MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. The United States Agency for International Development, better known as so many things in this town are by the acronym USAID, was created by President Kennedy as a way to meet American's moral, economic and political obligations abroad, but things have changed on the global scene in the 50 years since the agency was created.

MR. KOJO NNAMDIAnd USAID is now part of a growing complex web of agencies and organizations that provide development assistance overseas. Joining us today is the man in charge of finding the way forward. He is Dr. Rajiv Shah. He is the administrator of USAID. Raj Shah, thank you so much for joining us.

DR. RAJIV SHAHThank you, Kojo.

NNAMDIIf you have questions or comments and would like to join this conversation, you can give us a call at 800-433-8850. You can send email to kojo@wamu.org, send us a tweet, @kojoshow. Most Americans would guess as much as 20 percent of the U.S. budget goes to foreign aid. In truth, it's less than 1 percent administered by and large through your agency. What type of assistance does USAID offer, and where do you work? Give me your going-up-in-the-elevator story, so to speak.

SHAHWell, thank you, Kojo, and thanks for noting that in fact it is less than 1 percent of our federal budget, and for that less than 1 percent, we help promote American safety, security and economic prosperity in more than 80 countries around the world. As you point out, President Kennedy created USAID in 1961, and our mission is to reach the world's most vulnerable people and places to help build a more stable world with more economic prosperity because we've seen time and again that that helps to improve American security, and it helps create American jobs.

NNAMDISee, I said USAID. He said USAID. It is known by -- which acronym do you prefer, USAID?

SHAHBoth are fine with me.

NNAMDIOK. When this agency was first formed, China and India were considered poor countries, and there was a focus on nation building across Europe. Fifty years later, the geopolitical landscape has changed considerably. How are you adapting?

SHAHWell, the world has changed tremendously. As you point out, it used to be that official development assistance from partners like USAID and the World Bank accounted for nearly all investment flows into very poor countries. Today, we're at best less than 10 percent of those flows, and private investment is the defining feature of global economic capital movements. So our goal is very simple, and it was articulated by President Obama in the State of the Union address.

SHAHWe're working to help end extreme poverty in two decades, and that means we work in more than 80 countries around the world. It means that we work in real partnership, and increasingly, we have launched 1,600 public, private partnerships that have leveraged American investment with an additional $19 billion of investment from private companies, private philanthropies, remittance income from individuals that send money back to families that we can help enable.

SHAHAnd we believe those investments are generating real proven results, results that help reduce preventable child death, results that are helping to end child hunger around the world and results that help to usher in more democratic governance in greater parts of the globe.

NNAMDISo USAID is really a part of a broader network of agencies and organizations offering development and assistance overseas. The number is 800-433-8850. What changes would you like to see in the way the U.S. allocates and distributes foreign aid? 800-433-8850. You can also send us a tweet, @kojoshow. Current U.S. food aid policy dates to the Eisenhower era, but change is on the horizon. You have a proposal. What would your proposal mean both for aid recipients and for U.S. farmers?

SHAHWell, thank you, Kojo. The president has put forth a bold proposal to change the way we do food assistance around the world, and it's part of a larger effort that President Obama has led since he first took office in 2009 to help end hunger around the world. It starts by recognizing that helping farmers produce more food in remote places, like the eastern Congo or southern Ethiopia, can be a big part of the solution to addressing and ending chronic hunger that still affects nearly 860 million people who go to bed hungry every day.

SHAHWe've extended that effort to also embrace private companies. The president last year launched an effort called the new Alliance for Food Security that convinced more than 70 companies to make three and a half billion dollars of private investment to more than double our impact in helping to achieve the end of hunger through real agricultural development. And this year in our budget proposal, we put forth a vision of food aid reform that will allow us to reach four million additional children with high-quality nutrition to prevent them from going hungry and to enable their communities to make the pathway from self -- from dependency to self-sufficiency and dignity.

SHAHAnd the reform requires doing some things differently, changing the way we run a program that we've run in one manner since 1954 when the federal government had massive stockpiles of excess food. Today, we live in a world where U.S. agricultural exports are on a four-year peak where farmers and ranchers are able to sell their goods and products all around the world, including to food consumers and fuel consumers, and where the impact of this reform of essentially buying more food locally to reach these children faster and more efficiently will allow us to reach more people and have very, very minimal impacts on American farmers and ranchers.

