complication was added to the policymaking process, the creation of IDCA, the International Development Cooperation Agency. Simply put, despite admirable intentions, it became just another layer on AID's policymaking. Overall, I look back on that period of my PPC experience from, excuse me, 1974 to 1981 as very productive and exciting. We were able to cover an enormous number of areas because we had a top-notch staff, a very bright, able, and committed people. Working with our colleagues throughout AID at a time of changing aid priorities, we made major policy decisions, many of which still seem very sensible and practical to me. There were, of course, multiple political pressures, and no doubt many more that I have conveniently repressed. But my sense is that if AID today had the kind of strong PPC that existed in the 1970s and that it and development in general would be much better off. While it is very disappointing to realize how much has been lost in recent years, Administrator Shaw's major effort in very difficult circumstances to strengthen AID's policy capacity once again is very encouraging. Thank you. Thank you very much. I'm now gonna ask Connie Collins as a former project manager at USAID to talk about one of the case studies that's in the book and she's gonna talk about Egypt. I'm very pleased to be here to share my experiences with the Egypt Control of Diarrheal Disease Project. In August 1981, I arrived in Cairo to serve as a health officer. The USAID mission in Cairo was very busy planning projects because they had received money from the Camp David Accords and they were developing all types of projects. Health was identified as one of the major problems, especially with children under five and infant mortality was very high and it was mostly related to the hydration from Diarrheal Disease. During the planning of the USAID projects, the consultants suggested that we consider oral rehydration salts. Prior to that time, dehydration was mainly treated by intravenous fluids which were only available in hospitals and did not reach most of the population. ORIS was available in Egypt at that time but not widely used or known and the intravenous fluids were very expensive and as I say not available to much of the population. USAID had contributed funding to the development of ORIS in Bangladesh and it had proved to be effective in treatment and also cost effective. So we decided we would use that as UNICEF was funding production in Egypt. The National Project for Control of Diarrheal Diseases was funded at $25 million which was considered huge at that point but the funds were fairly liberal for the Camp David Accord so that was good. The project was awarded in 1982 and the chief of party was an ORIS expert who had worked in Bangladesh. We began the project with the establishment of a secretariat in the ministry and I was assigned as a project officer and we had a senior pediatrician, Egyptian pediatrician who was the project director and he had personnel secunded from the ministry to help him. In planning for the project we recognized that with a high mortality we didn't have time for doing the regular kinds of things that we needed to find rapid ways to reach the population and get ORIS out to the children who were suffering particularly in the hot season as this was a bad time for dehydration. Egypt is interesting because 95% of the population lives on 5% of the land and this has facilitated the development of roads and railroads and the majority of the population has access to transportation to urban centers. To urban centers. In the 1970s the World Health Organization developed a system of district health centers which were accessible to the population and the ministry had enough physicians to staff these centers. However, the quality of the services and was not good and the physicians did not like to go out to the rural areas. They wanted to stay in the urban areas so it was difficult to keep them staffed and the system was ineffective. The first task was to educate the Egyptian physicians about oral rehydration. We, as I say, Egypt is easy to get around so we were able to have regional workshops and the doctors came on Friday which was a holiday but they came and took the training. They were skeptical but they agreed that they would set up ORIS rooms in their facilities to treat the babies. And we also trained about 5,000 pharmacists, I'm sorry, we trained pharmacists as there were 5,000 pharmacies in Egypt and they mainly served as neighborhood health centers and resources. During these training sessions we learned a lot about the current management of diarrhea by physicians, mothers, and others and it was recognized that many of the practices were not beneficial such as giving antibiotics and withholding food during diarrhea. Egyptian doctors were doubtful that the mothers who were many of whom were illiterate could be educated about the prevention of dehydration but it became clear that we had to teach the mothers to use this in the homes if they were to use it effectively. It also became clear that the Ministry of Health System did not have a good outreach system. There were very few nurses and no health educators to reach the community. We looked at what was being produced in Egypt. There were leader packets of ORIS which are the standard UNICEF packets most of you have probably seen those in different