PHILANTHROPY REDEFINED IN AN ERA OF CHANGE

Humanitarian Symposium Proceedings September 21, 2009

The Capital Hilton Hotel Washington, D.C. TABLE OF CONTENTS

PHILANTHROPY REDEFINED IN AN ERA OF CHANGE

EXECUTIVE SUMMARY 5

OPENING COMMENTS

Steven M. Hilton, President and CEO, Conrad N. Hilton Foundation 8

Ralph Begleiter, Distinguished Journalist in Residence, University of Delaware; 9 Director, Global Agenda Program; former CNN World Affairs Correspondent— Symposium Moderator

PANEL ONE 11

“Innovative Financial Models for Community Water and Sanitation 12 Programs” Paul Faeth, President, Global Water Challenge

“Water-Food Nexus: Agriculture at a Crossroads” 14 Hans R. Herren, Ph.D., President, Millennium Institute

Q & A 17

PANEL TWO 23 “Putting Philanthropy to Work for Women and Women to Work for Philanthropy”

Melanne Verveer, Ambassador-at-Large for Global Women’s Issues, U.S. State Department

Dr. Judith Rodin, President, Rockefeller Foundation

Q & A 25 TABLE OF CONTENTS

PHILANTHROPY REDEFINED IN AN ERA OF CHANGE

PANEL THREE

“Hilton Prize Laureates: Greater Than the Sum of the Parts” 36

Jo Luck, President and CEO, Heifer International (2004 Recipient) 38

Molly Melching, Founder and Executive Director, Tostan (2007 Recipient) 41

William P. Magee, Jr., D.D.S., M.D., Co-Founder and CEO, Operation Smile 43 (1996 Recipient)

Karen Sherman, Executive Director for Global Programs, Women for Women 46 International (2006 Recipient)

Donna Barry, Director of Policy and Advocacy, Partners In Health (2005 49 Recipient)

Q & A 51

PANEL FOUR

“Open Dialogue on Future Trends in Global Health” 58

William H. Foege, M.D., M.P.H., Senior Fellow, Bill & Melinda Gates Foundation; Chairman Emeritus, Global Health Council

Professor Muhammad Yunus, 2006 Nobel Peace Prize Laureate; Founder and Managing Director, Grameen Bank

Dr. Christopher J. Elias, M.D., M.P.H., President and CEO, PATH

Q & A 61 TABLE OF CONTENTS

PHILANTHROPY REDEFINED IN AN ERA OF CHANGE

CONRAD N. HILTON HUMANITARIAN PRIZE PRESENTATION 75

Keynote Address 77 Professor Muhammad Yunus, Founder and Managing Director, Grameen Bank; 2006 Nobel Peace Prize Laureate

2009 Hilton Humanitarian Prize Recepient 83 Dr. Christopher J. Elias, M.D., M.P.H., President and CEO, PATH

LIST OF SYMPOSIUM ATTENDEES 87 Philanthropy Redefi ned in an Era of Change Executive Summary of the Symposium

“For those of us in philanthropy and humanitarian work, this is indeed an era of change. I am sure that virtually everyone in this room has been at least somewhat affected by the recent downturn in the world economy. Many foundation endowments have been reduced, government budgets are strained, and charitable giving has been plummeting. At the same time, the needs of the world’s most vulnerable populations are increasing. Thus, we need to be more creative as we look for new ways to more effi ciently deliver humanitarian aid and assist the development of poor countries with greater effi ciency and proven results.” —Steven M. Hilton, President and CEO, Conrad N. Hilton Foundation

The eleventh international humanitarian symposium sponsored by the Conrad N. Hilton Foundation brought together leaders from governments, non-governmental organizations (NGOs), foundations, corporations, academics and multilateral institutions to focus on making philanthropy both effective and effi cient at a time of great need and reduced resources. As in previous years, the symposium was held in conjunction with the fourteenth annual presentation of the Conrad N. Hilton Humanitarian Prize.

Professor Muhammad Yunus, Nobel Peace Prize Laureate and founder and managing director of Grameen Bank, provided the keynote address at the luncheon and ceremony honoring the 2009 Hilton Humanitarian Prize recipient, PATH. Launched in 1977, PATH, formerly known as Program for Appropriate Technology in Health, identifi es, refi nes, introduces and scales up affordable technology solutions to break long-standing cycles of poor health in developing countries. With a staff of more than 800 in 20 countries and a product development facility located in Seattle, Washington, PATH has developed more than 85 cutting-edge technologies. Its particular focus is on emerging and epidemic diseases; innovative health technologies; maternal and child health; reproductive health; and vaccines and immunizations.

Philanthropy Redefi ned in an Era of Change was a day of fi rsts and lasts for the symposium and Hilton Humanitarian Prize ceremony. It was the fi rst time these events were held in Washington, D.C., and the fi rst time that the Hilton Humanitarian Prize Laureates, as a group, led a panel discussion on the collaborative work their organizations have begun in the fi eld. As another fi rst, Steven Hilton announced that the Conrad N. Hilton Foundation has formed a new alliance with the Global Philanthropy Forum and, as a result, the 2010 Hilton Humanitarian Prize will be awarded during the GPF’s annual gathering in April 2010, in Redwood City, California.

The global economic meltdown that so haunted last year’s symposium with its dimensions, and unknown ultimate impact, still hovered over this year’s proceedings, informing much of the discussions. Its repercussions have now taken some shape and it is clear that, realistically, the humanitarian community is factoring the results into all future planning, and activities. Some components of the redefi nitions were not only in evidence but clearly considered central—a sharpened focus on innovation and collaboration, and the conviction that large scale, systemic and long-term solutions are the only kinds of solutions that can meet the demands of the time. If this symposium was about anything, it was about this.

Panelists and the participants who engaged them in dialogue were unfl inching in discussing systemic solutions. The unspoken consensus seemed to be that the very global economic diffi culties we were in demanded no less. Anything less would not be cost effective and actually would be ineffective in every sense; ultimately wasteful of time and resources. In other words, the harsh reality of recent times seems to have emboldened people.

For example, Hans Herren of the Millennium Institute had talked about water and agriculture and the growing need for agri-science to improve the issues of hunger and poverty in the world. His was not a discussion of soup

5 kitchens or food stamps. Rather, he said “I think we have to put real money into all this. Real money. The agriculture subsidies are a billion dollars a day in the North—a billion. And here, we’re spending maybe $800 million [a year] in agri-research in the whole of the tropics and we expect things to change?...It is not even close to solving the problem...If we don’t take action now and start to be serious, I think things are really going to go haywire.”

The need for innovation to address systemic problems was also a recurring refrain, and there were encouraging signs of creative approaches to long-term solutions. As stated by Dr. Judith Rodin, “…innovation is one of the most promising domains for philanthropy in the 21st century.” Cited were new creative models through technology borrowed from the private sector, including “crowd-sourcing”—fi nding new ideas from a company’s own customers—or an initiative by a company called Innocentive that has registered 150,000 scientists and engineers to sponsor competitions on a website to solve science-based problems. Dr. Christopher Elias described PATH’s work on new refrigerator technology where, if the unit goes out, it sends a message to someone to come and fi x it before the vaccine gets damaged.

The speakers covered a variety of issues, but in their presentations and the remarks of symposium participants, several intricately connected themes kept emerging:

Systemic solutions are imperative. This is a time to get to the underlying causes of the myriad symptoms humanitarian actions and development aid have addressed. Decades of work, results and analysis have brought us to this realization and provided suffi cient data to move forward. And stark economic reality is forcing us to implement systemic solutions now.

All solutions and actions must take into account the global context. People have been saying “think globally, act locally,” for years; the development community has also valued projects that are replicable. Now it is time for an even more comprehensive global context. Global also means taking both the developed countries of the North and the developing countries of the South—their resources, needs, habits, and impacts of their actions—into account in setting policies and designing and implementing projects.

Partnerships and collaboration must happen. The times and the economy demand that the private sector, governments and civil society work together. Further, this is no time for egos, ownership and boutique projects happening in isolation, duplicating efforts and diluting effects. NGOs must join forces, and philanthropists also must look beyond their particular goals. It is time for groups to identify what they do well, to identify what others do well, then join forces and work together.

The time is now. The continuing fallout of the global economic meltdown has shrunk resources, funding and budgets. However, despite the tough adjustments and cancelled expansions, the dire situation is serving as a wake-up call. Especially since the meltdown happened at a point when there are decades of experience for humanitarians to draw upon, it is starting to look as if necessity will be the driving force behind a bolder, more focused and global “era of change.”

SYMPOSIUM SESSIONS

PANEL ONE

• Paul Faeth, President, Global Water Challenge: “Innovative Financial Models for Community Water and Sanitation Programs”

• Hans. R. Herren, Ph.D., President, Millennium Institute: “Water-Food Nexus: Agriculture at a Crossroads”

6 PANEL TWO

“Putting Philanthropy to Work for Women and Women to Work for Philanthropy”

• Melanne Verveer, Ambassador-at-Large for Global Women’s Issues, U.S. State Department

• Dr. Judith Rodin, President, Rockefeller Foundation

PANEL THREE

“Hilton Humanitarian Prize Laureates: Greater Than the Sum of the Parts”

• Jo Luck, President and CEO, Heifer International (2004 Recipient)

• Molly Melching, Founder and Executive Director, Tostan (2007 Recipient)

• William P. Magee, Jr., D.D.S., M.D., Co-Founder and CEO, Operation Smile (1996 Recipient)

• Karen Sherman, Executive Director for Global Programs, Women for Women International (2006 Recipient)

• Donna Barry, Director of Policy and Advocacy, Partners In Health (2005 Recipient)

PANEL FOUR

“Open Dialogue on Future Trends in Global Health”

• William H. Foege, M.D., M.P.H., Senior Fellow, Bill & Melinda Gates Foundation; Chairman Emeritus, Global Health Council

• Professor Muhammad Yunus, Founder and Managing Director, Grameen Bank; 2006 Nobel Peace Prize Laureate

• Dr. Christopher J. Elias, M.D., M.P.H., President and CEO, PATH

7 Symposium Opening Comments Steven M. Hilton, President and CEO, Conrad N. Hilton Foundation

Steven Hilton is proud to carry on the philanthropic legacy begun by his grandfather, hotel entrepreneur Conrad Hilton. His tenure at the Conrad N. Hilton Foundation, one of the nation’s largest philanthropies, began in 1983. He was elected to the Foundation’s Board of Directors in 1989, named president in 1998, and in 2005 his responsibilities were expanded to include CEO as well. He oversees the Foundation’s worldwide humanitarian work while also serving on the governing committee of the Conrad N. Hilton Fund for Sisters. He previously served on the boards of the Conrad N. Hilton Fund, St. Joseph Center, Southern California Grantmakers, the Archdiocesan Finance Council, and Loyola Marymount University. Prior to joining the Foundation, Mr. Hilton worked for fi ve years in hotel management and also pursued his interest in fi sh farming. A graduate of the University of California at Santa Barbara, Mr. Hilton earned his MBA degree from the University of California at Los Angeles (UCLA).