NNAMDIYou mentioned very little impact on American farmers and ranchers, but there is going to be some impact. What kind of pushback have you been receiving from American farmers who said, look, this was our business, we used to be able to be the ones who got this food and sent it abroad, and now, you're taking money out of our pockets?

SHAHYou know, I've had a chance to spend a lot of time in rural communities in this country. I started in this administration, the U.S. Department of Agriculture, and I've met with farmers all across this country, from Nebraska to Montana, Oklahoma. In -- at the end of the day, I believe American producers in particular care deeply about the result of ending hunger. And when we explain that we can actually reach four million additional children without spending any additional resources, most say, to me, that that's something we should do.

SHAHWhen we explain that in the world we now provide humanitarian assistance, whether it's opposition-controlled parts of Syria or al-Shabaab-controlled parts of Somalia, the traditional kind of model of trucking in American food in big visible convoys now puts our humanitarian workers at real risks. They are targeted and often killed in the line of duty, and we need a more modern and a more effective approach. And most Americans embrace efficiency, businesslike effectiveness in the way we implement government programs, and that's exactly what this is.

NNAMDISo you're saying that American farmers also appreciate that in large measure?

SHAHWell, I think so, absolutely. I think every American, especially this point in time where we're dealing with sequestration and we're making real fiscal, you know, real fiscal reductions across so many parts of government, people wanna see government work more efficiently and more effectively. And that's why President Obama said, "Look, if we can reach four million additional children by buying food more locally, if we know that the new science of human nutrition says we should get a different kind of product to children, maybe a little bit less of traditional grains and a little bit more of high-protein foods, premanufactured foods, foods that are less likely to run the risk of causing disease and more likely to help children be resuscitated that that's what we should do.

NNAMDIOur guest is Dr. Rajiv Shah. He is the administrator of USAID or USAID. We're taking your calls at 800-433-8850. It's the agency for international development. If you're from or have lived in a country where USAID has a presence, what was your experience interacting with or observing the agency? Broader question, what do you think America's role is or should be when it comes to global development?

NNAMDI800-433-8850. You can also go to our website, kojoshow.org, and join the conversations there -- the conversation there. The changes that you talked about as the president's proposals were put forth as part of his budget weeks ago, where have they've gone, and how much farther do they have to go from there?

SHAHWell, Kojo, I think we've seen real progress on Capitol Hill and amongst so many different constituencies that are embracing certain aspects of the president's proposals for reform. You know, I just wanted to show one story. I had a chance perhaps the most difficult moment of this job for me was visiting the Dadaab refugee camp during the famine that took place in the Horn of Africa more than a year ago, and I had a chance to visit with Dr. Jill Biden and Senator Bill First on a bipartisan effort to bring visibility and aid to children who were literally dying.

SHAHWe saw kids wrapped in blankets who had passed away in the morning on cots sitting next to or lying next to their mothers who were weeping because of the loss. We met women who had traveled by land on foot more than 80 or 90 kilometers to come a place of safety. When they got there, they were rescued by American generosity and good will. They received high nutrition food products that helped to resuscitate some of those children.

SHAHThey were protected in refugee camps that are largely supported by American foreign assistance, and it was a very proud moment. But the reality is we now know and we knew at that time that if we were really gonna save people inside of famine-affected parts of Somalia, we had to do things differently. Al-Shabaab, a noted terrorist group that controlled parts of those areas, were targeting and killing aid workers that were sending traditional food convoys in.

SHAHSo we implemented a very innovative voucher program with our partners, and we got vouchers for food to hundreds of thousands of people in famine-affected areas. And as soon as that happened, we started by tracking market prices and food movements in the region. We started to see local market actors, salesmen move food into those famine-affected areas. We saw the prices of food actually go down as greater volumes went in.

SHAHAnd most importantly, retrospectively, we've looked at more than 60 studies, and we saw that it was precisely at that point when the rate of child mortality, the number of children dying from hunger and starvation started to come down. So this reform is really about saying, "Let's use data and businesslike thinking and real knowledge about what works and what doesn't work and saving lives to try to make sure that we implement our humanitarian mission with as much rigor sophistication and science as we would any other mission that is so important to America's future."

NNAMDIWhen you mentioned infant mortality and saving children's lives, it allows me to digress for a moment to the more personal, health care is one big way that the U.S. offers assistance abroad, and a subject that you're intimately familiar with, your background is in medicine. I'm curious to learn how you got from there to working in development.

