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Hillary Rodham Clinton

hen we think about frontiers, we

imagine unexplored territory,

unknown dangers, and often,

the thrill of discovering something new. The

possibility of the frontier is what sent explorers

to the edge of the map, drove America’s pioneers

west, and launched mankind into space. With

this book, we seek to bring that same spirit to

the frontiers of development. Although the idea

of development is familiar, and the places where

we work are well known, the challenges, the

excitement, and the new perspective of the frontier

is with us once again. Why? Because the world is

changing in remarkable ways. And these changes

mean that all of us who work in development have

to transform the way we approach our work.

To begin with, the context in which we

operate has shifted. In the 1960s, ofﬁcial

government aid represented more than 70% of the

money ﬂowing into developing countries. Today,

with the growth in private-sector investment,

NGO activity, trade volume, remittances, and

other activities, it is just 13%. More countries

Introduction

are working in development than ever before.

Emerging economies such as China, India, and

Brazil are engaging in more places. And as new

technologies continue to connect and empower

people in every region, the number of voices and

potential partners is growing exponentially.

At the same time, experience has changed our

understanding about how to achieve the results we

want. We used to diagnose development problems

in terms of what was missing—money, manpower,

infrastructure. Of course, resources remain vitally

important, but today we recognize that progress

also depends on the choices people make and the

leadership they show. It requires tough political

decisions, like reforming land-ownership rules or

changing tax policies so they don’t unfairly favor

powerful elites. A range of leaders—presidents and

prime ministers; ﬁnance and foreign ministers;

trade, defense, and justice experts—must be just as

engaged and committed as development agencies

and outside NGOs.

Taken together, these changes mean we no

longer look at development in isolation; we must

INTRODUCTION | IX

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survey the entire landscape. Before we commit

resources, we make strategic assessments about

the risks and opportunities in developing coun-

tries, and we make calculated decisions about

where to put our resources to help catalyze

economic growth. Where will we get the most

out of every dollar we spend? How can we work

with partners to best leverage their expertise and

resources? How do we ensure that our work will

lead to lasting change that helps people reach

their potential? Essentially, we no longer think

about development as aid; it is an investment.

And like all investors, we expect results. So we

are benchmarking and gathering comprehensive

data to help us determine which development

efforts are having an impact and which aren’t.

Where we are not seeing progress, we cannot be

afraid to re-evaluate, make adjustments where

possible, or, when necessary, start again.

To do this, we need to gather all the avail-

able resources and get them working together

toward the same ends. As the number of people

and organizations working in developing coun-

tries continues to grow, we risk working at cross-

purposes, or over-investing in some areas while

missing others. Governments, however, are

uniquely suited to bring partners together, set

common goals, and help craft shared strategies.

This is where diplomacy and the U.S. govern-

ment’s wide range of relationships are critical.

We are committed to elevating develop-

ment alongside diplomacy and defense as an

essential pillar of our foreign policy and a

critical element of our smart-power approach

to national security. In 2010, President Obama

issued the ﬁrst-ever Presidential Policy Directive

on development. I joined leaders from around

the world in Busan, Korea, last year at the

Fourth High-Level Forum on Aid Effectiveness

to make it clear that doing development right

is one of our foreign policy priorities. And this

year, I am sending instructions to every American

embassy and consulate with speciﬁc guidance on

how we must continue to modernize our diplo-

macy, improve our practices, and enhance our

leadership to better support development.

We are promoting broad-based economic

growth, because when more people can unleash

their entrepreneurial energy and innovative

spirit, everyone beneﬁts. Because we recognize

that accountable governance is the linchpin for

development success, we are investing in building

effective, democratic governments and vibrant civil

societies around the world. We want every partner

to become more self-sufﬁcient—and eventually

end their need for aid altogether. And we are put-

ting women at the center of all our efforts because

we know it’s an essential step in achieving our

foreign policy goals.