countries. But we had a lot of sociology people in Egypt so we had surveys. They talked to the mothers and the mothers said, no, no, we don't have leader containers. We can't give this much and it's not good. How about a tea glass? So this led to making just 200 milliliter packets of ORIS that the mothers could put in a tea glass and could be sold in the pharmacies as well as given in the clinics. In the meantime, we kept the leader packets for a larger clinics and doctor's offices places where more people were treated. We also hired an Egyptians communication expert who had received, you say, training under the population program. And he was hired to develop mass communication programs using the available resources. He identified television as a possibility for delivering ORIS information. Egypt was known as the Hollywood of the Middle East and they had been producing films, Arabic language films for many years. And this was now beginning to use for the development of TV programs. As electricity was widely available, thanks to the Aswan dam, televisions were all over the country and about 70% of the people had access to television. If they didn't have one in their home, they had one in the village square where they could go and watch in a public place. The communication experts began working with the TV producers to produce spots for the promotion of ORIS. After the first spot was produced featuring a well-known Egyptian comedian, surveys were conducted to obtain reaction. The surveys found that the Egyptian physicians did not like the use of a comedian to promote ORIS and there was a negative reaction to the national media through the spot. The initial survey information resulted in the redesign of the message and the development of a set of commercials that used a popular Egyptian soap opera star known for her good mother roles. Therial soap operas were telecast in prime time and were very popular with most Egyptians. The commercial had the star explaining the benefits of ORIS as told to her by her doctor as she demonstrated how to mix and administer the ORIS. She also talked about nutrition and continued breastfeeding during diarrhea which was very beneficial. The NCDDP project made the decision to fund the commercials in prime time rather than receive the free time from the government which would have made the commercials maybe about 11 or 12 midnight. So the commercials came on at eight o'clock right with all the soap opera and all the other soap commercials and so they were seen by a large percentage of population. The commercials were rapidly followed by sentinel surveys in different areas of the country to determine the level of comprehension and positive or negative reactions to the commercial. This information was used to revise commercials and other messages that needed on a regular basis. The spots were effective. Within a year, the number of mothers who knew the symptoms of dehydration increased from 32% to 90%. To the, secondly, those who knew about ORIS increased from 1.5% to 94%. And three, those who had ever used ORIS increased from 1% to 50%. By the end of the second campaign, 40% of the mothers reported using ORIS for their child's last episode of diarrhea as compared to less than 20% in 1981. From 1984, clinics and hospitals were busy operating ORIS room and training personnel. By 1986, 16,000 physicians, 300 pharmacists and 8,000 nurses were trained. And ORIS was being sold rapidly in pharmacies making keeping up with production and distribution difficult. By 1986, the MOH had recovered a large percentage of the production cost from the pharmacy sales possibly making this project the first, one of the first UCA projects to achieve cost recovery. These funds created issues as neither the Egyptian nor the US government had guidelines for managing the funds at that time. So they stayed in the bank because we didn't know what to do with them. Tracking of mortality and morbidity impact was difficult as baseline data was incomplete and under-reporting was an issue in 1981. Infant mortality was 100 per 1,000 births in 1977 and under five mortality was reported as 120 per 1,000 births in 1980. Reporting forms for the NCDDP were developed and used in clinics and hospitals to track progress. Although there were indicators that mortality was dropping from diarrhea, other factors such as improved food supplies and general health services were also given credit. In 1988, the first UCA demographic and health survey was carried out and the six subsequent DHS surveys through 2008 found that the infant mortality dropped from 73.2 per 1,000 births in 1988 to 24.5 in 2008. More recent has dropped this to 23 per 1,000s, I think was 2011. In 2007, the Center for Global Health Development recognized the progress that Egypt had made in reducing infant and child mortality and gave credit to the Diarrheal Disease Project for much of the decrease in mortality. The project not only directly impacted child health but was a morale booster for the Egyptian Ministry of Health and there was excellent cooperation between the MOH, UCA, UNICEF, and WHO and this led to the development of further child survival activities that have been successful. Egyptian women also benefited from the TV messages and were able to learn good practices, good health practices and better articulate their concerns to medical personnel and gain more confidence