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The CGD Podcast
What Do We Mean By Results-Based Development? – Podcast with Raj Shah and Michael Gerson
00:15:49
What is actually meant by "results-based development"? Dr. Raj Shah, former Administrator of USAID under President Obama, and Michael Gerson, former presidential speechwriter and Assistant for Policy and Strategic Planning under George W. Bush, have...
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- [00:05]
A
Hello and welcome to the CGD podcast with me, Rajesh Merchandani. Each week we examine some of the biggest questions and the boldest assertions in the world of development. We bring you new thinking from our experts here at the center for Global Development, new ideas, and we bring insights from development leaders. Now, there's a political and a generational gap between my guests to today, but like the Romeo and Juliet of aid, they have reached across the divide to share their passion. We'll establish that in a second. Gentlemen, they've reached across the divide to share their passion for one thing, the value of aid and the importance of rigour in its application. Let me welcome Raj Shah, the former administrator of USAID under President Obama until around exactly one year ago. And Michael Gerson, who worked for President George W. Bush as head of speechwriting and also assistant for policy and strategic planning, of course, now well known as a columnist for the Washington Post. Gentlemen, both of you, welcome. Great to have you here.
- [01:01]
B
Good to be here.
- [01:02]
C
Thank you.
- [01:02]
A
I'm not going to suggest which is the Romeo and which is the Juliet of the relationship, but you do come from different sides of the political divide, but you do agree on the importance of results based development assistance. So first of all, what do you mean by results? Let's establish that, Raj.
- [01:20]
C
Well, results are about, in my view, using American assistance to create human opportunity and to end extreme poverty around the world. You just have to know what you're trying to achieve, measure it with rigor and sophistication, and make adaptations to ensure you're delivering those results. And that's something that Mike and I both feel passionately is the purpose of our aid and assistance.
- [01:46]
A
I should just say that you've come together to write the chapter in this book, Moneyball for Government. Your chapter is called Foreign Assistance and the Revolution of Rigor. Michael, let's put that question to you first.
- [01:55]
B
Well, what Raj just said sounds obvious, but it's actually not obvious. In the history of aid, aid has been used for a variety of reasons. In Africa during the Cold War, aid was not always being used for outcomes in the way that. And even nowadays, I mean, there are pressures, whether it's Egypt or Pakistan or other places, aid has a variety of geostrategic objectives. Now, I don't think that's always wrong, but I do think aid is most effective when it is achieving the greatest effects. And we have had some recent examples of programs like pepfar, the President's Emergency Plan for AIDS Relief, and pmi, the President's Malaria Initiative. And feed the future in this administration and efforts to get power to Africa that I think serve both those goals actually, that are designed for outcomes and are good for America in the long term.
- [02:53]
A
I have to say, when you said it's not obvious. I mean, I've worked in development for now a year, I came from journalism and I was astonished that actually people do things in development that they don't know works. You wouldn't do that in any other industry.
- [03:07]
C
Well, you have to have a core sense of purpose with what you're doing. And I think Michael's point is well taken, that some people have in the past believed, and even today believe, that some aid should be about buying friends or buying influence or.
- [03:25]
A
Or just doing what you think works.
- [03:27]
C
Well, yeah. And what we would argue is that age should be purposeful. It should be by and large oriented around the mission of addressing extreme poverty and the corollary consequences of diseases like HIV and malaria that just wipe out human opportunity for so many children around the world. And that we have shown through a Republican administration and a Democratic one, that when you make aid about delivering those results, you can build a huge amount of bipartisan support and really do it even in a difficult time.
- [04:02]
A
You talked about pepfar, Michael. When you were working for President Bush, you were part of the team that created pepfar, helped set it up. In subsequent years, when you've travelled back to, say, countries in Africa, how have you seen that it worked? What have you seen that's shown you? Yeah, that worked. We've got results.