It is my pleasure to welcome you today to the 2009 Conrad N. Hilton Humanitarian Symposium which is addressing “Philanthropy Redefi ned in an Era of Change.” We also will be celebrating PATH as the recipient of this year’s Conrad N. Hilton Humanitarian Prize. Prepare to be inspired by PATH’s innovative achievements in creating groundbreaking technologies so that quality health care can reach the poorest populations throughout the world. At lunch, we will again be inspired by the profound messages from that champion for the poor, Nobel Peace Prize Laureate, Muhammad Yunus, who we are proud to say is also a former Hilton Humanitarian Prize Juror.

This is indeed an era of change, and I am sure that virtually everyone in this room has been at least somewhat affected by the recent downturn in the world economy. Many foundation endowments have been reduced, government budgets are strained, and charitable giving has been plummeting. At the same time, the needs of the world’s most vulnerable populations are increasing. Thus, we need to be more creative as we look for new ways to more effi ciently deliver humanitarian aid and assist the development of poor countries with greater effi ciency and results.

Some of the day’s speakers will be tackling issues that we know are critical to building productive and stable societies, such as focusing on empowering women as agents of change for their families and communities. We will also be discussing one of today’s most important global challenges—fi nding new ways to deliver reliable supplies of safe water to everyone. Our Hilton Humanitarian Prize Laureates will share how they have combined forces to create unique forms of collaboration, and, following the luncheon, we will all participate in a most stimulating dialogue on global health with three giants in their fi elds. The knowledge and experience represented in this room, both on and off the panels, is what makes these symposia so energizing, stimulating and unique.

Today it is our turn to redefi ne philanthropy for our era. In 1944, Conrad Hilton redefi ned philanthropy by establishing the Conrad N. Hilton Foundation and mandating that it serve a global mission, a visionary idea at that time. While his accomplishments in business are legendary, even more so is his philanthropic legacy, and that is what we in the Hilton family seek to emulate and expand. We join you in looking forward to an exciting and productive day. We all have a lot of work ahead of us; so let’s get started.

8 Ralph Begleiter, Distinguished Journalist in Residence, University of Delaware; Director, Global Agenda program; former CNN World Affairs Correspondent

Ralph Begleiter brings more than 30 years of broadcast journalism experience to the University of Delaware where he teaches communication, journalism and political science. During two decades as CNN’s “world affairs correspondent,” Begleiter was the network’s most widely-traveled reporter. He has visited 95 countries on 6 continents. He continues to travel, taking university students to Turkey, Cuba, South America and Antarctica, and conducting media workshops in several countries under the auspices of the U.S. Department of State. He regularly lectures on media issues at U.S. military institutions, service organizations and for visitors from abroad. He directs the University of Delaware’s “Global Agenda” speaker series and course, which has included “live” interactive video class sessions among students at UD and in the Middle East. At CNN during the 1980’s and 1990’s, he covered the U.S. State Department, hosted a global public affairs show, and co-anchored CNN’s “International Hour.” He covered many historic events at the end of the 20th century, including virtually every high-level Soviet/Russian-American meeting; the Persian Gulf Crisis in 1990-91; the Dayton Bosnia Accords; Middle East Peace efforts; and many UN and NATO summit meetings. In recent years he continues to host the Foreign Policy Association’s annual “Great Decisions” public television discussion series. He has received numerous press awards including, in 1994, the Weintal Prize from Georgetown University’s Graduate School of Foreign Service, one of diplomatic reporting’s highest honors. Begleiter has moderated the Hilton humanitarian symposia since their inception.

Thank you very much, Steve. It’s always been a pleasure to help the Hilton Foundation congratulate and evaluate the work of humanitarians as well as survey the challenges all of you face, during this symposium. I’ve considered it a genuine honor to have been asked to help facilitate these symposia for more than a decade now, and frankly I’m going to miss it.

It does seem as though every year brings new surprises to humanitarian work, and to those who are part of the Hilton Prize family—and that’s all of you who are in this room today and some people who haven’t been able to make it. Last fall, the devastating plunge in the U.S. economy, which of course infected the world economy, was very fresh. I would say it was an open wound in affecting the prospects for what all of you do around the world. By now, a year later, that wound is still open and nonprofi ts have seen their fi nances erode very signifi cantly in many cases. Foundations like Hilton, too, have suffered the effects of the market decline. So, actually, I think it’s quite fi tting that this year’s Prize winner is an organization known for its breadth of services and especially for making the most of health care technologies and providing those services at affordable prices.

PATH’s record is replete with bringing sophisticated medical and health technologies—from diagnostics to water purifi cation—to poor and remote communities at very low cost. So we’re confronting humanitarian challenges amid a need to redefi ne giving, hopefully only temporarily, in a period of reduced capabilities in the philanthropic world. We predicted last year that the worldwide recession would make your work harder, but of course no less important. In fact, the people who benefi t from all your services need them even more when the wealthy world is economically challenged.

I’m curious, based on a few conversations I’ve already had this morning with some of you; let’s do a show of hands here. I’m going to ask two questions, one about fundraising and one about endowments.

9 How many of your organizations would you say, despite the recession, are holding the line on the fundraising front? Let’s say holding the line? That’s good, that’s an encouraging sign. How many have been able to increase fundraising during the recession? A smaller number, but there is a handful. You should all look around and see where those hands are. And how many of you have seen declines in the last year? OK, not that many either, so it’s not as discouraging a scene as I had thought.

Let me ask about endowments. I would imagine everyone has seen a decline. Is there anyone who has seen an increase in endowments in the past year? We’re going to get your phone number right after class. Declines? OK, so it’s not a really positive scene but not as bad as I expected to see.

I can’t help repeating something that Molly Melching, executive director of Tostan, said last year, which is to me still very appropriate. She told a story about an African proverb that relates to being lost in the woods: it’s better to fi nd a way out than to yell at the forest. And of course, part of our goal at the Hilton Symposium is to help people explore ways out of—or at least ways to cope with—the fi nancial crisis and not merely to sit around and yell at the forest.

We’ll have many interesting discussions today, but I’d like to highlight one particular session if I may. After the Prize award luncheon, Panel 3 is an unusual one featuring the collaborative work of the Hilton Humanitarian Prize Laureates. These are organizations, of course, who have won the Prize, but who have also since discovered that they can work together to multiply the power, the reach and the effectiveness of their award-winning work. We’re going to showcase their collaborations this afternoon, as what we hope will be a launching pad for a more permanent Laureates initiative.

Speaking of Hilton Prize Laureates, how many of you have seen or read about New York Times columnist Nicholas Kristof’s Half the Sky? OK, about half of you. Those of you who haven’t, owe it to yourselves to pick it up, take a look at it, at least read something about it. It annoys me a bit that people say it’s Nicholas Kristof’s book. It’s actually a co-authored book. Nick and his wife, Sheryl Wu Dunn, were some of my earliest guests on an old CNN show I did back in the 1990’s, after they had returned from China. Their new book is about the terrible ways in which women are treated worldwide—sex traffi cking, genital mutilation, honor killings, slavery and so on. For now, I’d like to add that Kristoff and WuDunn highlight the work being done on behalf of women by several of the Hilton Humanitarian Prize Laureates, including BRAC, Women for Women International, Tostan, Heifer International, and the International Rescue Committee, among others. We think it’s a testament to the quality of people and organizations in this room right now, and to the high standards and sensitivity of the Hilton Prize jury’s selection process.

Of course, at midday today we’ll be celebrating PATH, which is an acronym for Program for Appropriate Technology in Health—you actually have to search hard to fi nd what PATH stands for. It’s the recipient of this year’s $1.5 million Hilton Humanitarian Prize, the world’s largest “Oscar” of humanitarian awards. At lunch, we’ll all have the privilege and pleasure of hearing from Nobel Peace Prize winner Muhammad Yunus, founder of Grameen Bank and father of micro-fi nance, who’s also a former Hilton Prize juror and a giant in the humanitarian world.

By the way, you’ll have a chance at the end of the day as well, not just to hear from Muhammad Yunus, but to interact with him as a panelist with the president and CEO of PATH, Dr. Christopher Elias and Dr. William Foege, another giant in the global health world.

10 PANEL ONE SUMMARY

This panel focused on water and agriculture—the seriousness of the increasing strain on the planet’s fi nite water resources, the goal of universal access to safe drinking water and sanitation, and the need for innovative solutions at the global and local levels. It addressed two different perspectives—the local and the global. Both panelists called for unifi ed, scalable solutions large enough to address the problem. This will require much more spending and good governance. Governments must order the research, enforce the regulations, invest in the infrastructure, and all people everywhere must examine the way they are living in the context of the entire planet.

Innovative Financial Models for Community Water & Sanitation Programs

There are innovative people in the developing world coming up with solutions that not only will work in their own communities, but are replicable. In Rwanda and in the slums of Nairobi, Kenya, two distinctly different solutions have emerged at a time of diminishing philanthropic resources. At their core is a business model/for-profi t motive—one to enable secondary schools to purify drinking water sustainably and sell the resulting carbon credits; the other selling slum dwellers access to toilets, showers, laundry facilities and drinking water, for the same price they now must spend on treating the typhoid that otherwise would strike the same family. By becoming self-sustaining, such solutions will need only short-term infusions of philanthropic resources.

“Entrepreneurs in [the developing world] don’t often have access to a retirement account or a home where they have some equity to pull out cash to get started. Many also don’t have educational resources to learn how to start a business, how to do basic accounting. Maybe engineers and architects have a great idea, but it’s tough to get going. [Philanthropy can help in] getting people over the gap from having a great idea to putting in systems where they can actually operate their businesses and access other sources of capital.”—Paul Faeth, President, Global Water Challenge

Water-Food Nexus: Agriculture at a Crossroads

A recent UN assessment of water and agriculture addressed how agri-science and technology can improve issues of hunger and poverty at a time of drastic and dire challenges—climate change, population growth and shrinking resources of water and oil. The world is faced with more people and less land, and water shortages, but it is refusing to respond seriously enough. Short-term two-to-three year solutions, piecemeal projects here and there, and limited spending make it impossible to approach the problems anywhere near the scale required. The North and the South have to be seen as a whole, and behaviors must change.