In practice, we are putting a much greater

emphasis on partnership and planning to get

everyone working together from the very begin-

ning. With Feed the Future, our presidential

initiative to end hunger and increase food security,

we are bringing partners and donors from many

different sectors together to help countries develop

their own investment plans for agriculture. It is a

ﬁeld-to-market-to-table strategy. We help coun-

tries build their capacity and policy environments

so they can jumpstart their agricultural productiv-

ity and achieve better nutritional outcomes for

millions of people.

Our Global Health Initiative (GHI) works

closely with host nations, helping them build their

capacity to run their healthcare systems. GHI also

coordinates all our efforts in a country so that our

work has the greatest possible reach and impact

on the ground. So far, we have worked with more

than 40 countries to develop integrated strategies

that focus on improving health systems instead of

X | USAID FRONTIERS IN DEVELOPMENT

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providing individual services. Through GHI,

we are leveraging our resources and platforms

to secure an AIDS-free generation, end prevent-

able child deaths, and save the lives of mothers

around the world.

Similarly, under our Partnership for

Growth initiative, we are working with four

countries—El Salvador, Ghana, Tanzania, and

the Philippines—to spark reforms that will pave

the way for sustainable development progress.

Each partnership agreement starts with all par-

ties sitting down together—our technical experts

and theirs, our political leaders and theirs, all at

one table—to identify the most critical barriers

to economic growth. Each country drives its

own unique plan for development, with both

sides making commitments that will help tackle

speciﬁc challenges.

These efforts are part of a larger, ongoing

conversation in the international development

community about how all of us can be more

effective while working in this new world. That

conversation is continued in this book by people

working on aid issues at every level, from senior

government ofﬁcials and academic leaders to

development workers in the ﬁeld.

In these pages, Emilia Pires, the Finance

Minister of Timor-Leste, makes a dramatic case

for why countries must lead their own develop-

ment efforts, even in fragile states. PepsiCo’s

Derek Yach and Tara Acharya highlight how

unconventional partnerships can be crucial for

addressing development challenges in new ways.

And Admiral James Stavridis, NATO’s Supreme

Allied Commander in Europe, illustrates the

nexus of our development goals and our security

priorities.

Many of these essays also stem from our

commitment to tap the deep reservoir of talent

that lives in the development world. We asked our

USAID experts for their input, and we invited

others from around the world to submit their ideas

for this publication—and they delivered. You will

be delighted to meet the Survival Girls who are

turning their stories of abuse into empowerment

in a Nairobi slum; be inspired by the Egyptian

entrepreneurs working against the backdrop of

the Arab Spring to grow their businesses; and be

impressed by the people making mobile money a

reality in the remote valleys of Afghanistan.

We have changed our conception of what

it means to work in development, and we have

changed how we deﬁne our objectives to better

navigate in this environment. But these are only

the ﬁrst steps. We must keep working together and

holding each other to account until we achieve our

goals. If we succeed, millions of people around the

world will have the opportunity to build more stable

and more prosperous lives for their families. That’s a

future worth braving any and every new frontier.

Hillary Rodham Clinton is U.S. Secretary of State.

INTRODUCTION | XI

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Rajiv Shah

Bending the Curve of Development

hroughout history, the greatest leaps in

social and economic development have

come when the development community

chose to do things a little differently, investing in

new technologies, forging strong public-private

partnerships, and leveraging the expertise of local

communities to generate groundbreaking solutions.

This approach enabled some of the most

signiﬁcant achievements in modern development:

a new vaccine delivery tool that made global small-

pox eradication possible; oral rehydration solutions

that prevented diarrheal diseases from rapidly

killing millions of children; a polio vaccine that

has helped nearly eradicate the debilitating disease;

and new strains of wheat and rice that ushered

in the Green Revolution, preventing widespread

starvation and poverty.

We need to learn from these experiences,

harnessing the same approach to generate ground-

breaking solutions against some of the toughest

challenges in development today.