- [04:24]
B
Well, it's difficult to go back in your mind to that period around 2000, the cresting wave of death that was taking place in much of that continent. It's higher in some areas than others. And when I first went to Africa, I would visit, like in South Africa, visit shanty towns where you mainly saw grandparents and grandchildren because the entire intervening generation was gone in their 30s and 40s. So we announced that in the 2003 State of the Union address. It only took four months from announcement to passage of PEPFAR, which was an extraordinary achievement.
- [05:05]
A
Can you imagine that now?
- [05:06]
B
Right, I know. And you know, you saw the heroes of the process were Nancy Pelosi and Henry Hyde in the House. You know, people that couldn't be more different. And, you know, Joe Biden and John Kerry were real supporters of this. It was just totally different. Even in a pretty bitter period of our political history, it was very different. But I started to go back. I remember visiting an orphanage in Addis with three or four hundred children. All of whom were HIV positive and all of whom had been abandoned often or their parents had died from hiv. That was often the cause. And at that orphanage, until the drugs through PEPFAR came, every single child died. There was no one who made it to teenage and then adulthood. And then the day after the drugs arrived, everyone was surviving. Children with opportunistic infections in their eyes had their sight restored. This was, you know, they called it the Lazarus effect. It was Africans that confronted this, not us, but it was done with, with the help of these drugs.
- [06:19]
A
And I think I've heard you tell a story before about how you visited Africa not too long ago and saw a very different story in clinics.
- [06:28]
B
Well, this is more recent. I went to a rural clinic in Rwanda, really middle of nowhere, at the end of a road to nowhere and a beautiful facility actually. But as I usually do, I ask the head of the hospital, I'd like to see the opportunistic infections that relate to AIDS and. Or I like to see the malaria cases, you know, cerebral malaria or the hard cases of malaria that they had. And the head of the hospital said, we don't have any of those. And I asked again, this was through a translator, you know, to see this. And he said, no, we are now dealing with low birth weight babies, diabetes, heart disease in this facility. You know, there's 94% coverage in our area with AIDS drugs. Malaria has essentially been defeated in that part of the country. And it was one of the most moving things I've ever seen in Africa were empty hospital beds. I mean, this is a return to normality. And that doesn't mean they don't have challenges, but it means that they don't have to live with this hanging over their head.
- [07:35]
A
And what's interesting about that is that it chimes with work that we've done at the center here. A book coming out called Millions Saved, which is a catalogue, if you like, that documents successful health interventions and gives the lie to people who say aid is wasted, it's a waste of money. And it's important to kind of make that point that this stuff works, it can work, but we've got to do it efficiently.
- [08:01]
C
Yeah, look, I think Michael's description of the success of the fight on HIV AIDS has become a model for a lot of other efforts. So when we launched Feed the Future, we looked at what were the components of doing it efficiently. Country led plans, public private partnerships, baseline surveys, followed up by follow on surveys to actually understand the effects. And that's why we can say when the Feed the Future has moved 12 million children out of a consistent of persistent hunger and poverty into an opportunity where they're not suffering that way.
- [08:36]
A
And how important was it for you to make sure that some of that Feed the Future budget was spent on evaluation?
- [08:41]
C
Well, it was critical. In fact, that was. I mean, that's. Otherwise you don't know. And you can't say with some degree of confidence and certainty that this is the impact. So when President Obama was in Ethiopia this past summer and released a study that found, I think, 6% annualized reductions in stunting in Ethiopia in part as a result of Feed the Future, you know, those are the kinds of outcomes per year, by the way, over three years. Those are the kinds of outcomes that then let us say as a nation, hey, we can end child hunger around the world, or we can end child death around the world, or we can end Ebola, we can end HIV and malaria. And those are the big goals that should characterize American foreign assistance as we go forward. And that's really what the chapter is about.
- [09:28]
A
Do you think enough is spent on evaluation, on understanding exactly what works?
- [09:34]
C
Well, no, but here's the. I think we could spend a lot more in that space and still be well under a few percentage points of total aid and assistance being spent on evaluation. So, no, but those would be percentage.
- [09:47]
A
Points well spent, you think?