“There are many [crises] out there…The fact is that they are all connected in that system and we need to stop taking pieces out and looking at them; we need to look at them within a system; to rethink the way we do a lot of things, agriculture in particular. That means how we eat, how we use water and energy. You cannot solve the problem with the same kind of thinking that created the problem in the fi rst place. It’s time for a different kind of thinking: systemic thinking. We cannot continue to think linearly, which I think most people do.”—Hans Herren, Ph.D., President, Millennium Institute 11 Paul Faeth, President, Global Water Challenge

Paul Faeth is the President of Global Water Challenge. He leads GWC’s mission of universal access to safe drinking water, sanitation, and hygiene education. Faeth helped launch GWC with a diverse coalition of corporations, foundations, and aid organizations. GWC is a unique partnership to build healthy communities and provide sustainable, replicable, and scalable solutions to ensure the availability of clean water and safe sanitation. Before joining the GWC in January 2007, Faeth was Executive Vice President and Managing Director of the World Resources Institute for fi ve years. He was responsible for day-to-day operations at WRI, including human resources, fi nances, strategic planning, and supported external functions, fundraising and public relations. Prior to that position, he lead the Economics Program at WRI, where he directed several collaborative efforts with industry on climate change policies, research on the sustainability of agriculture in the United States, research and implementation work on the application of emissions trading to improve water quality, and an assessment of trade and its impact on the environment. Faeth was WRI’s Liaison to the Sustainable Agriculture Task Force of the President’s Council on Sustainable Development organized by President Clinton. He directed WRI’s effort to help a power company mitigate its carbon dioxide emissions through forestry activities in developing countries, resulting in the fi rst project ever funded with the intention of balancing carbon dioxide emissions. Faeth previously worked with the International Institute for Environment and Development and the USDA’s Economic Research Service. He holds degrees in

“Innovative Financial Models for Community Water and Sanitation Programs” Thank you very much for inviting me to be here today, and thank you all for coming. I’m excited to have a chance to talk about this. Water is one of the priorities of the Hilton Foundation, and what I want to talk about specifi cally—and this is relevant in the context of diminished philanthropic resources and is our mission, by the way—is universal access to safe drinking water and sanitation. We’re looking for ways to bring in other resources, and as Muhammad Yunus has looked at alternates for fi nancing, we have taken a look at different ways of looking at community-level fi nancing to bring in more money, aside from just philanthropic money and aid money. Ed Cain, Vice President–Grant Programs at the Hilton Foundation was one of the judges of a contest we held with the Ashoka Foundation. Ashoka has a program called changemakers.net, which has a network of 2,000 social entrepreneurs who work on social issues at the community level. We looked at whether there were opportunities and saw that there were few, so we decided—with a grant from the Coca-Cola Foundation—to have a contest for social entrepreneurs for safe drinking water and sanitation at the community level. What I want to do is tell you two stories about that and how that might work. Both of these stories take place in Eastern Africa—one in Nairobi, Kenya and the other in Rwanda, actually on the western side of Rwanda, where there’s an orphanage with about 115 kids in it. A year ago, these kids were doing what other kids do. A few days before we were there, the kids were making three to four trips to get water with containers as heavy as 40 pounds and the oldest kid there was 14 years old. In the developing world, on average, typically women and kids walk about six kilometers— three and three-quarter miles—round trip to fetch drinking water, carrying 40 pounds. We saw these kids four times a day—one of the kids was about four years old; that’s what he did all day long. There’s a group that we’re supporting called Manna Energy and they’re certifi ed to sell carbon credits based on changing the way that water is sanitized in this place. Typically, it is fuel that is commonly 12 used—if it’s used at all—to disinfect. Rather than walk down 11 stories and a kilometer away, they actually put in a system to catch rainwater in bins, and then the water is taken and poured into a sand and gravel fi lter, and then passed under a UV light, and that UV light is run off a small solar panel. Greenhouse gas credits are generated because, typically, fuel would be used to boil the water and instead they use a solar-powered UV light to disinfect it after it’s fi ltered. So they can generate carbon credits. They also take the waste from the kitchen and the latrines, then bio-digest that to produce methane to cook with and to produce light. We’re helping Manna to get certifi ed. They want to deliver safe drinking water and bio-digested sanitation for methane in all 500 secondary schools in Rwanda—about a quarter of a million kids—and they actually think that, once they get up and running, they’ll be able to generate about $100 million in revenue and about $40 million in profi t over the next 10 years. I’ve always thought myself that philanthropy had to be the way in schools, that there isn’t any appropriate way to make money in schools, but this may prove to be different. Now we move over to the second-largest slum in Nairobi—the Mathare slum—where about 600,000 people live. Between the Mathare river and the slum is an open defecation fi eld. During the wet season, all the waste from the defecation fi eld washes down through the slum and into the river. Two to three cases of typhoid in every family each year are common here. There are pipes for drinking water but they get contaminated because they sit in these fl ows; the fl ows are leaky and part of the problem themselves. For 600,000 people in this slum, there are only about a dozen toilets, so everyone uses the open defecation fi elds. A Nairobi-based company, Ecotact has built sanitation, pay-by-use toilets in the city center that they charge about two cents to use, and have a payback of about nine months. These were built where there’s no other alternative for people like street vendors, taxicab drivers and so forth. What they’re doing is moving this model to the slums. We’ve helped them to get their fi rst fi ve of these systems up and running, which they’re hoping will give them enough revenue to self-support. They’re building these units—they’re calling them community centers—that have toilets, showers, drinking water, a place to wash your hands, a place to do laundry, a pharmacy and a community center in the back for other things like dances and the like. They charge a family the equivalent of about one cost of typhoid treatment per year. From the family’s viewpoint, it makes much better sense than paying for cases of typhoid. This is direct fi nancial cost, not accounting for loss of income from one’s job, etc. but just the cost of paying for typhoid cases. It’s unlimited water, unlimited access to toilets, unlimited showers—what they want to do is serve about 200 families each and they want to build enough, over the next fi ve years, to serve the entire slum.

What we’ve seen in other places where these units have been built is that a transformation of the slum is really quite dramatic. For example, we saw one in India that was a similar model where the days of work lost went from 72 days per year to nine days per year, where childhood mortality dropped from six in a hundred to one in a hundred per year. So you can get dramatic improvements. A couple of things just to sum up some points. What we think is that, fi rst of all, there aren’t that many models out there. It’s diffi cult to do, for a couple of reasons. Entrepreneurs in these types of countries don’t often have access to a retirement account or a home where they have some equity to pull out cash to get started. Many of them also don’t have educational resources to learn how to start a business, how to do basic accounting. Maybe engineers and architects have a great idea, but it’s tough to get going. One of the things that we’ve seen in the opportunity category, particularly in philanthropy, is getting people over the gap from having a great idea to putting in systems where they can actually operate their businesses and access other sources of capital. Thank you. 13 Hans R. Herren, Ph.D., President, Millennium Institute

Dr. Hans Herren has been President and CEO of Millennium Institute (MI) USA since 2005. MI provides tools and capacity development services to empower developing countries in the design and evaluation of sustainable development strategies and supporting policies. Previously, Dr. Herren was Chief Executive and Director General of the International Centre of Insect Physiology and Ecology in Kenya and Director of the Biological Control Program for the International Institute of Tropical Agriculture in Nigeria. He is currently Co- Chair of the International Assessment of Agricultural Science and Technology for Development and Life President of BioVision Foundation, which he created for the promotion of sustainable development. Among Dr. Herren’s many honors are the Tyler Prize (2003), the Brandenberger Preis (2002), the World Food Prize (1995) and the Kilby Award for Extraordinary Contribution to Society (1995). He holds a master’s degree in Plant Breeding and Entomology and a Ph.D. in Biological Control of Insect Pests from the Federal Insitute of Technology in Zurich.

“Water-Food Nexus: Agriculture at a Crossroads”

Thank you, it’s a pleasure to be here. I will give you a quick overview of what the International Assessment of Agricultural Knowledge, Science and Technology for Development (IAASTD) says about water and agriculture, since we’re talking about water, and what the way forward may be in the direction of sustainable agriculture.

Co-sponsored by many United Nations agencies and published recently by Island Press, it’s called Agriculture at a Crossroads, 2,000 pages long with 450 people writing for four years around the world, and its composed of a global, and fi ve sub-global reports as well as the corresponding Summaries for Decision Makers and an overall Synthesis Report and Executive Summary. This is what the International Panel on Climate Change (IPCC) is to climate, but for agriculture. It was signed by 60 countries minus the U.S., Canada and Australia who really didn’t see eye-to-eye with our views on genetic engineering and trade.

The big questions we were actually trying to discuss were how agricultural knowledge, science and technology can improve issues of hunger and poverty, rural livelihood and inequity, nutrition and health, all this in an environmentally, socially and economically responsible manner. For example, the people in the slums that Paul just discussed, would remain in the rural areas, if agriculture and the related activities would provide suffi cient income for them But the fact is that there is little to do, so half the global rural population has already moved into towns. Improving nutrition and human health is very important and there is an obvious link to agriculture, hunger and poverty. Again, water is a key issue here because somehow we have to grow our food and stay healthy. These areas are where agriculture comes in heavily and we can do a lot if we do it right.

Now, that would be easy to do if we didn’t have these extra challenges out there, like climate change, population growth, shrinking natural resources such as oil and water, things which are very much needed here to add resilience into a system which will be heavily impacted by climate change. Just to talk about crises, there are many out there, almost one every month somewhere in the world. The fact is that they are all connected in the global system and we need to stop looking only at pieces and take a holistic and integrated approach to analysis and decision making. 14 Food production has done quite well and actually increased over the years since the Green Revolution. Even food per capita has gone up despite the fact that the population has been growing very fast over the past 50 years or so, but was recently hit by a food crisis. We have a billion people right now who are malnourished or under-nourished. This is up from some 780,000 in 1995, so things are actually going the wrong way, and for many different reasons. One of the reasons is that food prices are too low, so farmers get discouraged and can’t make any money. Why is this? Because farmers in the North get huge subsidies and that makes for unfair competition with farmers in the South. People are migrating from rural to urban areas, and also from poor to richer countries, because they can’t make a living off the land.

The latest decrease in food production has a lot to do with the decrease in water resources. Water consumption in agriculture has gone up—70% of all fresh water available is used in agriculture—and there are ways to do better now and in the future. We have to do so for two reasons—there’s less water available and there’s more demand for water. Never mind that pesticide use has gone up, which has led to increased pollution in the water and the ground and making people sick. Fertilizer use has also gone up. It’s all based on inputs which are all in short supply and will be in even shorter supply in the future, and also more expensive. For all the good the Green Revolution did over the years—a lot more food for a lot more people—it came at a huge cost for the environment, and the soils in particular, which has been heavily impacted in the North and in the South. In the South because insuffi cient soil fertility management has been introduced to help rebuild and improve the soils at each cropping cycle; the soils have been exploited, mined.

Water is a big problem, no doubt about it, as is the loss of diversity and, again, climate change. Agriculture could actually be part of the solution to climate change, but right now it’s part of the problem—32% of greenhouse gases come from agriculture and related activity like deforestation. These are huge contributors to be made by agriculture and the IAASTD key fi ndings and options for action toward a new type of agriculture that will make it the solution rather than the problem need immediate implementation. As the reports say “business as usual is not an option,” agriculture as we know it today needs a new paradigm, a change of course.

In Africa, productivity remains very low. Elsewhere in the world, it has gone up and this has a lot to do also with water availability and soils on that continent. Very little research has been done to fi nd better ways of improving agriculture under more critical conditions. More people, less land, less water; so here again we have to fi nd better ways forward and I think that the report has given us some ideas, which I will share with you in a minute.

Regarding the challenges of climate change, two degrees above the long-term average since the Industrial Revolution is where we’d like to be. I think the way people are living and dealing with climate change, we’ll be at three-and-a-half degrees difference if we’re lucky. I don’t see any signs that something serious has been done about changing the way we live, particularly in the North, to make sure we don’t go to three-and-a-half degrees. You see what happens, if you look at water, there’s signifi cant decrease in water availability in many areas, including the Mediterranean and southern Africa. So, in many places in the world that are already water-stressed, matters will get worse; this will affect food production, the eco-systems; we will have more extreme weather systems—you can see that a lot of problems are coming upon us and I think it’s past midnight for the wake-up call to do something.