Consider the phone. Fifteen years ago, hardly

anyone could have imagined that the mobile

phone would become one of the most powerful

development tools in existence. Today, mobile

phones are ubiquitous, having moved in less than

a decade from the briefcases of the wealthy to the

pockets of farmers, teachers, and health workers

nearly everywhere on earth.

Today, thanks to mobile technology, poor

farmers can use text messages to compare prices and

get more for what they grow. Community health

workers can use phones to collect information and

track disease outbreaks in real time. Protestors can

use them to document and share videos of electoral

violence. And mobile banking can give billions the

chance to save money for the ﬁrst time.

This is not to suggest that technology itself

solves all our problems. But new tools like the

mobile phone have created a sense of possibility

that motivates diverse actors, including govern-

ments, the private sector, and local communities,

to come together to generate dramatic results.

In order to leave behind generational legacies

of success, we cannot afford to stick with the status

quo or be content with linear and incremental gains.

XII | USAID FRONTIERS IN DEVELOPMENT

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Technical staff members from the Litani River Authority rehabilitate the face joints of the Qaraoun Dam in

Bekaa, Lebanon, through the USAID-funded Litani River Basin Management Support Program.The program

inspected the dam in November 2010 to detect minor leaks from aged joints. | Photo: Nabil Amacha/Litani River

Basin Management Support Program

We need to see over the horizon, adopting lessons

from our own history to bend the curve of progress

and foster a spirit of entrepreneurism and innovation

that can dramatically accelerate development.

In some areas, in particular, we stand poised to

achieve transformational results through the power

of science and technology. We can harness innova-

tion to help communities build real resilience to

disasters, so that droughts do not shatter develop-

ment gains or give rise to violence. We can develop

new production technologies, like better seeds,

fertilizer, and irrigation systems, to signiﬁcantly

boost harvests and ﬁght poverty. And we can scale

up proven technologies, like vaccines and bed nets,

as we develop new scientiﬁc breakthroughs to help

bring an end to preventable child deaths.

Development is full of competing priorities,

but only a few represent signiﬁcant opportuni-

ties to have the greatest impact at the lowest cost.

Innovation, partnership, and the inspiration

born of local solutions hold the key to achieving

unprecedented gains in human health, prosperity,

and dignity.

Building Resilience through

Innovation

Last year, Dr. Jill Biden, Senator Bill Frist, and I

traveled to Dadaab, Kenya, site of what has now

become the largest refugee camp in the world. In

2011, the worst drought in 6 decades forced more

INTRODUCTION | XIII

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than 290,000 Somalis to seek refuge in neighbor-

ing countries.

The drought caused enormous suffering

throughout the Horn of Africa, where more than

13.3 million people needed emergency assistance.

In southern Somalia, where 20 years of conﬂict

wore down the country’s ability to cope, the

drought led to a famine. At least 3 of every 10

children there were malnourished, and 2 out

of every 10,000 people were dying each day.

One in ﬁve lacked access to basic foods like

bread or rice.

While we cannot stop disasters from occurring,

we can do much more to help people withstand

them, whether it is a drought in the Horn or an

earthquake in Haiti. The development community

has to expand its focus from relief to resilience—

from responding after emergencies strike to prepar-

ing communities in advance.

In the Horn, this effort began with an

innovative early warning system we established

years ago in partnership with the U.S. Geological

Survey, NASA, and the National Oceanic and

Atmospheric Administration. Able to predict the

severe drought months in advance, we shipped

food ahead of time to storage sites in the region so

we could quickly distribute it once crisis struck.

Because studying past famines showed us that

preventable disease, not hunger, was the leading

cause of death among children under ﬁve, we

stockpiled vaccines in advance of the crisis. And

we helped communities in Kenya build catch-

ments so they could collect and store as much

water as possible before the drought.