- [09:48]
C
But they would be percentage points well spent. And I think now, even more than in the past, we can use new ways of collecting data on mobile phones through satellite photo capture and image processing that would give us the ability to visualize what's happening. You know, when Michael was talking about hiv, I recall a trip through rural Kenya around that time. And the number one sell the item driving the economy in rural villages in Kenya at that time were coffins that were being sold because. So, because that's what was going on. Right. And it's just extraordinary that you need signals like that to see how bad things are today. We can have a much more granular understanding of who's hungry, who's vulnerable, who's not getting medical care when they need it, who has malaria, who has Zika, and where's the mosquito load in parts of Brazil? And we can go after things in a much more efficient, much more targeted way using modern data and evidence.
- [10:47]
A
But it's fine for us to sit here in Washington and say that. But for people on the ground working with shrinking budgets in programs, how do you convince them? What is the obstacle that you have to get over? The culture shift, the mind shift, whatever the mindset that says give me 3%, give me 5% of your budget and use it to evaluate.
- [11:06]
C
Well, first let me point out something Michael's pointed out, which is when the programs are about results and when you're serious and and professional about collecting data for measurement, optimizing interventions based on a knowledge of what works and an absolute commitment to deliver the outcome, the budgets don't have to be declining. I mean, PEPFAR was a massive infusion of billions of dollars to tackle a disease that was ravaging a continent. It is not ravaging a continent anymore. Similarly, even at a time when no one could find money for anything, we took global investments in agriculture and food security from about 200 something million to 1.2 billion a year and sustained that level throughout the Obama administration to power feed the future and deliver those core results. So the argument is we're going to get more resources to go after a goal, in that case child hunger. We're going to then spend a greater percentage of that resource envelope doing baseline studies, collecting information about how families are actually doing and then using that data in real time to change our programming to better achieve the result that we've committed to. And that's the magical kind of political consensus that we think it's possible to build. Get serious about doing evidence based programs and then ask the Congress and the American people to be more aggressive about investing in these big goals. End extreme poverty, end disease, end child hunger.
- [12:36]
B
The amazing thing which we point out in the book is that these programs that people have an image of throwing money down rat holes or whatever, have a traditional view of, have become models for the way government should work. It's something that people need to know. These outcome based, rigorous programs through two administrations that have had broad support in the Congress because they deliver results, there's not too many other elements of government that do that effectively. Driving down policy change based on data that's a really flexible, effective bureaucracies in the best sense of the term and strong leadership.
- [13:20]
A
So if either of you were advising the next President of the United States come November or January, what would you tell them are the development challenges to look out for in the future and what should America do about them?
- [13:32]
C
Well, I would not get into a lot of depth on this. I would just tell the President and I suspect of both parties, they would know this already, that during your tenure you have an opportunity to put America on the front line of the fight against extreme poverty, child hunger and child death. And that for the first time in human history, we can envision achieving those goals in, in just 15 or 20 years. But to do it, you have to be personally invested in this outcome. You have to appoint leaders of the institutions like USAID that matter, that are both technically focused on delivering results and fighting bureaucracy to demand outcomes and able to and willing to put the time and effort in to build a bipartisan consensus that this is an adequate reflection of American exceptionalism and American foreign policy. And the politics matters.
- [14:31]
B
I would only add that there are some vivid goals that are now realistic prospects. You know, when Bill Gates talks about malaria eradication in his lifetime 10 years ago, that would have been insane. It would have been not even feasible. And there are many, you know, there are a number of other areas where we have these vivid possible goals. The end of extreme poverty, for example, as a serious goal. That's because a groundwork has been laid, because results have been achieved, because political coalitions have been built that are very important moving forward between Republicans and Democrats in Congress and between a Republican and Democrat administration. So, you know, I would only say to the new president, think boldly, because things that once seemed impossible are now possible. And that, I think, can motivate people.
- [15:25]
A
Rajshah Michael Gerson, been really interesting talking to you. Thank you very much for joining me. Good to be with you. Don't forget, you can find out much more about CGD's work on our website, cgdev.org I'm Rajesh Merchandani, and please do join me for the next podcast from the center for Global Development.
- [15:45]
C
SA.