in medical services. In turn, the doctors gained more respect for the women in their contacts. The project helped the Ministry of Health to cut costs. One large chiropediatric hospital saved more than $60,000 over a three month period which was a large part of their budget in one year just by switching from ORS, from intravenous solutions to ORS. The use of prepackaged ORS was also a good factor, positive factor, okay. I'm getting the hook. Because while ORS can be mixed and prepared at home, it's not easy. I'm a nurse and I know it's not easy. So it was much easier to produce this in the Egyptian medu and sell it and the mothers could easily use it. So the project not only decreased the mortality but it also improved other factors in health. And I think that this has been also a factor in the decrease in fertility rates in Egypt over the last 20 years too. Sorry. It's an incredible story. It's an amazing story and it should be. I mean, it's, thank you. Thank you very much, Connie. Thank you. I'm gonna ask Owen Silke to wrap this up and he's a former career minister at USAID. Had he retired in 1989 and then went on to have a second career is at the World Wildlife Fund. He has had a number of other roles as well since then but Owen is gonna tell a story from his time at AID regarding India. Well, thanks. Thank you. Thank you. Nancios and Alex, Connie and I served in Egypt together and it's kind of a, it's a privilege to be here and it's also a responsibility to represent the thousands of people who served with AID over a 50 year period. The contrast between Connie's presentation of mine is probably that Connie did very well describing where the rubber meets the road. I've been known to focus on where the rubber meets the sky and so here we're gonna go to a story about India. The story I'm gonna tell took place in 1984 and at my age it's sometimes hard to even think back 30, 30 years to these kinds of stories but each of the stories in the book that Janet so carefully collected had a before and an after. They all set in some kind of a context before and after and I think before I get into the very brief story about India it's useful to look at those bookends of before and after 1984. It can be found before and the minds of Nehru and Franklin Roosevelt. Franklin Roosevelt who really was the first to beard Churchill on the necessity of independence for India following the Second World War. And there's some wonderful stories. Elliot Roosevelt recounts wonderful stories of the interactions between Roosevelt and Churchill on just that issue. They're really wonderful stories. It's also in the actions which I'm gonna refer to of Presidents Truman, Eisenhower, Kennedy and Johnson. And so as we look before at what happened in 1984 there was a before and the after. There was a remarkable US India joint statement issued in 2005 under the Bush administration which reflected the importance of development in the bilateral relationship between India and the United States, not aid, development. I also referenced Mr. Nacios mentioned, Administrator Nacios mentioned the 3Ds. Actually this document actually recognized the inevitable relationship between the 3Ds, development, diplomacy and defense. And I'm gonna come back to talk about that relationship a bit in the story. So there was a beginning, there's an end, but there's also 1984. I arrived in India in 1983 which was the height of my ambition with AI Day. This is for those of us of my age, if we knew anything about development before we came to aid we knew something about India. At any rate, I'm at my desk in 1984, I receive a cable from Washington from Julia Chang Block asking me to go to the Indian government and get a thank you note for the food aid that we had provided over 30 years to India. Now I had been in India for a year and I was wise enough to know or not wise enough to know that this was not a go. I was not gonna go down to the Indian government and ask for a thank you note. So I threw the cable in my outbox and was done with it. Of course there was a local employee who was wiser than I, who took some action and three weeks later I had a letter from Rajiv Gandhi who, which not only referenced the role that food aid had played in India but quite specifically made reference to the food development and political support over a major longer period in which contributed not only to the prosperity of the nation but to its very existence. Extraordinary, extraordinary from the prime minister. I was surprised, but in 1984 Rajiv had to run for an election and the major election campaign in both Hindi, other languages and English newspapers was a cornucopia, kind of our Thanksgiving cornucopia saying you recall the sour taste of dependency the Congress party brought you the sweet taste of self-sufficiency. So development and the success with development in India was fundamentally important to the political understanding and the political commitment of India's own understanding of itself as a nation. This importance of development and of India was mirrored in the United States. We go back to Roosevelt Bearding Churchill on the whole process of decolonization and foreshadowing the formation of USAID. Harry Truman who founded the Point Four program appointed Chester Bowles a very prominent political figure in the United States to be ambassador to India and actually visited India in 