As we shift our focus to long-term resilience,

some of the most important innovations are not

1 Jason Corum, “Understanding the Declaration of Famine in Somalia,”

World Food Program USA, July 27, 2011, http://usa.wfp.org/blog/

understanding-declaration-famine-somalia

focused on saving lives, but saving livelihoods,

enabling individuals to hold onto their sources of

food and capital throughout a crisis.

In Kenya’s drylands, families rely on live-

stock for 95% of their incomes, making them

especially vulnerable in times of drought. To help

strengthen their ability to cope, we are focusing

on their animals by promoting vaccine programs

and accessible veterinary care. Since the onset of

the drought, we helped vaccinate nearly 300,000

livestock, protecting this main source of income

for some 25,000 Ethiopian households.

But it is not just vaccines and new knowledge

about resilience that is making it possible to help

vulnerable populations weather adversity. Today,

signiﬁcant advances in actuarial science have

allowed us to partner with insurance ﬁrms to pilot

cutting-edge microinsurance programs to compen-

sate farmers and herders who suffer grave losses.

Last October—during the height of the drought

in the Horn—those programs made payments to

more than 600 cattle herders who had purchased

coverage for their animals earlier that year.

Bridging the divide between disaster response,

resilience, and sustainable development is not easy,

but it is critical to saving lives more effectively in

an emergency, and it is essential in our efforts to

ensure that droughts no longer lead to food crises.

Pioneering a New Approach to

Agricultural Development

In 2008, the balance of the world shifted, as more

people lived in urban settings than in rural com-

munities for the ﬁrst time in history. But despite

the rapid growth of cities and the slums that tend

to surround them, poverty has remained, by and

large, a rural phenomenon. The majority of the

very poor and hungry are still farming families

who tend small plots of land. That is especially

true in countries like Ethiopia and Tanzania,

XIV | USAID FRONTIERS IN DEVELOPMENT

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where three out of every four workers lives on a

farm. For most poor people in the world, tending

the land is one of the only ways to earn money

and feed their families.

That is also why almost every country that

has emerged as a developed economy has done

so by increasing the productivity of its farms. In

fact, just a 1% gain in agricultural production can

generate a 46% increase in the purchasing power

of the poor.

As a result, growth tied to gains in

agricultural productivity is up to three times more

effective in raising the incomes of the poor than

from other sectors.

Simply put, ﬁghting poverty means boosting

harvests.

At the 2009 G8 Summit in L’Aquila, Italy, gov-

ernments agreed to reinvest in food security, in large

part because of personal appeals made by President

Obama. Most critically, these governments pledged

to direct their funding in a very different way.

This new approach, embodied in President

Obama’s global food security initiative Feed the

Future, directs money toward plans that are devel-

oped and led by partner countries and focused on

smallholder farmers, especially women. The strate-

gies emphasize science and technology to increase

agricultural output and private-sector investment

to develop strong market linkages. Within this

framework, Feed the Future is investing across

20 countries in the speciﬁc crops and regions that

our partner countries believe will most rapidly

spur economic growth and ﬁght malnutrition.

To accelerate progress, we are focusing on

scaling up access to agricultural technologies

and prioritizing research into new seeds that can

2 Ethan Ligon and Elisabeth Sadoulet, “Estimating the Effects of

Aggregate Agricultural Growth on the Distribution of Expenditures,”

Background Paper for the World Development Report 2008, siteresources.

worldbank.org/INTWDR2008/Resources/2795087-1191427986785/

LigonE&SadouletE_EstimatingEffectsOfAggAgGr.pdf

withstand droughts, thrive in ﬂoods, and resist

climate change. As a result, vitamin A-rich sweet

potatoes are now helping children in vulnerable

regions like the Horn of Africa resist disease and

improve their nutrition.

In the last three years, we have more than

doubled our agricultural research investments,

building new bridges between U.S. universities and

their counterparts in the developing world. In the

We need to adopt lessons from

our own history to bend the

curve of progress and foster

a spirit of entrepreneurism

and innovation.