15 There is brand new information from the Human Development Report (HDR) 2009, that shows that around the world there will be fewer yields by 2050. Three degrees increase in temperature would mean something like 20 to 30% less yield in Africa. Some areas will be lucky and have a bit more water, but in others the climate change impact will make agriculture more diffi cult.

So, what needs to be done? If, for example, we look at yields in high-income countries and yields in low-income countries, we see a huge gap and need to decide how we go about changing this. For one, we don’t have to further increase the major crops’ yield potential because we only realize about one third of it. It’s just that we have to have better ways of using those existing varieties in the South and also make better use of water. In many countries where people suffer from hunger, you can see very little irrigation or dry land crop management systems.

The report has been quite strong in looking at the multifunctionality of agriculture. Some countries did not come to the meeting because of this. Among them, Argentina, which was concerned about the trade implications. Food production is really the coming together of the environmental, social and economic spheres and so we cannot ignore that agriculture is more than just growing food; it also has, in addition to the economic aspects, a major cultural and environmental role (i.e., ecosystem services).

There are other solutions out there as well. The report says, let’s do agroecology and organic farming where every year we build soil, we don’t remove it. Phosphate will run out in about 100 years, so what are we going to do then? Oil and gas are running out sometime soon, maybe toward the end of the century. So we have to act; we have to change the way we do agriculture now. In Africa, we have shown that you can grow up to 10 times more maize totally naturally, without any synthetic fertilizer. It’s been done the last 10 years, so we are now promoting this rather than more synthetic fertilizers or pesticide use, or even genetically modifi ed crops. They won’t do much more unless the soil gets better, so we have to start fi rst with the soil and the water.

Regarding water, a lot of it has to do with water management, from maintaining yield to adapting to climate change, closing yield gaps as we’ve seen; so, again, a lot has to do with water management. A lot has been shown about how we can do better: just go to Israel and see how they grow crops there. And I think a lot of technology could be used, even traditional farming in the Middle East, Central Asia—they have very good systems for production of crops in extremely dry areas.

The report indicates that there may be some useful longer-term outcomes from the fi eld of biotech. We need to continue research, but for the time being let’s apply what we know, because otherwise we’re going to have even bigger problems. Twenty years of biotech research has done little to increase yields and even less to make crops drought-resistant, contrary to traditional cultivation. Nothing will happen unless we change the conceptual patterns in the North; in particular, because by this September, we will start to eat our natural capital. Every year, our ecological footprint gets a bit larger and moves the date where we start eating up the earth’s capital further forward. This has limits, and the less capital we have, the less interest we will have. We need to rethink the way we do a lot of things, agriculture in particular. That also means how we eat and how we use water and energy.

You cannot solve the problem with the same kind of thinking that created the problem in the fi rst place. It’s time for a different kind of thinking: systemic thinking. We cannot continue to think linearly, which I think most people do. I think that’s the message here. Thank you.

16 PANEL ONE—QUESTION AND ANSWER SESSION

Q: Begleiter. Thank you both. I’m going to pose a few a questions. It strikes me that the two of you are speaking from opposite ends of the spectrum here. Hans, your main point was the need to think about these problems systemically, on a global level, to solve problems in a similar fashion worldwide. Paul, your focus was at the very micro level. You’re one of the people—no negativity attached to this—who are not thinking of it systemically, at the large level, but at a piecemeal level at the moment. So my question to you both is, are these in contradiction to one another or is there a way for programs like Paul’s to fi t into a systemic solution? Or are the resources and the energy being devoted in the wrong direction?

A: Herren. I think we need a more top-down, global approach as well as a bottom-up, regional and local approach. In addition, if farming was done in a more sustainable manner—with less erosion and better soils—you would actually improve the water table and the water quality. It looks to me like these things are systemic, you have to work from different places. People have to drink water; you have to get it out of the ground, it has to be clean. That’s important for many reasons, also for human health. A healthy farmer in a healthy environment can work harder and grow more food.

I think it’s all a continuum, it’s not bits and pieces, and I think we have to be very careful and always look at the integration of the systems’ factors—their interconnectivity and the many feedbacks, also the negative and often unintended ones. There are too many projects out there, a gazillion of them; one does something here, one does something over there and they don’t integrate properly, actually often working at cross purpose. I think it would be better if people would work together in certain places and develop good models which can be duplicated, rather than “I’ve got project here or there, a fl ag here and a fl ag there,” and that’s certainly what happens on the national level.

Q: Begleiter. In some ways, the group of people in this very room represents “that fl ag here and that fl ag there” model you just talked about. Is there any advice you could offer in terms of collaboration? Is there some overlay that could be placed on groups like this?

A: Herren. I think it would be worthwhile for people, when they start a project somewhere, to ask and see what else is happening in that particular region. Very often the question arises: Are the local people being asked what they need and want, or are we just going there because someone in a donor agency or help organization has an idea? Are we discussing with the communities, bringing them on board from the beginning, asking them what they want, what they think is needed fi rst? If all the different agencies do that, eventually people will start to work together instead of having little pieces of a larger puzzle scattered all around, with no one having an idea what the fi nal picture looks like.

A: Faeth. I think it goes back to the old saw—think globally, act locally. When we look at the water and sanitation issue, a lot of things come into play. First, a couple of numbers: there are almost a billion people in the world who don’t have access to safe drinking water. With regard to sanitation, there are 2.5 billion people who don’t have it. Most of the world’s water is used by agriculture fi rst, then industry— people who we’re talking about have such a tiny, minuscule percentage of global use that it doesn’t have any impact. But they are the ones who are the recipients of the negative developments. Climate change is a particular thing that we look at; for the people who don’t have water, what’s going to happen when things get worse? Typically, these are the people who have no money to adapt. We’ll be able to adapt. Western Europe will adapt, other places will be able to adapt. People who are the very poorest are the

17 ones who just have to accept the changes. Scientists have said you have to do three things. You have to mitigate, you have to adapt or you have to suffer the consequences. For these people, they can’t do the fi rst two. What we’re looking at is how to develop those systems that, globally, can be replicable, sustainable, scannable. We’re looking at pilots that we think have the hope to achieve those ends.

Q: Begleiter. I can’t help following up. You talked about the fact that these are people who can afford the least and don’t have the resources to affect the two top tiers as you characterized them, and yet your models are pay-per-use models. You’re asking the people who can afford the least to pay two cents every time they go to the bathroom. What’s the philosophical connect between those two points?

A: Faeth. These people are paying now anyway. They’re paying for typhoid and for illness, so they might not be paying for drinking water but they’re paying in other ways—days lost at work. They’re eager to pay a little if the resource can be there and be there all the time. Actually, what you see in poor places like this, if there isn’t some sort of municipal supply, is that they buy from tank trucks. It’s twelve times the cost of what a municipal supply would cost, so they’re paying the highest prices now. If you think about it in terms of trying to develop a more sustainable supply, if you can deliver a better product for a reasonable price, not an overcharge, they’re ahead.

Q: Begleiter. You talked about the carbon credits they generate with the small solar unit attached to the UV light that purifi es the water. Do the people using those systems understand carbon credits? Is that something they can wrap their heads around? Do they understand the $40 million annual profi t?

A: Faeth. No, that’s over a 10-year period. I would say that, for the kids who are in the orphanages and the schools, the answer is no. For the headmaster, the answer is yes. The choice is what the alternatives are, and the alternatives for these kids are not good. They spend hours a day fetching water, which is very burdensome. So we’re looking for models to bring capital in to help solve this problem. I would say even now, there’s no shortage of capital relative to the scale of this problem. There are still trillions sloshing around in the world economy, but in order to attract them, you have to have some degree of return. I think that’s critical.

A: Herren. These water projects are good. They need money, but, if at the same time we would help farmers add value to their products and make money—rather than to sell where other people are selling the same stuff, or where half gets lost—it would help. The idea is to integrate, to help people make money from agriculture, that’s what their main source of income is. They grow fruit, for instance mangoes in Kenya, where most of them rot on the tree. Why not make juice? Why don’t we have small- scale, high-quality product juicing factories so they can be sold in town? Add value, create jobs, create skills. How can we make this sustainable? To pay for the water, I think, is right because if not, nobody will maintain the pump or the equipment. Whatever is free is worth nothing. Even an organization like Heifer International provides cattle but eventually they have to give one away, so it is always linked to something else. That’s the key to make things work.

Q: Begleiter. Hans, you made a point in your presentation of highlighting that the United States, Australia and Canada excluded themselves from the agreement that you were talking about. Where does that stand in terms of the timetable? Are you seeing any change in the U.S. point of view from, shall we say, a random date—January 20, 2009?

18 A: Herren. I did contact the U.S. government, and especially the Secretary of Agriculture, whom I know well from the World Food Prize, when he was the Iowa Governor. He hasn’t yet contacted me to have a meeting to discuss this, because surely it was the Bush administration that didn’t like the report. I thought the Obama administration would. I’m still trying, I have put out feelers but nobody has called yet.

Q: Bernard Kibirige, Saph Integrated Training Centre. I’d like to thank Dr. Herren for his report. I’ve come from Uganda and I want to concur with him on almost everything he has said. In Africa, the issues are not issues about irrigation. We are not short of water. What we need is to manage the water sources that we have. As an example, Uganda has vast natural water resources, and one of them is the river Nile that begins in Uganda and goes to Egypt. But today, as I speak, Uganda is one of the countries where hunger is widespread—almost 70% of the country. Yet a country like Egypt that is more advanced and has more access to resources than Uganda, but taps water that comes from Uganda does not have food problems. So where is the problem? The problem is, how can we help countries like Uganda and Kenya and so many other countries in Africa that have these water resources but don’t have the fi nancial resources to enable them to carry out large-scale commercial farming and to enable them to get the skills to manage the water they have?

A: Herren. One thing I didn’t touch on, but was very big in the report, was governance. A lot of it has to do with good governance. Where are the investments? Why are Uganda and Kenya having blackouts all the time? Industry can’t work. It’s because of lack of foresight of governments and this includes people at the World Bank and the International Finance Corporation (IFC); it’s all short-term thinking. It’s all one-year or two-year planning; nobody bothers to think 25 or 50 years down the road. We need to start thinking and planning for what do we have to do today to ensure that, in 25 or 50 years, there’s going to be water and soil for agriculture, so that people and the environment will be healthy.

A: Faeth. I take a slightly different spin on this: I think it’s a question of voice. I think the poorest, in particular—and we’re talking about the poor farmers as well as the people I’ve been talking about— don’t have access to people who are making decisions, or have any input into the decisions that are being made. As a result, it tends to be in favor of the more elite, which is not entirely different in some ways from here, but at least we have a voice, and we can vote.

Q: Begleiter. That was a little of what I was getting at when I asked you whether the people in your water systems understand about the $40 million profi t and carbon credits, and so on. If you’re able to get those points across to the poorest people, would that empower them to wave their $40 million profi t in front of their governors and representatives?