SHAHWell, thank you. I was a medical doctor. I went to school at the University of Pennsylvania medical school and did some training there and then had the chance to join -- actually at the time, president -- Vice President Gore's campaign for president working on health care issues and from there had the wonderful opportunity to work with Bill and Melinda Gates as they were establishing their foundation and really using their philanthropy to bring, you know, businesslike, measurement-focused efforts to reduce extreme poverty and its most dire health consequences in particular all around the world. So I had a chance to work with the Gates Foundation for more than eight years before joining President Obama's team.

NNAMDIFrom 2000 to 2010, your agency staff went down by 30 percent, which meant outsourcing a lot of work. It's my understanding that one of your goals is rebuilding capacity within the agency. How does one go about doing that?

SHAHWell, it's -- in this political environment, it has required a lot of effort to build a strong bipartisan consensus around...

NNAMDIA lot of creativity.

SHAHExactly. Around what American aid should accomplish around the world. I will say this: USAID and America has a very bright history in our development partnerships around the world. We ushered in a green revolution in Asia that saved hundreds of millions of lives. We invented new health solutions that saved tens of millions of children in the '80s and early '90s. We led the effort to reintegrate Eastern European economies by creating enterprise funds after the fall of the Berlin Wall.

SHAHAnd we've helped lead the charge to end HIV/AIDS in Africa and elsewhere. So we've had bright days. But you're right that, especially in the early days of the Iraq and Afghan military engagements, USAID was called upon and America was called upon to do a lot of wartime reconstruction after its staffing and processes had been decimated. So we have helped rebuild this agency.

SHAHWe have grown our staff to 9,600 worldwide, and I'm very proud of the bipartisan support we've received from senators like Lindsey Graham and Sen. Leahy who chair many of our committees. There are so many leaders in Congress on both sides of the aisle that believe America is safer and more secure when we can engage around the world in our core moral mission and in our core effort to ensure that we create human opportunity for people so we're not fighting with them through our military.

SHAHAnd for less than 1 percent of our budget, if we can show that we can deliver measurable results, as we've done in health, as we've done in food security, as we've done in so many other areas where we work, I believe America has a great capacity to make these investments.

NNAMDIGot to take a short break. If you have called -- and many of you have -- stay on the line. We will get to your calls. If the lines are busy, you can go to our website, kojoshow.org. Or send us a tweet, @kojoshow, or email to kojo@wamu.org. Do you think the U.S. has demonstrated leadership and can continue to do so in foreign development assistance? Kojo@wamu.org, that's our email. I'm Kojo Nnamdi.

NNAMDIWelcome back. Our guest is Dr. Rajiv Shah. He is the administrator of USAID or U-S-A-I-D. We invited your phone calls, and you responded. So I'll go directly to the phones. I will start with Bellai (sp?) in Washington, D.C. You're on the air, Bellai. Go ahead, please.

BELLAIYes, sir. Thank you for this opportunity, Dr. Rajiv. And I just wanna ask you. I'm a doctor here in Washington, D.C., and I see some programs, you know, in USAID leveraging migrant resources for effective development. What programs, you know, actually are there, you know, like for diaspora to invest in Africa, for example?

NNAMDIYou know, D.C. is home to many diaspora populations that retain strong ties to their countries of origin. And it's been estimated that worldwide, diasporas contributions are equal to double all development aid. It's my understanding you're trying to engage with those community so you can include that in your response to Bellai.

SHAHWell, thank you, Bellai, and thank you for your comments. USAID has -- we've launched an effort we call USAID Forward to really transform the way the agency works by engaging in new types of partnerships, by prioritizing real innovations and by ensuring that we measure and report clearly on results when we make investments. And one of the proudest areas of work and transformation has been our partnership portfolio with diaspora communities.

SHAHDuring the Somali famine, for example, we worked with Somali Americans in Minneapolis and Ohio and here to help identify different local partners we could work with inside of Somalia that could often reach communities in need when others couldn't. Today, we partner with Ethiopian Americans to help leverage more remittance income back to certain organizations and communities in Ethiopia where needs are most significant, and we use our resources to help enable those types of transfers.

SHAHIn fact, one of the things we've been very focused on in the innovation area has been ushering in mobile banking and mobile payment systems. Those types of programs where people don't really have bank accounts, you know, and Haiti, more than 90 percent of the population is unbanked, we have an innovative partnership with local Haitian mobile phone companies and the Bill & Melinda Gates Foundation to reach millions of Haitian women, in particular, with phone-based banking services, so they can receive remittance income, and they can be part of a more expansive local economy.