Philippines, USAID and the U.S. Department of

Agriculture worked with two U.S. universities and

the International Rice Research Institute to develop

submergence-tolerant rice. More than one million

farmers are already seeing improved harvests.

By partnering with national rice research centers

across South Asia, we hope to reach 70 million

more people.

We also saw staggering results last year in

Haiti when we piloted a program designed to

intensify rice yields through improved planting

techniques in the areas surrounding Port-au-

Prince. Haitian farmers saw their yields increase

by almost 120%, while lowering their cost of

production. The farmers even cut 10 days off

their normal harvest. Today, that program is being

expanded to reach farmers in other priority devel-

opment areas throughout the country.

Although innovation in agricultural

INTRODUCTION | XV

development begins with new research and

breakthrough technologies, it does not end there.

In order for agribusinesses to thrive, smallholder

farmers need access to durable supply chains, reli-

able sources of capital, and affordable insurance

products. And women farmers need exactly the

same access as men. Without these fundamental

elements, farmers cannot succeed—here in the

United States or anywhere else.

That is why we are helping unlock the power

of the global—and local—private sector through

innovative, high-impact partnerships that can

deliver proﬁts for companies, lift up smallholders,

and reduce poverty at the same time. As impor-

tant to agricultural development as a new seed or

irrigation system, these public-private partner-

ships abide by high standards of responsibility,

transparency, and accountability—in deep contrast

to some of the more controversial private-sector

engagements of the past. As we work, we are also

consistently measuring and evaluating our efforts

to ensure that our investments effectively empower

women in their businesses and lives.

This past year, we partnered with PepsiCo

and the World Food Programme to help 10,000

chickpea farmers improve their yields and join

PepsiCo’s supply chain. PepsiCo will use those

chickpeas to create a highly nutritious food paste

to sell to the World Food Programme, which can

use it to save the lives of malnourished children.

We are also working with J.P. Morgan to drive

capital toward East African agribusiness. Along with

the Bill & Melinda Gates, Gatsby, and Rockefeller

Foundations, we enabled a Kampala-based fund

manager to invest $25 million in at least 20 agricul-

ture ﬁrms throughout the region, raising incomes

for at least a quarter of a million households.

Inspired by the legacy of the Green

Revolution, it is easy to think of new seeds as the

silver bullet. But success will be determined not

just by investments in science, but also by our abil-

ity to mobilize responsible private-sector invest-

ment to generate real results. Ultimately, we can

help developing countries transform their econo-

mies, reduce poverty and address the staggering

rates of malnutrition that rob children around the

world of their potential.

Ending Preventable Child Deaths

When we emphasize the importance of breast-

feeding, train a community health worker to use a

low-cost bag mask to help newborn babies breathe,

or provide bed nets, we do not often stop to con-

sider that we are harnessing signiﬁcant innovations

in development. But it is precisely these break-

throughs that make it possible today to achieve an

unprecedented legacy in global health.

Thanks to tremendous progress over the last

several decades, the global community has the

knowledge and the tools to end preventable child

deaths and bring child mortality in the developing

world into parity with the developed world.

But in order to realize this vision, we need to

do things very differently. We need to engage more

effectively with emerging economies that do not

receive development assistance, but have the ability

to reach this goal. We need to ﬁgure out how to

improve the rate of child survival in large countries

that have lagged behind, including Nigeria and the

Democratic Republic of the Congo. And we need

to help shape a policy and political environment

that can maintain focus on this critical goal in a

fast-moving world that always offers new priorities.

The effort to end preventable child deaths

begins even before the moment of birth. Through

the President’s Emergency Plan for AIDS Relief,

we are ensuring pregnant HIV-positive women can

give birth to an AIDS-free generation. On World

AIDS Day in 2011, President Obama announced

that the drop in the cost of a year’s supply of AIDS

XVI | USAID FRONTIERS IN DEVELOPMENT

medication—from $1,100 to $335—allows us to

provide lifesaving medication to six million people.