A: Faeth. I think there is an opportunity for businesses to provide some sort of help. Businesses can actually be part of the solution, even though it has to be well-regulated. There’s a limited amount of innovation that occurs privately. Most innovation occurs by government and by government-mandated research, etc., which I think is positive, but we haven’t created an environment that allows for much innovation to come in. I think that’s really the central aspect of it. There does need to be a prominent government role and it’s a very signifi cant challenge for entrepreneurs to come into our space. There are a limited number of entrepreneurs who actually have some capability. Also, there have been a limited number of models in the last fi ve or 10 years. Even microfi nance is still growing; it hasn’t reached its potential. We need to look for different ways, bring in different people and different funding, even using a different fi nancial model. 19 Q: Begleiter. Hans, do you think that, if these smaller programs had the kind of clout that Paul is talking about, they would offset a big tendency—particularly in Africa—to mine your way out of economic problems, and see that there are other alternatives?

A: Herren. It would certainly help. A lot of small rivers make a big river. I think we have to look at the scale here. We have to put real money into all this. Real money. The agricultural subsidies are a billion dollars a day in the North—a billion. And here, we’re spending maybe $800 million in international agricultural research in the whole of the tropics, and we expect things to change? Look at how much money even the carbon credits are going to make—with 500 million people in the forest, each would not make even a thousand dollars per year. It is not even close to solving the problem. I think if people would take the back of an envelope and do some simple math, they would see how ridiculous the numbers are to solve the problem, a full order of magnitude! If we don’t take action now and start to be serious, I think things are really going to go haywire. All the little things we do are fi ne, but I think its time to change gear and become serious about the way out of the whole.

Q: Jose Maria Figueres, DATA International. Thank you for the presentations, you’re both very well- versed in climate change and your numbers are very clear. Some of us believe the water challenge is the fi rst brick wall we will face in the advent of climate change. One of the problems is scaling up solutions we have. Why don’t we scale? You mentioned fi nances as a constraint. Are there other challenges out there that don’t allow us to scale? We’ve been looking at the water challenges for years: there were 2,500 water experts at the recent conference on water in Sweden, and 20,000 people gathered in Turkey about a year ago to discuss water. What are the challenges? Why can’t we scale up existing solutions?

A: Faeth. One of the things that does matter a lot at the community scale is that there’s a much tighter interaction between the people who are the recipients and the program. In fact, in this case, we’re part of the community, unlike some cases where there have been riots, and people died as a result of the changes in water charges with big companies coming in. The real question is, who has access to the resource base? Locally, these entrepreneurs are interacting with their communities and the communities have given their permission, whereas at a much higher level there often isn’t any access; people don’t have much of a say about the program, what it looks like. The poor don’t have any access at all.

Q: Begleiter. Are you essentially saying that there aren’t enough incentives for the private sector to get involved?

A: Faeth. There are almost none. For example, we’re trying to make an investment right now in India in a company that makes water kiosks. One of the things that we’ve found is that we can’t get approval to make that investment. We’re waiting for approval to make the investment. Because it’s a small group and because we want to invest dollars, it’s a problem. Others have found the same thing; they want to invest in India and similar places and can’t make the investment. I think the regulatory barriers are really a problem.

A: Herren. Government regulation can be a part of the problem, and the other part is infrastructure. There has to be more investment in infrastructure because that will allow you to go to these places and do things. You can’t make progress if the rural areas are not really connected. To make the economy work we need a lot more infrastructure. In Africa in particular, there’s a huge lack of infrastructure. Where are those roads, railways, and power? These are the kinds of infrastructure that have to be there. You have to make sure that government in the North and South work together to get this done. 20 Q: Begleiter. Paul, you said earlier that you set up a contest to come up with new methods and fresh ideas and one of those ideas succeeded. Is that a new model? It seems that it’s only been done in recent years, put it out there and see who comes up with a solution. The Internet has facilitated that sort of model. Is that something that provides enough incentive to open it up to entrepreneurs who are not in it for the big bucks, but who get a thrill out of saying that here’s a problem that I know the answer to? Does the contest work?

A: Faeth. May I say that I hope so? When we looked, we could only fi nd a couple of examples, but when we did the contest, there were only about 30 who were entrepreneurs looking for business. The rest were looking for grants. Part of it is the mindset. I think there’s an entrepreneurial spirit out there, getting people to think, “I can do this, I can start a business to do that.” Part of what we’re doing is to get people thinking in that direction because there are answers there. Where in the long term, I’m not sure. We’re looking at one aspect where governments have failed.

Q: Sr. Janice McLaughlin, Maryknoll Sisters Center. I’ve been working in eastern and southern Africa for the past 40 years, and I have a question for each of you. For Paul, I’m wondering if you have any projects in southern Africa, where there are greater conditions of drought and less water available? I’m thinking, for instance, of Zimbabwe where we’ve had cholera. Some of that is a result of the lack of water; the water table is dropping. For Hans, again in southern Africa, I’ve seen the importance of seed banks where farmers preserve their seeds and you get the healthiest seeds for the environment and the soils. I’m wondering if you could say more about the interaction between biodiversity and biotechnology? Again, my concern would be whether there are some models of biotechnology inhibiting or preventing the emerging of local initiatives or ways of solving the food problem?

A: Faeth. We do have programs that we’re looking to support in arid areas, but not in southern Africa per se. One is in India; in these kinds of areas you rely on ground water, but there may not be any surface water that would be suffi cient to provide the resources people need. In India, they’re building kiosks and the ground water actually has fl uoride, salt and in some cases, arsenic. They’re actually using an advanced technology—reverse osmosis—to treat the water and then sell it for a nominal cost to provide water for drinking and cooking needs. It’s a few cents for a bucket; it can provide for 5,000 people for $15,000 and lasts for 12 years. Actually, they’re building 40 of these a month.

Another example involves a group in Madagascar where they have been putting in wells for nonprofi ts and this company is now moving them in and leasing them where there isn’t enough philanthropy or government money. They make an agreement with the local villagers. They put in the well, and they lease it. What’s interesting about this is that, about half the municipal wells don’t work within 5 years. This is because there isn’t enough operation and maintenance money recovered. If these wells don’t work, they get no money, so the villages don’t have to worry about capacity and the company provides it at a minimal cost and makes sure it continues to work.

A: Herren. We’ve done a lot of studies on biodiversity and genetic engineering. The issue is that if you go the genetic engineering way, you’re bound to narrow down the diversity. Genetic diversity within crops and across the crops—because it costs a lot of money to transform crops, so you’re going to end up with only a few varieties—is a big problem in Africa, particularly with so many different climate zones. So, you would need many different genetically engineered crops, which is not something that is in the cards fi nancially and time-wise, so that’s one problem and a reason to look at other solutions that are at hand and don’t create undue dependence for farmers. 21 The other problem is that we actually try to diversify the crops grown to improve nutrition rather than to modify crops with everything in them. Furthermore, with climate change we need resilience. Resilience is not something you get by narrowing down your genetic bases; you really have to go the other way. If those guys who do this come up with a way of doing a lot of variety, maybe one can reconsider. But for the time being that’s certainly not the case.

Q: Mark Lancaster, Global Footprint Network. My question is a little bit broader. Many organizations here are really of the humanitarian stripe, and Hans has talked about the impact of climate change on pretty much everything we do. The question for both of you is, to what extent do you think the humanitarian community needs to be involved in the climate change conversation? Also, how, in an appropriate way, might we attempt to infl uence what could happen at Copenhagen (parenthetically, probably won’t), what happens post-Copenhagen and the roles of humanitarian actors in trying to move those discussions in a way so that we can really do our work?

A: Herren. I would suggest that the humanitarian community get involved in the education of the larger public and bring along NGOs, because the danger with this discussion in Copenhagen is that a number of governments sit down and decide they cannot do it because of GDP or growth, etc. To me it seems that the humanitarian organizations, governments and the society-at-large may have different views on how to make the much-needed societal changes, but we really can’t afford this and need to start now on a common path forward to a sustainable future for all. The IAASTD has given the signal, so have the IPCC and the Ecosystem Assessment among others. We cannot afford to keep so much wisdom and insight sleeping in between pages.

A: Faeth. I have to agree 100%. The big issue—and it surprises me still how few people know about it—is the lack of drinking water. In other issues, there’s been a lot more awareness, around AIDS and malaria. Child mortality has dropped signifi cantly in the last 20 years. But people don’t make the connection between climate change and the poor, and I think that’s where the poor defi nitely suffer the consequences. We have very limited understanding about what those impacts are, but those people are going to pay the highest costs. I actually fi nd that when people are made aware, they want to respond. We did a survey, and with very limited information, three quarters of the people surveyed said they want to help in some way or another, directly, and that would include making phone calls or writing to Congress. So I think that we haven’t done a good job, in many cases, in making the public aware.

22 PANEL TWO SUMMARY Putting Philanthropy to Work for Women, and Women to Work for Philanthropy Both panelists—one from government and one from philanthropy—used as the basis of their remarks the growing body of evidence that investing in girls and women is one of the best investments a society can make. Data has shown that obtaining the economic growth necessary for a thriving society will take equipping women to participate and involving them in their country’s future. Nevertheless, it is a slow message to get across suffi ciently. People, societies and governments continue to resist and to discriminate. Moreover, even those more enlightened readily defer these investments as “luxury items” to “more pressing, more immediate and more important” crises, like economic recessions and wars.

From the perspective of government: Despite mounting evidence that points to the benefi ts of investing in women, the case has not been suffi ciently made. Women sense that too often they are perceived as victims—worthy of help, but not critical to a country’s well-being and growth. Women need to be seen as agents of change, which they are proving again and again to be. It is a different frame for the debate. One encouraging development is that it is no longer just governments and philanthropists that appreciate women’s contributions to actual and potential economic growth; there is growing awareness in the private sector, especially the business community.

“No less important, women are understanding themselves as part of the solutions, not the problems.” Responding to a question of why ‘women’s issues’ are asked to take a back seat to more pressing issues: “One of the problems is calling them ‘women’s issues.’ While they do directly affect women, they’re about the kind of better world we want to create in all of these areas… [We need to] understand the multiplier effect of these investments, and how women utilize the investments and actually pay them forward for their communities…I don’t think many of us believe we can solve the challenges we’re confronted with, whether they’re government’s challenges, environmental, economic or even security challenges, unless women are fully participating in the solutions to those problems.”—Melanne Verveer, United States Ambassador-at-Large for Global Women’s Issues

From the perspective of philanthropy: The speaker observed that even within countries that have benefi ted from globalization within the past decade, inequity, or inequality, has disproportionately hit women. Her foundation is defi ning its work for the 21st century as building growth with greater equity and greater resilience so that people can withstand the shocks that are certain to come in an increasingly globalized and interconnected world. In particular, innovation will facilitate resilience—innovation not just in products but in processes, in the markets, and in organizational structures.