SHAHAnd we found that some of those efforts are the first time these women have the ability to save assets and money for themselves and for their families and make real impacts on their ability to move themselves out of poverty. And importantly, when you invest in women, they invest in their children. So we're seeing real results from these types of efforts especially with the diaspora community.

NNAMDIBellai, thank you very much for your call. And I'm glad you brought up Haiti because that's what Claire in Washington, D.C., would like to talk about. Claire, your turn.

CLAIREHello. Thank you very much, Mr. Shah, for accepting questions. My question is about Haiti, and I work with a lot of groups working on Haiti and Haitians. And I was curious if you could speak to the USAID's investments, particularly in textile exports in Haiti given the relatively poor returns of the sector it had and also the other pressing crisis that are in Haiti including housing and food security. So could you tell us a little bit about what's different now that USAID is doing with relation to textile industry in Haiti?

NNAMDIAnd you're talking to the right person because Rajiv Shah was responsible for coordinating the distribution of aid in the aftermath of the earthquake in Haiti. So, please, go ahead.

SHAHWell, thank you, Claire. You know, after the tragic earthquake that killed more than 250,000 Haitians in Port-au-Prince, the United States not only lead a global response that was the largest humanitarian effort ever mounted within weeks feeding more than three million people and helping to reach basic services outreach to many, many more, but after that, the U.S. has been a primary partner with the government of Haiti and with Haitian businesses and nonprofits to lead the reconstruction of that country.

SHAHAnd the effort has been broadly based but very focused on a few specific core results. In agriculture, for example, we're working with hundreds and thousands of Haitian farmers helping them improve their food production. And we've seen, crop yields, as you point out, go up more than 200 percent in certain parts of the country. In health, we’ve expanded the outreach of basic health services, especially immunization, throughout the countryside and help control disastrous cholera epidemic that took hold and has killed more than 8,000 Haitian children but is now being managed.

SHAHAnd in the effort to create more jobs and trade and investment, we've done everything from facilitating investors like Coca-Cola to help reach 25,000 Haitian farmers create mango juice and working with companies in a place called Caracol to build more textile-based manufacturing job opportunities and export markets for those communities.

SHAHSo it's a broad comprehensive effort that recognizes that for Haiti to be successful, Haitians themselves, leading with their government and their businesses, have to lead in the effort that this has to be a public-private effort that includes a strong role for trade and investment businesses like the textile sector and that we need to continue to make results or any investments in health, education and agriculture and malnutrition so that everyone in Haiti has a chance overtime.

NNAMDIBut a lot of things went wrong in the aftermath of the earthquake in Haiti. We spent a week broadcasting from there in 2010. At the time, nearly every vehicle we saw had a logo flagging at us either from the U.N. or being from a U.S. agency. Since then, we've had several conversations with aid workers and policymakers about what went wrong and what went right in terms of distributing aid in the aftermath. What have your takeaways been from that?

SHAHWell, you know, I've really had two or three big observations or learnings coming out of our Haiti effort. The first is that no matter where you work, for success to take hold, the efforts have to be county led, that you can't come in from the outside and dictate to people the principles of partnership and growth, and sometimes, that takes longer. The Haitian government has had some ups and downs in creating an effective coordination structure and in making sure they're seeing through investments to results.

SHAHBut they do have to lead because we won't be able to lead on their behalf, and it would be unfair to the people there if we were trying to. Second is we do need to be more flexible and more focused on local solutions. This has been a big theme of our USAID forward reforms especially in how we partner. And so we have worked aggressively to make sure we reach Haitian organizations, Haitian small businesses, Haitian companies.

SHAHI had a chance to visit more -- some of the 400,000 housing units we've either built or reconstructed after the earthquake. And by training local Haitian construction companies on how to use rebar and other improved processes, we were able to help ensure that those 400,000 rebuilt homes were built to a much higher earthquake standard that existed before. And they did it using Haitian labor and Haitian materials. That's one of the solutions and one of the paths forward and critical to success.

SHAHAnd then the final real observation is that the role of science and technology partnerships with American institutions is always gonna be very important. Part of why they've had 230 percent improvements in rice yields, for example, come from partnerships with the University of Florida and professors and scientists there that are able to engage in work in the rural countryside in Haiti.

SHAHSo I do -- I'm very optimistic about the future, but, you know, rebuilding a country after such a tragedy especially a country that was already the poorest in the hemisphere and with very real governance challenges is going to take time. But I'm very optimistic that doing things differently will yield more sustained results.