Because many infants die from asphyxia

during their ﬁrst “golden minute” of birth, our

Helping Babies Breathe partnership is equipping

midwives and caregivers with low-cost tools that

can help newborns take their crucial ﬁrst breaths.

That is also the spirit behind Saving Lives at Birth:

A Grand Challenge for Development. This global

competition we helped launch last year garnered

more than 600 cutting-edge ideas to help mothers

give birth safely in low-resource settings, including

a creative device to resuscitate newborns at one-

fortieth the cost of currently available tools.

It is only recently that we began to under-

stand the long-term societal consequences of

widespread stunting—or how easily an effort like

breast-feeding or child nutrition could ﬁght this

hidden hunger. To support these simple, effec-

tive, and life-saving interventions, our 1,000 Days

Partnership is shifting our nutrition efforts to

focus on the critical window between a mother’s

pregnancy and her child’s second birthday.

Thanks to the dramatic scale-up of malaria

prevention and treatment efforts under the

President’s Malaria Initiative—driven, in part, by

new long-lasting insecticide-treated bed nets and

combination therapies for children who get sick—

we have seen extraordinary results in child survival

around the world. In Senegal, child mortality

declined by 40% in ﬁve years, largely because pre-

venting children from contracting malaria creates a

cascade of other life-saving health beneﬁts.

This past summer, when children arrived with

their families at the Dadaab refugee camp in Kenya,

they received polio, measles, and pneumococcal

vaccines at the point of registration. It was only

recently the world came together to help ensure

that children everywhere have access to the latest

vaccines that will protect them against pneumonia

Chairwoman Rose Peter of the Upendo Women

Growers Association in Mlandize, Kibaha,

Tanzania, shows off the rst batch of sweet peppers

the women have grown in their new greenhouse.

The 22 women in the group received support,

training, and technical assistance through USAID

Tanzania’s Feed the Future Initiative. | Photo: USAID

and diarrhea, the two leading causes of global child

death. Offering a lifetime of protection, vaccines

remain one of the smartest, most effective invest-

ments we can make in global health.

Interventions are only truly successful when they

reach those who need it most. For instance, although

oral rehydration therapy has been hailed as one of the

greatest development innovations in recent history,

less than 40% of children with diarrhea in develop-

ing countries receive the life-saving treatment. By

focusing on this key bottleneck, we can dramatically

INTRODUCTION | XVII

The newborn daughter of an HIV-positive mother receives the antiretroviral drug Nevirapine at the

Paarl Hospital, about 70 km from Cape Town, South Africa. Some 70,000 babies are born HIV-positive

annually as a result of mother-to-child transmission of the virus, which aficts one in nine South Africans.

AFP Photo: Anna Zieminski

reduce childhood mortality from diarrhea, which

kills 1.3 million children under 5 every year.

To close gaps like these, we have established

the Center for Accelerating Innovation and Impact

at USAID, designed to help rapidly transform new

scientiﬁc and technological discoveries into life-

saving impact in the ﬁeld. The Center will support

our efforts to work more closely with product

manufacturers, ensure our country programs can

rapidly introduce cost-effective technologies, and

serve as a hub for learning and knowledge dissemi-

nation around this critical task.

To realize the goal of ending preventable

child deaths, we need to do more than spur

innovation. We have to overcome ﬁnal barriers to

success, transforming facility-dependent programs

designed to treat diseases into community-driven

programs focused on treating patients. When

expectant HIV-positive women receive medication

to protect their children, they should also receive a

bed net to take home. And children should receive

nutritional supplements and their vaccinations at

the same time.

By working closely with countries and continu-

ing smart investments in global health, we can bring

the rate of child mortality in poor countries to

the same level it is in rich countries. This tremen-

dous achievement would not only save millions of

lives, but would help nations accelerate economic

growth through a shift in their population called

XVIII | USAID FRONTIERS IN DEVELOPMENT

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