1951. Eisenhower who was responsible for the PL480 program as such and also visited India in 1959. Kennedy of course our book right here USAID, the Peace Corps and sent John Kenneth Galbraith a very distinguished American economist to be our ambassador to India. And Lyndon Johnson who was very involved with food relief and actually was a supporter of what was called the short tether policy where shipments of food aid to India were actually called down from the White House in response to development criteria supported by John Lewis who was on the Council of Economic Advisers and then was subsequently appointed to be the director of the program in India. So the point I'm trying to make is that development, India was important at the highest levels of political society in both the United States and in India over this period. So in thinking a little bit about that it occurs to me and it's something that I've been thinking about over the last few years is development as a big idea. Development both as a global reflection of US values and as a key factor in the growth of the local, national, regional and global economies and the promotion of international security. Development is not simply an aid program, it's simply not a collection of projects, it's a big idea about the kind of world in which people actually inhabit and live. Early on in India in the late 70s and the 80s economic growth and investment was seen as the early key to our understanding and approach to development and India was the focus of that analysis as I've suggested before. And for those of you who have read in the literature in the history of development names like Gus Raines, Halvis Chennery, John Miller, all these people were people who contributed to our understanding of development at large, a good part of that written out of the experience that the United States and India shared in the development years in India. And in that time, those times structural transformation, India went through the structural transformation from an agricultural and rural economy to a more sophisticated industrial and urban economy and AID was fundamentally important in both of those measures with regard to the Green Revolution as Andrew mentioned earlier and later with investments in rail transport, iron export, hydroelectric and thermal power, finance, and today as we're out on the highways here in Massachusetts Avenue and see the jaguars going up and down, that's from the Tata Steel Company in India which was supported by AID in these early years of formation. So we come to 1983, I'm just so excited, I'm gonna get to go to India, Peter McPherson calls me in and he says, here's the deal, it's gonna be S&T, it's gonna be science and technology. I really wasn't prepared for that, I had thought about development in very different kinds of terms, but Peter made the argument that S&T could play a transformative role across a wide range of development challenges, including agriculture, education, health, climate change, poverty reduction, shelter, sanitation. And he clearly recognized that the role of public investment was not gonna be AID's game into the future, but that policy and partnership could be a powerful development tool and particularly with regard to raising productivity which was the counterpart of supporting economic growth. So Peter I think recognized that we no longer had the resources for the massive kinds of investments which actually we were able to make in Egypt with security assistance, but that S&T soft power if you will could play a very powerful role in development. What's interesting here is that this interest mirrored Indian interest going back to Nehru's initial thought about development which was rooted in the importance of developing a science and technology community in India and mirrored in the interest of the State Department which was allocating, we had about a billion dollars in local currencies from earlier PL480 statements which was entirely devoted to technology collaboration between the United States and India. We had two science counselors at the embassy in India and there was a sense that at a broad diplomatic kind of political level that supporting the S&T community in India was a way of securing rational thought about development and politics as well that the science community could contribute to a more balanced kind of political relationship. And at the same time the Defense Department was extremely interested because India was pushing to get a supercomputer into India. So we had real development interest pushed by Peter McPherson. We had substantial interest in the diplomatic side by the State Department and a serious concern in the Defense Department. So the 3Ds if you will were at work in India. And what I want to stress is that we were allowed to play our development role. We were not seen as a piggy bank for the State Department. We were seen as someone who was to contribute to the development of a sound science shift actually from an Indian emphasis on science to a technology community. And there we developed three throng program. One was focused on Bangalore. When I arrived in India in 1983, there was one flight a day from Delhi to Bangalore. When it left four years later, there were five flights a day to Singapore. This happened very, very, very quickly. We supplied and supported a range of conferences of bringing people from Silicon