NNAMDIClaire, thank you very much for your call. And, you know, Rajiv Shah, with each of your answers, you lead me into a question that another caller has. Therefore, stifling my own, which some people might think is not such a bad idea, here is Malcolm in McLean, Va. Malcolm, speaking of science and technology. Malcolm?

MALCOLMYes. Can you hear me?

NNAMDIYes, we can.

MALCOLMYes. Kojo, thank you for this program. And, Dr. Shah, thank you for all your doing in the development area. I'm aware of a program called the Higher Education Solutions Network which involves U.S. universities in identifying and deploying new technologies for development. And you touched on both universities and technology, but I thought you might wanna talk a little about that program which struck me as pretty innovative.

SHAHWell, thank you, Malcolm. And I so appreciate you're raising that point. You know, if the old model of development was hiring a contractor to build a road, we really believe that the new model is partnering with engines of American innovation, corporations, foundations, universities to help nations build innovation economies and real democratic societies that are connected to our own. And a great example of this is the Higher Education Solutions Network we've established in the last few years.

SHAHWe now have development innovation laboratories on college campuses across the United States as well as in some international settings, where students and faculty come together to say, can we invent new solutions to traditional problems? Can we look at something that's difficult and bring American ingenuity and science and technology to the solution set? Let me give you just a couple examples. In Berkeley in California, I had a chance to visit student groups that were working on one of our efforts.

SHAHAnd they've taken an iPhone, connected it to something they call a CellScope which is kind of a small plastic microscope and by putting a drop of blood on a slide and putting it under the CellScope, you can have that iPhone take a photograph of the image, process it through its own internal software algorithm. And they're working on technology that can then diagnose malaria or tuberculosis in the field without ever having to go back to a traditional laboratory.

SHAHOnce we get that technology fully developed and deployed, it will dramatically lower the cost of saving people's lives from those diseases in the farthest corners of the globe. And it will make the elimination of those diseases even more possible. We've had other groups that have developed ways to use mobile phone-based photography as well as something called parallel vote tabulation.

SHAHAnd we've tested that in places like Afghanistan and Kenya which basically helps citizens of those countries hold their own election processes accountable and reduces the likelihood that elections can be rigged by saying, let's deploy the existing technology networks that exist, create some new software tools and algorithms and have citizen watchdog groups make sure that, you know, vote rigging goes way down in some of these very difficult settings. That was highly effective in the recent Kenyan elections.

SHAHIt was proven effective in parts of Afghanistan where we tested its deployment and was developed by graduate students on one of our development innovation laboratory. So our vision of the future is really unlocking so much more of that science, technology and innovation to tackle some really difficult development challenges. And I'm very confident that American innovation will win the day.

NNAMDIMalcolm, thank you very much for your call. We're talking with Dr. Rajiv Shah. He is the administrator of U.S. A-I-D or USAID -- is the Agency for International Development. We're taking your calls at 800-433-8850. You can send e-mail to kojo@wamu.org. Are you a development aid worker who is part of a government agency or NGO? We'd like to hear from you, too, 800-433-8850. I know one of your missions is the facilitation of democracy.

NNAMDIBut the president of Bolivia recently asked USAID to stop its work there. It's not the first time the agency has been asked to leave a country. Russia did the same in 2012. What's your understanding of why Bolivia no longer wants the agency there?

SHAHWell, let me just say that America has played a proud role in supporting democracy and governance all across the world. One of the things I mentioned earlier was in Eastern Europe. That was in -- a real area focus for us. President Obama and Secretary Clinton, now Secretary Kerry, have made very clear that development and democracy go hand in hand.

SHAHAnd our capacity to support the implementation of free and fair elections -- whether it's mobilizing 1 million youth in Kenya through an effort we called Yes Youth Can to help ensure that elections move forward peacefully and transparently or fielding 4,000 election monitors in the Ghanaian elections or working in any other part of the world to help support democracy -- is a core part of our vision of how we will all end extreme poverty in the next two decades.

SHAHSo we're proud of that work. Sometimes it does create tensions with governments that don't necessarily share the same commitments to maintaining space for civil society to be open and effective. But it's a core part of our engagements abroad. And it's a part of all of our programs abroad.

NNAMDIThe president of Bolivia claims that USAID was involved with "alleged political interference in peasant unions and other social organizations," to which you say what?