“This is an area that demands a systemic approach that…focuses on three domains in a leveraged, really interactive way: education and training, laws and policy, and access and distribution…If we could look at how we could create an integrated system focusing on those three domains simultaneously—if we in the civil society with government, could position different interactions in the system—that would be, in my view, philanthropy for the 21st century…It’s very much a partnership, with everyone understanding their role—we shouldn’t do what they can do better, and they shouldn’t do what we can do better. But if we leverage one another, think of the multiplicative impact that’s likely to occur.”—Dr. Judith Rodin, President, Rockefeller Foundation 23 “Putting Philanthropy to Work for Women, and Women to Work for Philanthropy”

Dr. Judith Rodin, President, Rockefeller Foundation

During Dr. Rodin’s fi rst four years at the Rockefeller Foundation, she recalibrated its focus for the 21st century. Today, it helps ensure that more people can tap into globalization’s benefi ts while developing stronger resilience to risks, affi rming its mission, since 1913, to “promote the well-being” of humanity. Dr. Rodin is the fi rst woman to serve as the Foundation’s president in its 96-year history. She was previously president of the University of Pennsylvania, the fi rst woman to lead an Ivy League institution, and provost of Yale University. At Yale University, Dr. Rodin chaired the Department of Psychology and served as dean of the Graduate School of Arts and Sciences before becoming provost. As a faculty member for 22 years, she helped pioneer the fi elds of behavioral medicine and health psychology. She received both the American Psychological Association’s Distinguished Early Career Award in 1977 and its Distinguished Lifetime Contribution Award in 2005. Dr. Rodin is a member of the American Academy of Arts and Sciences, American Philosophical Society, and Institute of Medicine of the National Academy of Sciences. She participates in the annual World Economic Forum and serves on several boards, including those of the Brookings Institution, Alliance for a Green Revolution in Africa, Global Humanitarian Forum, and Clinton Global Initiative’s poverty alleviation track. She is also a director of AMR Corporation, Citigroup Inc., and Comcast. She authored more than 200 academic articles and wrote or co-wrote 12 books, including her most recent, The University & Urban Renewal: Out of the Ivory Tower and Into the Streets.

Melanne Verveer, United States Ambassador-at-Large for Global Women’s Issues

President Barack Obama appointed Melanne Verveer as Ambassador-at- Large for Global Women’s Issues. The President’s decision to create a position of Ambassador-at-Large for Global Women’s Issues is unprecedented, and refl ects the elevated importance of these issues to the President and his entire Administration. In her capacity as director of the Department of State’s new offi ce on Global Women’s Issues, Ambassador Verveer coordinates foreign policy issues and activities relating to the political, economic and social advancement of women around the world. She mobilizes concrete support for women’s rights and political and economic empowerment through initiatives and programs designed to increase women’s and girls’ access to education and health care, to combat violence against women and girls in all its forms, and to ensure that women’s rights are fully integrated with human rights in the development of U.S. foreign policy.Ambassador Verveer most recently served as Chair and Co- CEO of Vital Voices Global Partnership, an international nonprofi t she co-founded. Vital Voices invests in emerging women leaders and works to expand women’s roles in generating economic opportunity, promoting political participation, and safeguarding human rights. Prior to her work with Vital Voices, Ambassador Verveer served as Assistant to the President and Chief of Staff to the First Lady in the Clinton Administration and was chief assistant to then-First Lady Hillary Clinton in all her wide-ranging international activities to advance women’s rights and further social development, democracy and peace-building initiatives. She also led the effort to establish the President’s Interagency Council on Women. Prior to her time in the White House, Ambassador Verveer served in a number of leadership roles in public policy organizations and as legislative staff. Ambassador Verveer has a B.A. and M.A. from Georgetown University. She is a member of the Council on Foreign Relations, Women’s Foreign Policy Group, and numerous other organizations.

24 Q: Begleiter. I guess the obvious fi rst question to both of you is, what are top priorities right now for women in a time of economic challenge? What do you have to focus on now?

A: Verveer. Thank you Ralph, and thank you to the Hilton Foundation for all the good work it’s done for such a long time. I think to answer a question on priorities, one has to contextualize it in terms of why we should invest in women. We know from all the data, and it is a growing body of research, that investing in women is among the best investments one can make, certainly for poverty alleviation and for a country’s general prosperity. Within that context, particularly in these times, the ongoing consequences of the global recession on women has been particularly tough, even those who have found themselves in the formal economy for the fi rst time—in factory jobs, maybe not the best jobs but the best they’ve done in their lives heretofore with a constant paycheck—now fi nd themselves in rather diffi cult situations. This has consequences across the board, as all of you who are on the ground know very well.

It also has longer-term consequences, for investments in girls’ education, for example. What we’re seeing is a drop-off in girls in school as a result of what these diffi cult times have done to their families. I think it behooves us, and the Administration has responded as best we can, to try to cushion this blow by providing support so girls can stay in school. While it may seem like a longer-term development goal, it is really a critical issue in terms of what investments in girls’ education represent for positive consequences. Beyond that, when the economy does improve, we are going to be critically in need of boys and girls, certainly girls, educated to move those economies forward. So these are consequences that we need to mindful of now, particularly in terms of the immediate effects of the global recession.

There are many cross-cutting issues that are initiatives of this Administration. There’s been a lot of discussion in the previous panel on food security, which is a major initiative. That issue of climate change, global health—these are all issues that, at fi rst blush, no one would consider to be women’s issues. Yet women are absolutely critical to the outcomes of how successful we are to moving forward.

A: Rodin. Let me add my voice of thanks to the Hilton Foundation and to so many of you who are on the ground, day in and day out, working. It’s a privilege to be able to add my voice, but also to learn so much from you.

The Rockefeller Foundation has a 100-year history of working toward the betterment of humankind. We now interpret this mission for the 21st century as building growth with greater equity and building greater resilience. Both of those are issues that dramatically impact women. We’ve seen a decade of increasingly inequitable growth around the world, even in countries that have benefi ted from globalization and advanced economically. But within those countries, both in the developed and the developing world, inequality has grown, and that inequality has disproportionately affected women.

Our second important lever is building greater resilience. When you think about the fi nancial crisis or climate change or the growing food insecurity in many places in the developing world, we need to build greater resilience in individuals, in communities, and in systems, so that they all are able to withstand shocks. Because, no matter how well we do going forward, shocks will happen, and we’ve got to build more capacity in people and places in order to withstand them.

At the Rockefeller Foundation, we work on fi ve main issue areas, all of them really central to the question

25 of thinking about women. First, easing basic survival insecurities in water, food, shelter—in all of these, women are disadvantaged quite signifi cantly. Our second issue area is health, and inequality in health is extraordinarily dramatic when you look at maternal mortality and many other areas where women are disproportionately affected. The third area is climate change, and obviously this is dramatically affecting many parts of the world now, and we are spending important time talking about mitigation, but we need to focus on adaptation, which is a development issue that really affects women. Think about the discussion of the last session—when the farms become unproductive, it is the women farmers who are affected disproportionately because often they don’t own the land. So the men, in times of economic disadvantage, migrate to the cities and fi nd jobs, and the women are left with the children, with unproductive land, and increasing disadvantages as a result. That’s why those land tenure and micro-fi nance and micro-insurance issues become such important issues.

The fourth issue on which the Rockefeller Foundation works is increasing urbanization. Again, if you think about that and about cutting women in on that question, we know from statistics that half the world’s population is now living in cities. That will be increasingly so, and it will be increasingly true in the developing world in particular, often on fragile ecologies and where people are migrating without opportunity. To those areas you are starting to see increased traffi cking. All those issues have to do with women in those urban areas. Everything seems to be coalescing around this extraordinary, unplanned urbanization, which is such a challenge for many countries in the developing world that don’t have municipal infrastructure the way we do in many places in the developed world—whether that’s governance or actual physical infrastructure. Again, women are being disproportionately affected here. In so many of these areas, if you have a substantive domain that drives your interest, and you say “Let me take a slice and see the effect on women,” you can see the disproportionate impact on them. Forty- three million girls around the world don’t get education. Start there.

We’ve talked about the importance of education at the primary and second levels, the importance of training women, and whether women are being trained. There are wonderful experiments going on in Rwanda and India, training women as village health workers. We have been doing a lot of work at Rockefeller, training women as agro-dealers which is also part of our fi fth issue area, social and economic security.

Janet Matumba is the prototypical example, a women in Malawi who previously sold soda and crackers, took a six-week agro-dealer certifi cation course, learned some business practices and is now selling seeds and fertilizer and teaching the women farmers in her village how to do it. Janet’s business last year was $200,000 and she employs almost everyone in her village, and this network of women entrepreneurs across Africa who have become agro-dealers through training programs like this, should hearten all of us about the example when opportunity is given.

A: Verveer. Maybe it’s something in the name Janet, but there’s a Janet in Rwanda who’s been exceptional. I think the point that Judith is making is the importance of investing in human capacity and the potential that women represent. It’s almost as though we need a new frame. In fact, I think we do, the frame of women as agents of change. The Janet in Rwanda, for example, was provided with skills training. She’s clearly entrepreneurial by bent, she had—speaking of new philanthropy—access to business people who helped her, Americans who helped her think strategically from how to grow a business to long-term strategy. I saw her several years after she had gone through this training—which was not extensive by any defi nition, but she was a quick study—and she said to me, “My life has changed.” I asked how that

26 happened, and she said, “Remember the training that I got?” Today she is running a co-op of basket makers with a steady market in the U.S. and other places, and their lives are dramatically changed and they’re driving the GDP in Rwanda.

Q: Begleiter. We have a lot of organizations in this room who already understand the leveraging power of working on behalf of women and with women, but there are at least a couple who could benefi t from just a quick list of why you think investing in women, particularly, is a good investment in these economic times.

A: Rodin. The data are really powerful. Many places have now had systematic studies that investing in women is investing in better health care for their families, and better education for their children, both daughters and sons. The evidence from many countries is that when the man in a household gets a dollar, it’s often spent on tobacco or alcohol. But when the woman gets a dollar it’s spent on health care and her children. That builds family capacity—that contributes to community capacity. Those data are really irrefutable. I think the other element of why it’s so benefi cial is more anecdotal evidence but still powerful. As women get greater economic security, family violence against women goes down. It’s such a great investment to produce the outcomes that we all work toward. I think it’s well worth the investment.

A: Verveer. Ralph, that’s a good point that you make. While many of us may be familiar with the data, what is often missing, including in the government frequently, is acting on the data. I remember almost 15 years ago—many of you will no doubt remember as well—that the fourth UN Conference on Women took place in Beijing. At that time, we had considerable research—studies from the World Bank, the United Nations, etc.—that documented empirically how investments in women have tremendous payoffs in terms of the kinds of positive changes that are required. What we have today, joining all that, is the business community in signifi cant numbers. The World Economic Forum, for example, issues an annual competitive study in terms of what drives growth in countries, and access to health care, education and economic participation are measured. In no country are men and women equal, but in some countries it’s a pretty horrifi c situation, and yet we know that until that equality becomes more likely and more real, we’re not going to see the kinds of outcomes that we need to see.