Valley, from Route 128 around Boston, from Cambridge and England to talk to the Bangalore people about what constituted a technology kind of community. We made the point that it was not just science, you had to be connected to entrepreneurship to the private sector to finance and finance the collaborative program called PACT, which in the times of India when I was there called PACT is a fact, which supported collaborative R&D ventures between private sector firms, India and the United States. And to demonstrate that this could work, we supported the Serum Institute, which was the first private sector producer of vaccines in India, which is today the third largest producer of vaccines in the world and India's 65% of global manufacturer of vaccines in the world. So a remarkable transformation. And I give enormous credit to Peter McPherson in his vision that science and technology could be an important driver of development in a big D kind of sense. So what conclusions might one draw from this experience? And I wanna refer to Dan's charge to us when we came today. How does our story fit into the broader USA development agenda? Well, there's two points I think I'd like to make. First, that development as distinguished from aid and its manifestation and projects remains important to U.S. interests. However you might wanna come to define that. And I think Alex this morning tried to describe a little bit of how that definition of what we mean by development has changed over time, yet trying to maintain the relationship of basic human needs, poverty reduction, back to economic growth, productivity and employment. I think this is the first important point that it's development that's important and we sometimes get confused between our understanding of development with aid and with projects. Aid and projects support development but we shouldn't lose sight of the overarching kind of agenda which we have. I call that big D development. And in that regard I believe it's not only important to relate the projects and the aid that we have to this larger perception of development however you might wanna define it. But that shouldn't just be a Washington kind of rationalization, it ought to be at the center of the dialogue between AID at the country level. This was fundamentally important in India. There was a complete coincidence of interest between what we were trying to achieve in the aid mission and with the Indian government. They wanted access to the American science and technology machine. We thought it was fundamentally important to development. And I think this is sometimes lost in today's world. Back then, back then 30 years ago, we had training programs for aid directors and aid program officers on what development was about. And it seems to me we have lost that conversation with governments that this constellation of projects which we have in a country has to be related to some larger understanding of how we move toward a big D development regime. So that's one kind of point which hobby horse of mine. And the second is an argument that we worry less about the fact of what has been come to known as the 3Ds but rather be concerned with the content. There is inevitably a relationship between development, diplomacy and defense and security. It seems to me this is reality. And so I'm not certain that the argument, some of the argument that takes place today which fights against that reality is the right argument. The real argument ought to be what do we mean by development? And what we mean and how development is relevant to U.S. interests, not seeing use aid simply as a piggy bank for either development or security interests, but a structural process that takes place over time which I think both Andrew and Alex have stressed here today. So it's a second kind of conclusion that I draw from my experience in India in 1983. Thanks a lot. Thank you very much. So I'm gonna, I could ask questions to the panel but I wanna, there's some very thoughtful people in this audience so I'm gonna do this World Bank style which is a, and I'm gonna collect a number of comments and questions so I'd like to see some hands and I'll call on several people and then I'll ask the panelists to respond to the various points that we have. I know there are a lot of thoughtful people in this room so if not I'm gonna call on you so you can either raise your hands or you'll hear from me. So I wanna hear, if not I wanna hear, I've got some people I wanna hear from but go ahead, yes ma'am, first you and please go ahead and if you identify yourself and we have a microphone coming to you. Hi, thank you. I'm Marilyn Merritt and I was particularly, I guess my comment is particularly directed towards Owen's recent remarks but I think the kinds of things that you were just pointing out, Owen sort of display the kind of creativity that I think aid officers in the field and even in PPC in places like that have to exert in sort of getting to know what a particular country is interested in and what the political will there is and what is actually, as much as we wouldn't like to admit it, what is in terms of appropriation on the menu of what we could negotiate about and I think that's something that needs to be thought about more too and I think some of the mentorship programs that are coming up sort of lead to that but any comments that you might have on that? Thank you. I'm