SHAHThat's not true. We are very transparent with our funding and financing. In fact, today, you can go to usaid.gov and click on a map of the world and see what every project and program does and where those projects and programs work. That's part of our commitment under President Obama to join something called the International Aid Transparency Initiative. And we're very transparent with what we do, and those allegations are simply inaccurate.

NNAMDIHere now is Joel in Leesburg, Va. Joel, you're on the air. Go ahead please.

JOELCan you hear me OK, Kojo?

NNAMDIYes, we can, Joel.

JOELGreat. It's very interesting listening to your program especially the last statement the doctor is making. I would like to know, since we don't have diplomatic relations with Cuba, what an aid worker was doing there, namely Alan Gross, who is now in jail and there's 12 years left on his 15-year sentence. I would also like to know what AID is doing to get him out. Thanks.

NNAMDIAlan Gross, for those of you who don't know it, was sentenced to 15 years in Cuba for what the Cuban government said was subversive, and what he said was he simply was delivering equipment to Cuba's small Jewish community so that it would have access to the Internet without passing through government sensors. Dr. Shah.

SHAHWell, our efforts in Cuba have been very transparent and very consistent. We focus on investments in certain humanitarian activities and, as you mentioned, efforts to expand access to information for communities on the island. You know, I -- my heart and prayers go out to the Gross family. As this administration has said repeatedly and Secretary Clinton and Secretary Kerry have both validated, we believe Alan Gross is being wrongly held.

SHAHHe should be released, and we are working aggressively to secure that release and working aggressively to support the Gross family through this difficult time. But America will also continue to support efforts to expand democracy and transparency around the world. I mean, we work in that setting in Cuba and eastern Congo.

SHAHWe're partnering with companies that range from, you know, Apple to gold mining companies to help make sure that minerals that come out of that country are transparently mined and that revenue flows don't go to militia groups that rape and pillage in the countryside there. And we will just continue to have this focus of bringing transparency information and real democratic governance to all parts of the globe.

NNAMDIA lot of you have called. Stay on the line, even though we have to take this short break. We will be returning to this conversation with Dr. Rajiv Shah. He is the administrator of the U.S. Agency for International Development or USAID. You can also send email, if the phone lines are busy, to kojo@wamu.org. Joel, thank you for your call. You can also send us a tweet, @kojoshow. I'm Kojo Nnamdi.

NNAMDIWelcome back. We're talking with Dr. Rajiv Shah. He is the administrator of the U.S. Agency for International Development or USAID. I'd like to go directly to the telephones, and, well, let's solve Christopher's problem. Christopher in Lanham, Md., you're on the air. Go ahead, please.

CHRISTOPHERThank you, Kojo. My name is Christopher Anjem (sp?). I'm calling from Lanham, and I'm a forester by training, and I've done a lot of work in the forestry sector in Cameron. My question to the administrator focuses on the hiring process. Each time you have a position advertised by USAID, they're asking for prior experience with the USAID operating procedures. Is there a service in his department that offers training enough for anyone to qualify to compete for a position like offered by the department?

NNAMDIInternal training.

SHAHWell, absolutely. We -- first, let me just say, we've had the opportunity to hire more than 1,100 staff during my tenure, and we have focused very much on rebuilding the core technical capabilities of our agency. So, today, we now hire dozens of Ph.D. experts in agricultural sciences. We've hired in health experts and energy experts and people with strong public-private backgrounds and skills.

SHAHIn fact, we've created a whole category of the foreign service that we called field investment officers that are deployed around the world to help literally source and execute financial transactions, usually with local banks to try to leverage our resources so that for every dollar we spend through a program we call the Development Credit Authority, we're able to leverage another $28 of local investment in small-scale and medium-sized enterprises towards the effort to end extreme poverty.

SHAHSo we have really rebuilt our workforce, and we continue to seek people with very diverse backgrounds and experiences and especially people with strong private sector experience and the capacity to do these kinds of local transactions. And so we've implemented a whole suite of training to help support that effort.

NNAMDIChristopher, you probably need to reapply. Thank you very much for your call. Here is Lizbeth in Woodbridge, Va. Lizbeth, you're on the air. Go ahead, please.

LIZBETHYes. Good afternoon, Kojo, and Dr. Raj Shah. I only have two questions. First one is, is USAID helping the Syrians that are now in Turkey and Jordan? And then my second question is, are you an advocate for (word?) to help starving people around the world? I'll take my answer off the air, and have a great day. Bye-bye.