Similarly, Goldman Sachs has done a series of studies, and the studies were compelling enough for them to invest a hundred million dollars into a program called 10,000 Women. It’s about investing, through academic institutions, in training for business and management—American universities teaming up with their counterparts in the developing world and providing training to women, because as the CEO of the company says, you can’t neglect what the evidence shows. Women are the lowest-hanging fruit in terms of driving economic growth, and economic growth is critical to poverty alleviation—possibly the best tool. Whether it’s any number of companies, there is recognition today that, unless we lift up women, educate them and meet their needs, we aren’t going to have the kind of world we’re in this room to discuss.

A: Rodin. Ralph, we’re talking a lot about education and training as stimulating growth and why the investment is so important, and so strategic, for a country that is looking to develop and promote economic growth. But there’s another domain here that often is neglected and where we have to pay a great deal of attention as well, and that is laws and policies. We will never completely solve these issues—and this has been an area where I think we may need a new paradigm in terms of thinking about

27 philanthropy in the 21st century. Obviously, it is much more diffi cult to get involved in legal and policy change in a country. It’s diffi cult in one’s own, let alone in countries that aren’t one’s own. Yet this is going to be absolutely essential when you think about women.

Unless land tenure reform is really taken head-on, seriously, the lack of it is correlated with a lack of economic development. There are countries that have passed laws, but it then requires the efforts of the NGOs on the ground to make sure those laws are enacted. Often the laws are sitting on the books but not suffi ciently enacted. Getting good laws passed is also correlated with how many women are in parliament in a particular country, how many women are in government—again, Rwanda is an example, but so is Algeria and other countries, where we’re really seeing the impact of women, both in the executive branch and in the legislative branch. I could go on and on, but I won’t.

In the prior session, you asked the question about people doing things in scattered ways. I think this is an area that demands a systemic approach that—in my mind—focuses on three domains in a leveraged, really interactive way: education and training, laws and policy, and access and distribution. There is still inequitable access to health care, fi nancial resources, etc. Or sometimes the sticking point is distribution. If we could look at how we could create an integrated system focusing on those three domains simultaneously—if we in the civil society with government, could position different interactions in the system—that would be, in my view, philanthropy for the 21st century.

Q: Begleiter. Let me put you on the spot for just a second. You’re at the Rockefeller Foundation now, previously you were in education, which is different. Are you looking to government, are you looking to Ambassador Verveer to solve the policy and law problem, or are there things private philanthropy like yours can do, or perhaps are doing, to deal with that systemic issue of policy and law?

A: Rodin. Absolutely. We’re doing a great deal of work right now on land tenure reform, but we also look to our government to make certain demands in their negotiations with other governments that perhaps they might not have thought about, or thought about as secondary until they approached this in a systemic way. Certainly, our trade policies, our own agricultural policies need to be thought through in terms of the impact that those policies have on these issues in the developing world. I am extraordinarily heartened that our government now looks to our community and to civil society as a partner, and we can look to government in the same way.

We don’t have the money in the philanthropy sector to take these things to scale, but we do have the money, with you on the ground implementing, to work on the next generation of innovations that governments can then scale. So it’s very much a partnership, with everyone understanding their role. That’s why I like the whole system being characterized as: “we shouldn’t do what they can do better, and they shouldn’t do what we can do better.” But if we leverage one another, think of the multiplicative impact that’s likely to occur.

A: Verveer. Following up on the need for policy change, which is absolutely true and which is an impediment in so many ways, let me just give you an example of a program I’ve been very familiar with over the last couple of years. The World Bank embarked on a project called Women’s Equality Equals Smart Economics, and in the process of putting together their annual publication about doing business— measuring which countries are the best on a variety of criteria, which countries would provide the biggest economic returns to whoever is interested in investing—they discovered that women were not

28 in the picture at all. They took that one step farther and realized, given the body of evidence, that they needed to do something about it. In Africa, they have embarked on a project to look at impediments to women’s economic participation, and many of them are long-standing policies and practices, but there are great inhibitions to unleashing the economic power that is potentially there. They haven’t gone in and said with a heavy hand, “We will identify what those problems are,” but have brought key women together from across the sectors. I think this is really important—bringing together women who are acting in the economic sector, in the NGO sector with governments, etc., to identify what is impeding that progress; certainly property rights, land tenure rights, tax gains that negatively affect women as opposed to men. As they are coming together and identifying these problems with facilitation from NGOs, they are also benefi ting from support from the Gates Foundation. We think of Gates and the extraordinary commitment they have made of big, big dollars, but in this case, these are very small grants that go to groups within countries to provide the resources to help them mount advocacy campaigns that engage the broader community in petitioning their government—local level and up.

I think part of this discussion today is really, how can we do things in a more innovative way, with greater effect, working collaboratively, in a more coordinated fashion, with partners across the board? Often, the solutions are not that complex, but we have to recognize what the basic issues are.

Q: Begleiter. I know you’ve only been in offi ce a short time, it’s pretty new, but it seems to me that in tough economic times, “women’s issues”—and I’m putting that in quotes—are the sort of thing that falls off the men’s agenda pretty quickly. They say things like, “We’re fi ghting two wars and we’ve got this economic crisis. Come back later.” Am I wrong about that, do you feel that pressure, and what can be done to keep these issues at the top of the agenda?

A: Verveer. I think one of the problems is calling them women’s issues. While they do directly affect women, they’re about the kind of better world we want to create in all of these areas. If they’re just women’s issues, it’s really soft, soft power. But if you understand the multiplier effect of these investments, and how women utilize the investments and actually pay them forward—not just for the benefi ts of their families, as critical as that is, but for their communities—it is important for us to do. Beyond that, I don’t think many of us believe we can solve the challenges we’re confronted with, whether they’re government’s challenges, environmental challenges, economic challenges or even security challenges, unless women are fully participating in the solutions to those problems.

You know, in places around the world that are most dangerous for women, we have societies imploding and failed states. We have problems that we are all aware of today that have to be addressed with high-power solutions. I think that, in a very gratifying way, what I’m fi nding is that there is greater recognition. Congress, in many of the sessions we’ve already had, truly understands the implication of investments in women and is addressing these major foreign policy challenges. Indeed, with the President’s creation of this position—the Secretary of State has talked about development being a pillar, with diplomacy, of smart power today—we all recognize that without women as part of the solution with men, we are not going to get to those outcomes. Whether we’re talking about Afghanistan or we’re talking about severe problems that continue to affect our world through climate change, we have to consider the role of women.

Q: Begleiter. Both of you have talked about innovation as an engine for moving forward. Dr. Rodin, please comment on this fi rst. Are there technologies, methods, collaborations, styles of working—things you can throw out here for these participants, some they may be aware of, but not all. Tell us what’s new 29 on the horizon, what’s working, what shows great promise.

A: Rodin. I think innovation is one of the most promising domains for philanthropy in the 21st century, because there has been a lot of evidence-based research in recent years about innovation. We tend to think of innovation only as the product, and although that’s one element, innovation is also about the processes, about the markets and about the organizational structures, if you think about all four domains in which innovation can occur [supply chain, process, organization and products.] That’s extraordinarily important and enabling for civil society. Let me give a couple of examples of some of the work we’ve been doing.

We became interested in innovation through the observation that, in the for-profi t sector, the companies that seemed to be differentiating themselves signifi cantly were writing about new models of innovation, models like user-driven innovation and crowd sourcing. We asked ourselves, is this being used suffi ciently in terms of social sector problems? Could we apply the same kinds of notions? After all, we talk about listening to our benefi ciaries—that’s rhetorical mantra in social sector work. Yet, here the private sector is saying, “We’re really listening to our consumers and we actually think that a lot of the innovative ideas that we’ve had aren’t coming from the R&D lab around the corner, but are really coming from user-driven, crowd-sourced information.” And so, we sought to support people in places where that was already being applied in the social sector, but also tried to experiment where it wasn’t, and I’ll give you three examples.

First, we funded a group called Positive Deviance. They work to identify what users are doing already that makes them different from other people in their village, so they’re positive outliers. For example, they went into a village in Vietnam, an extraordinarily impoverished village, and identifi ed three families whose children looked well-nourished compared to the impoverished children in the rest of the village. They followed those families and observed that those women were not washing the little crabs and shrimp out of the rice when they boiled the rice. So, those children were getting protein in the rice when the rest of the children were not, and they taught those practices to other villagers and then replicated that in a thousand other villages across Vietnam. They are observing what users are already doing and then multiplying that experience. They are applying that to female genital mutilation, to governance issues, and they’ve already done it to hospital-based infections in the United States, among other areas.

Second, take crowd sourcing. You talked about competitions in the last session. Ashoka is experimenting with collaborative competitions, a new form of crowd sourcing in which a challenge gets posted, everyone’s solution gets posted transparently, and then you see what starts to happen as people revise and iterate—they fi nd where the white spaces are and they start to fi ll in other people’s solutions. Ultimately, it is found in a lot of the work they’re doing, that better and more interesting, more innovative solutions come from using the crowd in the competition.

Third, we’ve been funding InnoCentive, which is a for-profi t company. About 180,000 scientists, technologists, engineers from around the world have registered on this platform to solve both biological and physical science-based problems that companies post. It was spun off from Eli Lilly originally to try to reduce their R&D costs and to see whether you could get scientists, if you just pushed a piece of the solution. A prize is offered, the company that posts it decides who the winner is, and then the prize is given. InnoCentive just manages the platform. These are scientists who solve science problems for fun, after their day jobs, the way I do crossword puzzles at night. They’re fantastically interesting people. One of our “challenges” was with somebody who was looking for a solar-based anti-malaria treatment, 30 something that he hoped would be cheaper than bed nets, but might help people in mosquito-infested places in the developing world. The solution was a tiny panel that people rub their human sweat on; it was then put out during the day and put into their room at night, and the mosquitoes were attracted to the human sweat. It had a little component, energized by the solar power, having been out in the sun all day, and they were zapped. It was actually cheaper than bed nets. He posted the challenge in New Zealand, a Chinese scientist gave the solution, and we’re now providing some funding to see if this can be taken to scale. So here, the solutions are everywhere—people who will never meet one another, never have worked together, and everyone is part of the solution cycle. I think that is the 21st century way of working, and that’s the idea that we want social sector innovation to take on as well.

There are lots of these models. We funded IDEO, a design company to work with NGOs to bring design thinking to some of the areas in which they’re working, and the results have been extraordinary. So I’m very bullish on innovation processes, innovation techniques being brought to the sector, as well as looking for innovative products and outcomes, which I think we all will continue to do.

Q: Begleiter. To interject a technical note, some of this is perfectly obvious, but not everyone may know that some of these techniques would not have been possible 10 years ago. This is enabled by Internet technology. You talk about crowd sourcing, but it’s not about going out into a crowd, it’s a crowd that’s accessed electronically using cell phones and the Internet. So there are areas where you might begin to think about doing something that you always thought about or wished for, but suddenly it’s enabled by the technology.

A: Rodin. I’m sorry, I just want to jump in and say clearly that, even in countries where the Internet isn’t as present, so much is happening through text messaging and through mobile technology throughout the developing world that is enabling all kinds of innovation.