just so pleased by the effort, Janet, that you made in 76, the de facto head of AID asked me what to do with some money he had left over and I said, well, why don't you do some oral histories on the founders of foreign aid because that was such a unique generation in the history of the world and he sat back and he looked at me and he said, Bob, that's the most foolish idea I've ever heard so glad you persevered. I'm wondering if you were, I'm wondering if you would consider a thematic second volume and I think the theme which would be really interesting now is would be the mature phasing from an aid relationship to a wider relationship because we don't seem to know as much about that history of going to bi-national commissions and finding mutual interests and we seem to kind of hang on in some cases when we ought to be transferring to a higher level of relationship and I think histories of where we've made these transitions could be extremely helpful to current and coming policy makers. I'm gonna capture these and then we'll do that. I'm David Shear and actually I retired in 84, so. But two comments, one is that the best training I've ever had for a post-aid career was AID itself in terms of both skill sets, knowledge of the context in which development goes forward but also in which the private sector prospers and one of the things that I have learned in the post-aid period is the link between the importance of private investment in key areas such as in Eastern Europe and development and then the transfer of that technology in non-governmental ways through the private sector to other private sectors and to the government itself has had huge impacts on places like Hungary and in Poland and it brought about transformation in those places. So those links in terms of the application of what we have learned as the College of AID experience in the later parts of our life have had I think significant influence and can be transformative both in the area of public employment as well as public investment. Great, okay, let's take those three and Owen why don't you go first? One was on Bob's on the evolution from a quote AID relationship to some broader development, diplomatic, political, mature relationship among nations and I do have a copy here but I think the 2005 agreement between India and the United States is a wonderful reflection of that. It was not caught up with some of the institutional mechanisms that we've used in the past moving to commissions, et cetera but to a broad political understanding between the two governments as to what was important to them and the role of development played a really important role in that statement. So I think that's really the 2005 joint statement. The second is Dave's point on the private sector and I couldn't agree more but it seems to me that AID can get caught in supporting the private sector in many of the same ways as it can get caught in trying to support diplomatic and defense kind of initiatives. If it's not related to a clear understanding of how those investments relate to development in an important kind of way, AID can end up being an agent of the Commerce Department rather than an agent of development and so it seems to me again it's that relationship to a broader understanding and commitment always of testing, how do these investments relate to a broader understanding and agreed agreement with the country on how that advances the processes of development? I guess what I wanna say is every private sector investment isn't a good one in terms of development as we're seeing in large parts of Africa, it seems to me. Connie, could I ask, I'm just gonna go down this way from Owen if you could just, if you wanted to respond to any of the comments that you heard. I don't have anything on that one. Okay, okay, Alex. I don't think I. Okay, Janet. Well let me respond to Bob Berg's challenge that we broaden the scope of any follow on volume I think we're looking for somebody else to do that that somebody with a lot more time because this is not going to be a six month project. I guess my concern is everybody wants to write a history of aid and there have been a number of histories of aid and none of them have really done it because it's just too big. Andrew is doing a history of aid now but I think that we'll probably be focused a little more focused than some of the ones that have come in the past. This was just to take one slice, a slice of the people. I'm going to talk to my friends at the Alumni Association and ask, you know, why don't we send out something to the Alumni Association and say, well, people submit their stories and we'll do a volume two or a volume three or whatever it is. Because this is sort of within the gradual interest of somebody like me who doesn't like getting up at seven o'clock in the morning like I used to do. That's a lovely thing about retirement. But I know who to come to, Bob, when we start that project. And I want to associate myself with Bob's comments about the middle and how countries transition. We did a report here a couple of years ago looking at five cases where US government had changed its relationship with the country. South Korea, Portugal, it's called Strategic Foreign Assistance Transitions and I commend that to you. I don't think it captures all of the point that Bob is making, but it gets a piece of it and so I appreciate you, Bob, raising