NNAMDIRaj Shah?

SHAHThank you. With respect to Syria, you know, as President Obama has said repeatedly, this is just an unacceptable tragedy with more than 70,000 people having died to date. More than 6.8 million Syrians inside of Syria have been displaced and are in need of real humanitarian support. And there are more than 1.4 million refugees in countries like Turkey and Jordan and Lebanon. So we have been leading the world in our humanitarian response.

SHAHWe've committed more than $400 million to that end. But as important are -- as the numbers are the outcomes, and, in fact, we've conducted tens of thousands of specialized surgeries at field hospitals and trauma centers in opposition-controlled parts of Syria. We are reaching more than two million people with basic assistance, whether it's food or winterization kits for home during this past winter season and other basic services like water and diesel fuel for the generation of power at field hospitals in particular.

SHAHThose efforts are critical, but as you point out, our aid workers take serious humanitarian risks and real human risks every day. They've been targeted by the regime and others. Many have lost their lives. But even today, some proud Syrian-American doctors and others go in and do heroic work. I met a Syrian-American physician who goes in and works on children who have been hit by shrapnel and takes literally shrapnel out of babies.

SHAHIt's heroic work that Americans can be proud of, and it's important to continue that. The efforts have also supported important responses in Turkey and Jordan. Both countries have taken in a large number of refugees, and we work to help implement programs in their refugee camps and in their communities. The Jordanians, for example, have 42,000 Syrian children entering Jordanian schools, and we were just with Queen Rania and the king and working on efforts to help that educational system absorb that level of need so quickly.

NNAMDIBut there was a piece in The Post back in April that said, "So secretive is the operation, however, that almost none of the Syrians who receive the help are aware of its American origins. Out of concern for the safety of the recipients and the delivery staff, who could be targeted by the government if their affiliation to the United States were known, the Obama administration and the aid workers have chosen not to advertise the assistance."

NNAMDIWhich brings me back around to a point you were making earlier. Oxfam America has found that giving local organizations on the ground more autonomy over the spending of aid dollars can be a more efficient model for development projects. You talked about this early. But just how much of the work that you are now doing involves those kind of public-private partnerships? And how do you decide who to work with, especially in a place like Syria?

SHAHWell, thank you. You know, this is at the heart of our USAID Forward reform agenda. It's ushering in a new model of partnership that gets more value for every dollar we spend on behalf of the American taxpayer. Sometimes that means, as it has in Senegal or Liberia, that we will work with local governments to implement education programs.

SHAHAnd we found that we've been able to double the size of those education programs, building more schools with the same amount of money, educating more kids, implementing testing to make sure that they're getting real educational results for the American commitment. In other places that will mean working less with governments but working a lot with local business startups and private entrepreneurs.

SHAHIn parts of Kenya, for example, we support a technology hub that's helping to spin-off new technology businesses to serve Kenya and all these young entrepreneurs that are gonna be the change agents for that country and for that part of the world. And we put out a USAID Forward progress report in March that showed that because of our reform efforts we now support 1,200 local organizations, having moved more than $750 million of investment to those 1,200 organizations.

SHAHAnd we've done it carefully, sourcing, vetting, making sure that American resources are managed well and that we can report on the results of those investments.

NNAMDIThank you very much for your call, Elizabeth. Here now is Willie in Columbia, Md. Willie, you're on the air. Go ahead, please.

WILLIEThanks for taking my call. Dr. Shah, good work. But I have a question. USAID has been doing "good work" over the last 50 years. Does aid not create dependency and prolonged poverty and corruption in recipient countries?

NNAMDIDr. Shah.

SHAHWell, let me -- I'm so glad you asked that question because our goal is to move people from dependency to self-sufficiency and dignity. And that's why the president put forth this food aid reform proposal that says, look, let's not just send American food into communities decade after decade when we know that if we buy food locally we can create some incentives for local farmers to produce. We know that will then help reach children with more effective and lower cost products.

SHAHAnd we know, over time, you'll get the outcome I saw when I visited part of Western Guatemala through a partnership with Wal-Mart, where Wal-Mart is now sourcing onions and potatoes from these local communities, reaching tens of thousands of people so that instead of receiving American food aid, they're producing food. They're selling it into a global supply chain. They're now actually raising money in their community to build schools for the kids who are coming off the farm.

