A Conversation With: U.S.A.I.D. Administrator Rajiv Shah MUMBAI - Each year, about 1.5 million children under 5 years old die in India, which has the largest number of such deaths worldwide. A majority of these deaths stem from pneumonia, diarrhea, malnutrition and complications at birth and can be prevented. In February, at the India Call to Action on Child Survival and Development Summit, India's Ministry of Health and Family Welfare released a strategic road map to tackle preventable child deaths and introduced a National Child Survival Score Card and a dashboard to track progress on child survival and development. On March 6, the United States Agency for International Development announced the extension of two initiatives on child survival in India. The Integrated Maternal and Child Health Project will support the Indian government in establishing quick response teams and the Health of the Urban Poor Project will provide support in the implementation of urban health programs. As the 16th administrator of the aid agency, Rajiv Shah heads the efforts of 80 offices worldwide and over 8,000 professionals. Since he joined the agency in 2009, Mr. Shah has managed the United States government's response to the 2010 earthquake in Haiti, helped head the State Department's first review of American diplomacy and development operations and now leads the Feed the Future food security initiative. India Ink spoke with Mr. Shah on his recent trip to Mumbai about transformations in the development sector, the function of the private sector in development work and the aid agency's new programs and partnerships aimed at reducing preventable child deaths. In the rapidly transforming landscape of international development, how has the role of the international development community, and U.S.A.I.D. in particular, evolved over last five years in India? You're absolutely right that the landscape has changed completely and the United States has changed its approach completely. U.S.A.I.D. used to be a traditional development partner supporting government activities and initiatives. Today, we focus on using our India mission as a development innovation laboratory to try and find those partners in the private sector, scientists and entrepreneurs who are creating great new solutions for development and then helping them apply those solutions here in India but also elsewhere in the world. Today, we have important partnerships with private sector and civil society in India that work in Afghanistan and in Africa on a range of issues. Our view of the future is India working as an active development partner to end extreme poverty and its consequences in other parts of the world and in India as well. A common critique of foreign aid in India is that very often resources do not reach their intended beneficiaries. What can be done to improve transparency and accountability in development outcomes? Let me give you a very concrete example to show you how we are doing that in India. Last June, the United States together with the government of India and the government of Ethiopia hosted the entire world in Washington, D.C. to pursue what we described as a call to action to end child mortality. Today, India is one of the co-leaders of this international initiative. In Chennai, just a few weeks ago they brought together all of the different leaders in health from all of the Indian states and from the private sector. They agreed to report on results on under-5 child mortality, with each state publishing a very specific report card that describes exactly what money is being invested and exactly what results are being achieved in terms of saving children's lives. Since 2001 U.S.A.I.D. has promoted a model of public-private partnerships and collaborated with over 3,000 organizations in more than 1,000 partnerships, leveraging billions of dollars for the agency's development goals. Can you tell us a little bit about the new programs and partnerships that U.S.A.I.D. is undertaking aimed at reducing preventable child deaths in India? We have a partnership with government where today six of the states that have particularly high levels of child mortality are going to announce their strategic plans and put forth their public report cards so that there is transparency in what they are achieving. We're also announcing three new public-private partnerships that total nearly $30 million investment - about half of that comes from U.S.A.I.D. and half of that comes from the Indian private sector. Our partnership with the Bill and Melinda Gates Foundation and IKP Knowledge Park will help to identify really new innovations in diagnostics in order to make sure that we can identify and treat more effectively tuberculosis in children. Another partnership we are undertaking is with Kiawah Trust and Dasra, which will bring private philanthropy into the task of accelerating child mortality reductions. We are also creating something called a "diarrhea partnership" to work with a company called Pharmasynth that will make a zinc syrup so that young children can take that zinc syrup, which has recently been proven to protect children from dying when they get a stomach virus. These are great partnerships because they are all about creating new innovations and they all demand real results and accountability. The entrepreneurial spirit of individuals is behind much of India's economic growth story. Can that be leveraged toward development and how? Absolutely, and that is why I'm visiting Mumbai on this trip. For nearly the entire time I'm meeting with leaders in the private sector who have been very successful business leaders and entrepreneurs and working with them to figure out how we can have partnerships like the ones I've just described to bring their entrepreneurial spirit to ending child mortality in India. Mukesh Ambani has committed his time and efforts. Yesterday, we were with the leadership of Lupin Pharmaceuticals in order to see if they can develop new drugs for tuberculosis and make them available at a lower cost. We also have innovation grant awards with partners like Federation of Indian Chambers of Commerce and Industry to help Indian entrepreneurs who are developing new solutions gain access to private equity and venture capital self-financing. While India has made significant strides in reducing child mortality -since 1990 the child mortality rate in India has fallen by 45 percent - the preventable deaths of millions of children continue each year. What are the challenges involved in the goal of reducing childhood illness and death and fulfilling the goal of ending preventable child deaths within a generation? The biggest challenge is that often services and efforts to try and reach middle-class children and are less effective in reaching children in very low-income rural communities that have less services and reaching urban poor children in slums. As part of our support, we're focusing on helping the government and these private companies and philanthropists reach the hundreds and millions of those people who live in a lower-income setting. And we know that every dollar or rupee invested in reaching those children is far more cost effective at saving those children lives. The innovations we've developed to save children's lives, from the zinc syrup to the new vaccines, are more effective in saving children's lives when they reach poor children, most because those children often don't have medical systems and doctors they can go see when they get sick. Very often, the resources and energy of development organizations and nongovernmental organizations are funneled toward tackling crisis situations and not addressing the long-term issues. How can organizations move beyond that practice? We're trying to break that cycle in this partnership to save children's lives. Here's how we're trying to do it: First, we're focused on a long-term challenge. We know that the more children's lives we save, the more families choose to have fewer children. That's been proven everywhere in the world including in India. And we know that that reduction in total birth rate helps countries achieve more stability and more broad based and inclusive economic growth. So it's a long-term challenge and a long-term opportunity. Second, in doing this work we're very focused on supporting local institutions. So all of the partnerships I mentioned aren't about finding American contractors and giving them resources. It's about finding who are the most innovative and important Indian institutions that can build themselves up through these partnerships so that we can have an exit strategy over time and so that India can lead its own efforts to end preventable child death. I'd say third, it's about trying to find the innovation and the technology. All of these different solutions can be applicable in other parts of the world, and we're working with Indian institutions to do this work in Africa and Afghanistan and elsewhere. So even as we learn from other places we can also export the innovations here around the world. This interview has been lightly edited and condensed.