it because I agree with you that I think this is something that needs further review and study. So thank you for flagging that. I just want to take advantage of, Andrews, you're here in the audience. Do you want to just reflect on what you've heard on the panel since we have you here and I know you're never short of opinions? Well, it's a problem, excuse me, it's a problem. It's also easier to explain. One of the changes, the Nixon administration, in fact, they made a number of changes that were beneficial to aid, one of which was to concentrate all spending in AID through other federal agencies. So there was an executive order that apparently came out when Nixon was president saying you cannot spend any, domestic agencies can't spend money in foreign aid abroad unless it goes through aid and aid would control the money, which I think is a much better way than these coordinator positions we've had through the State Department where the people who are career diplomats who do this don't really understand the developmental issues and cannot resolve some of the conflicts between federal departments on these issues. But the sector-based approach is easier to explain, which is when the other initiative of Nixon was to change from the budget being in technical assistance, training, infrastructure, rather than in sectors, which is what we have now. That was the change Nixon made. The problem is it doesn't capture this central issue in my view and that is how does AID sustain these changes? And the only way to sustain these changes is through institution building. It doesn't have to be through the government necessarily, it can be through the nonprofit sector and it can be through the private sector. The question is what have we learned about successful institution building? When I was doing my interviews for this book, the book is not a history of AID, it's a look at some of the clashes actually between AID and state and DOD over the years. When that happens and when there is a synergy that actually works, because you've described how it can be successful and it has been, but there's also a lot of tension between the 3Ds that is not being properly described in the conversations in Washington right now. They act as though these three things are always in unison with each other and that's just not true. It's just, I'm from my own experience in 10 years in AID, it's nonsense. There are fundamental issues that divide the 3Ds from each other. Doesn't mean you can't work something out, but this is the question. When I did my interviews at the World Bank, they said, and the World Bank is a repository now of much of the best research on AID. I'm not sure their programs are as good as our programs, but in terms of research and data, they are a huge storehouse of information. And the comment made, which was extraordinary, there is a vast literature on the centrality of institutions in development. No institution is no development. Whether it's you take Douglas Norris's view of that or you take a more institutionally, organizationally based, either definition. There's almost no literature, they all said this and some people in AID said this and in the academic community. There's almost no literature in how to do it, okay? We actually have, through this book and through my own research, examples of us having created institutions 50 years ago. Now, a lot of the people in the Institute don't even know we had anything to do with it, okay? The question is, what are the factors, what are the programmatic mechanisms that lead to sustainable institutions that can keep whatever change you've made permanent so that it's sustainable over the long term? How do you do it? And there is very little literature on that and I think if we, instead of doing a sector-based approach, which is one way, I don't disagree with what Bob's saying is, but I'm saying one other thing we could do is to look at the toolbox that we use because I don't actually think we're doing, we're designing programs now using all the tools necessary to create a sustainable institution. We use some sometimes, we don't see how they relate to each other and there's no general theory of how to do this and we need it because that's the only way, ultimately, that what we do is gonna be sustainable over the long term. Janet, I'm gonna give you the last word. Well, Dan, thank you very much and thanks CSIS for letting us see your wonderful new digs here. CSIS has always maintained a very active interest in the development community and all of us appreciate this very much and thank you for coming out. It's such a lovely day. I mean, I was really thinking of just sitting out in the backyard until somebody pointed out it was 28 degrees but having sunlight makes such a huge difference but thank all of you and one question that came up before was why isn't this book online? Marilyn Merritt and her husband have been pushing this for some time. We are looking at a way of putting this online so Andrew's students and colleagues in Texas can look at it and other universities, I'm involved with some university work now. It is a question of getting the people with the copyright and the people with the know-how together and we're still working on that but thank you all for coming out and thank you for maintaining your interest and your input into the development process. Thank you. Thank you. Thank you.