SHAHThey used to work on a farm. Now the kids wanna go to school. And that's the path to progress. And that is a better path for us than some of the traditional ways this work has been done. And that's why, across the board, whether it's food, child survival, our efforts to bring water access to people or our efforts to invest in technology entrepreneurs that can reach communities with off-grade energy, our approach has been, let's do things differently. Let's reform the system.

SHAHLet's ensure we get the most for every taxpayer dollar. And let's ensure that we build the kinds of local institutions so that aid is not necessary over the long haul. One of the things I'm most proud of doing as USAID administrator, we've shut down nearly 30 percent of all programs around the world. We have closed out of in our graduating 14-country mission programs.

SHAHAnd in our areas of real focus, like food and health, we've shut down 22 country programs in agriculture so we could focus in the 19 places where countries are fighting corruption, making the right policy reforms, ushering private investment and where our money is a catalyst towards ending hunger, not just perpetuating ongoing service delivery. And that transformation has been tough, but I have a huge amount of respect for our people around the world that have put those tough reforms into place because it's delivering real concrete results.

NNAMDIWillie, thank you very much for your call. I should have mentioned that the report in The Washington Post I mentioned in April was written by reporter Liz Sly, for those of you who might be looking for it. The health and rights of women and children is one area where you and other organizations are focusing a lot of attention. Why do those populations remain especially vulnerable? And why is making it to age to five such an important milestone?

SHAHWell, we know that a dollar of incomes that goes to a woman is more likely to generate economic development and improve social outcomes in a community anywhere in the world. I suspect that's true in America although I know the data better in rural Bangladesh. And that's why in all of our programs, we focus on reaching women with the benefits of our efforts. We focus on measuring something we call a women's empowerment index to make sure that when we spend our taxpayer funds, we know the benefits accrue in part to -- in large part, to women.

SHAHAnd it's why we measure and report on those types of results. So that's been a central part of our effort, and it continues to define our approach in so many other parts of our work.

NNAMDIIn an increasingly connected world, diseases that crop up in one country can quickly spread to another, which is one reason you're concerned -- or some are concerned, I should say, about cuts in USAID that have been proposed to its tuberculosis program. Why do you think those cuts are necessary?

SHAHWell, let me step back, you know, Kojo, and address the second part of the question you asked previously, which is about why do we focus on -- in our health programs, children under the age of five.

NNAMDICorrect.

SHAHOne of the greatest success stories in human history is unfolding right now but few people are aware, and that is that the number of children under the age of five who die has been coming down slowly but steadily over the last several decades. It's gonna be an amazing outcome when we end once and for all preventable child death. Today, 19,000 kids under the age of five will die, just today, around the world.

SHAHAlmost all of those could be prevented by helping kids sleep under insecticide-treated bed net and, therefore, not get malaria, or by giving them vaccine that might cost a few pennies or a few dollars when they're born so that they don't get a particular disease. And USAID has been on the forefront of this effort. In fact, last year, we brought together more than 150 countries around the world. Every country signed a pledge to end preventable child death, including America.

SHAHToday, those countries put out actually annual report cards that track their progress. We've implemented dozens of public-private partnerships, including noble new partnerships with people to mine more zinc, for example, and produce a zinc syrup because we know that that can protect children who get diarrhea from dying.

SHAHAnd so we have looked carefully at our entire health budget and we said, we're gonna focus our resources on ending preventable child death, and we're gonna do it in a way that is results-oriented, embedded in partnership, embraces this effort, embraces more than 200 faith-based organizations in the effort. And it's going to be successful.

NNAMDIWe're running out of time pretty quickly. The cuts in the tuberculosis program?

SHAHSo we -- the United States supports tuberculosis through a couple of different accounts. The biggest area of support is linked to our HIV control efforts. And so when you look at it all in, we're actually not reducing the tuberculosis investment. But we are saying in countries like India and Peru that can and want to take on more of the responsibility of basic TB control that we wanna provide technical partnership.

SHAHWe wanna help countries invent new solutions. We wanna partner our scientists and come up with great new diagnostics or drug solutions to XDR or multi-drug-resistant TB. But we don't need to be the, you know, the funder of every TB control program. These countries can pay for it themselves. And that's progress over time.

NNAMDIAnd I'm afraid, speaking of time, that's all of it that we have. Dr. Rajiv Shah is the administrator of the U.S. Agency for International Development or USAID. Dr. Shah, thank you so much for joining us.

SHAHThank you for having me.

NNAMDIAnd thank you all for listening. I'm Kojo Nnamdi.