A: Verveer. I think the 21st century calls for 21st century solutions, and all of us really thinking through that technology and its implications for the issues that we’re all so passionate about. I think that mobile banking has possibilities that we have yet to see. I was just in Kenya, and the experiments that are going forward are really striking. Continents that aren’t for the most part banked, where poor people for the most part have not been able to have their money make money, are going to see themselves in a very different place. My good friend Dr. Muhammad Yunus told me that in Bangladesh there is now one cell phone for every three people. The power of the cell phone is yet to be fully realized. It’s now being used increasingly to teach literacy. Kids who want to text and can’t read or write have a real problem, so they’re now more eager to be educated.

So we have yet to fully understand the rightful recognition that PATH is going to get today with the Humanitarian Prize. I think this is a wonderful example for this discussion, because what PATH has been able to do—take great technological innovation and apply it to critical needs across the spectrum from health to the economy—is an example for all of us of what’s possible. In the government, we see it the same way. Frankly, I want to bring together more and more representatives from the community, and there’s a great willingness on the part of entrepreneurs. Many of them have approached me without my even going to them fi rst, because I think, collectively, we understand that if women can have access to technology in greater ways than is available to them today, it can make a difference in poverty alleviation and changing their lives for the better.

31 When Secretary Clinton was just in the Democratic Republic of Congo (DRC), she made a series of announcements in that terrible, terrible place—in eastern DRC, where the confl icts have been going on for a long time—and among the things she talked about was our desire to explore the potential for technology, cell phones, to help service providers in ways that still aren’t being done and to help victims like they’ve been helped in this country and in Europe, for example. So there’s a lot of work across collaborative minds in ways that perhaps haven’t been done on a big scale, but we’ve been doing increasingly in the kinds of things that Judith talked about.

A: Rodin. I just want to pull together something from your last question about whether people are going to be focusing on women in these tough economic times. All you have to do is say to yourself, “All right, when I do this technology intervention, if I think about the interests of women, what would I do?” We do a lot of work in Kenya on food security. We gave mobile phones to each village so they could assess what their crops could bring. We decided to give the cell phones to the women in the village rather than the men and completely transformed the interventions. So you can have a win-win situation, if you just ask yourself that one additional question each time, and I think it’s eminently doable in tough times.

Q: Sergei Sorokin, Perkins International. Thank you very much. My question is on innovation, which is a risky business. If you would comment on that, as compared to the growing trend in the search for accountability, which is very welcome too. A promise of deliverables and measurable impacts could be in confl ict with investing in something that doesn’t exist and we’re not sure if it will be there or not, which is kind of the defi nition of innovation.

A: Rodin. I just challenged that assertion with the Toyota Company, which we took the original model from. Toyota asserts that they became the largest car company in the world because they invested early—the earliest, actually—in innovation. So it is risky, but if leveraged properly, it can lead to enormous economic growth and capacity.

Q: Musimbi Kanyoro, David and Lucile Packard Foundation. Ambassador Verveer will know that I have been working with women for many years, together with her. I want to ask what your comment is on this. I feel that when it comes to women, we’re caught up in a paradigm that marginalizes women because we think of the things that affect women. What if we were to change this paradigm and say, with every bilateral relationship the U.S. government has with any country, that relationship will begin by asking what we think about the security that this country has in relation to women—how do we think about the water system, whatever it is, but from the perspective of women.

Secondly, I think when we talk about education, what we know succeeded in education in the past was not just about individuals and education but about those who drive toward mass education that included men and women together. If this doesn’t happen—real mass education in all locations—I doubt that focusing on just the women will succeed.

Lastly, the other point that I wanted you to comment on is this: It seems very easy to get stories of “Janets” in various places—entrepreneurs who succeed, especially in the developing world—but we know that what has succeeded, particularly in Africa, is not so much that you get individual trees but that you get a whole forest growing. That’s why cultures seem to take a greater prominence, because they bind people together. What can we do that brings masses of women together and not just individual “Janets?”

32 Q: Begleiter. I’m going to exercise a moderator’s prerogative and ask you not to comment on education since we’ve talked quite a bit about that already. But maybe, Ambassador Verveer, you can comment on the issue of putting a women’s perspective fi rst in dealing with bilateral relations, and maybe both of you can comment on the culture issue.

A: Verveer. On the integrative model, this is really the basis in which I was asked to take on this position, which is that the Offi ce of Global Women’s Issues not be an adjunct of some kind, off to the side, but that the real commitment on the part of the Secretary of State and the Administration is that we really integrate these issues into all aspects of our foreign policy work. Whether it’s the work of the regional offi ces or the economics bureau, the Secretary has personally raised these issues in our bilateral relationships. Obviously, we have a great deal more to do. We talked this morning about creating a new paradigm, and it’s important not to just talk about it but to effectuate it and that’s certainly the path on which we wish to travel.

In terms of the larger cultural issues, the reference to the Janets wasn’t as individuals but what building the capacity of numbers of women across the world has done to unleash the potential of others. It is this multiplier effect we’ve been talking about. Janet herself, in Rwanda, employs several thousand women, and that number is growing. There are many, many, many women like her across the country and in other places. To create that critical mass, I think we have to do a better job in investing in emerging leaders who can make the kind of impact they have the potential to do.

Q: Carolyn Rose-Avila, Plan USA. One area we’ve focused on, and I’d appreciate your comments, is looking at the role of girls in the media and whether they are either reported on or under-reported on in the media. We’re focusing on building girls’ capacity to be journalists in Africa and other parts of the world, to be a part of reporting on their lives and their circumstances, and helping to improve the kinds of reporting that we have on girls. Also, to increase their access to technology and to communication technology in particular. I would like to hear from you about what kinds of experiences and comments you have in that regard.

A: Rodin. As I commented, women in all branches of government have become role models. They also tend to take broader perspectives when they think about policy issues that they are confronting. So too the issue of women in the media is going to be central both in terms of kind of coverage and role modeling.

I will say one negative thing that I hope you will look for. I was in Kenya recently and was interviewed extensively by the television media because we were announcing a signifi cant $100 million initiative on transforming health systems. I was struck by how very beautifully and made-up and skinny they all were. That’s something we’ve done in the developed world, in terms of promoting a single look for women in the media. I would really hate to see that disservice promoted around the world. As you’re thinking about these things, and what model and image women in the media are to perpetuate, I commend to you that very thorny issue.

A: Verveer. I agree with the point that Judith made absolutely, but I also want to say that investing in the girls is absolutely critical. I was just with a group of really vibrant teens in Africa who described what their lives are like every single day, whether in their families or in their schoolrooms; anywhere they go, violence lurks just around the corner. They are targets for abuse because of the low status that girls and women have in so many places. The role that the media can play in a very positive way is to

33 help lift up the esteem of girls, to put before them the possibilities they have, the differences they can make, that they aren’t relegated to the terrible circumstances in which they fi nd themselves. They are so critical to our future.

Q: Begleiter. One of the things that journalists do is that we’re able to translate complicated topics into simple forms that people, even like me, can understand. I think that’s what you’re saying: think about women in that context. Put them in a situation where they have to explain the climate change issue or the micro-economics issue in a way that everyone in the village can understand and, suddenly, you’ve empowered a small sector that is not technically-oriented but is media-oriented.

A: Rodin. And it can be very honest. One of the things they wanted to discuss with me is how they defend themselves. Imagine if they could do this much more broadly.

Q: Dr. Gerald Barney, Our Task, Inc. Both panels have noted our need for a long-term, systemic perspective, one informed by the views of women and the poor. The young people I work with—from 20 countries—are concerned about the Earth they will soon inherit, and they’re studying the outlook reports and sustainability strategies published by the World Bank and UN agencies. They are creating their own Earth Wiki to summarize what they fi nd in these reports, and preparing their own Youth Earth Plan describing changes they would like adults to make. What I think is most striking to them, is that many of the “long-term” outlook studies looking at their futures extend only to 2030, or sometimes to 2050. Think about how old a young person will be in 2030—about 40 years old! When the “long-term thinking” is so short-term, young people begin to think that adults really don’t care very much about planning for young people’s futures. I’m wondering if any of you on the panel see ways in which the voice of young people—who are doing serious thinking about the future of the planet—can be given some attention and taken into consideration?

A: Rodin. The scientifi c evidence and the Intergovernmental Panel on Climate Change reports extend well beyond 2030. I think one thing that you can help young people understand is that the reason that 2030 is the fi rst line of sight is that, unless we start enormously improving some of our goals regarding CO2 emissions—and in my view well before 2030 because the planet is in such dire shape according to the data—we won’t be able to have the long-term future that these young people want. I think we need to help them understand that 2030 is the fi rst timeframe for a rallying point for future action. Certainly, all of the discussion of mitigation strategies—whether deforestation or energy use or new kinds of cars or bio-fuels that don’t compete with food security goals—are conversations that are meant to be ensuring the future that these young people will have.

I’ve been in so many of these meetings, and the only times that I ever see opposing advocates agree is when somebody says, “Do this for your children and your grandchildren.” Then suddenly you see all the heads nodding in the room across so many opposing perspectives. So, young children saying to their parents and their grandparents, “Do this for me,” has tremendous impact.

We can see in another domain, for example, the impact that children had on their parents in smoking cessation campaigns and other kinds of health risk behaviors. So tell those young people they have enormous power and they need to start by infl uencing the behavior at home—their parents’ energy use, the kind of car they drive, etc. That should be enormously empowering to them. Get that Wiki with good ideas about how I got my dad to buy that or do this, and then move on to broader constituencies. I see a movement really led by the young people that will have enormous impact.

34 A: Begleiter. Not to mention the technologies themselves, for example, texting on phones. Young people are going to be motivated in directions that they might not have been by merely the technology itself.

Q: Doris Lee McCoy, American Spirit Foundation. I’m just fi nishing up on a book called Visionaries Change the World, and I’ve been fascinated by some of the things you’ve talked about. I’ve gone to all the UN international women’s conferences, and my question is, how can we really empower women to embrace the position that some of the countries have given to them, where previously they’ve been considered second-class citizens?

A: Verveer. Well, I think it’s role-modeling and mentoring to a large extent. I am really inspired every day by things I see in places around the world, where you wouldn’t expect women to be on the front lines of change. They are making a huge difference, sometimes with great sacrifi ce and effort, by infl uencing others, by leading by example, and by seeing the benefi ts of change and their desire to improve.

One of the most powerful modalities in which to do that is when you talk to women about their children’s futures and the kind of world they want to create. It brings them to peace tables where they make huge differences, and it brings them to other areas where they make critical decisions for action in their countries. It is happening in every place, and I think with greater efforts on the part of all of us to invest in those possibilities for them, greater numbers will be participating.

Q: Susan Davis, BRAC USA. Is there a concrete example you can give us on how, in Afghanistan and Pakistan, the U.S. government is considering women’s issues or the perspective of women in formulating our strategy, and do you see some light there?

A: Verveer. Susan, thanks for that and for everything that BRAC does. Certainly, the counter-insurgency that’s been adopted for Afghanistan—obviously a very diffi cult situation, but a strategy to help civilians and to help the people improve their lives—cannot happen without women participating. I was there several weeks ago in an effort to convey how critical women are, which I try to do with everybody from the President to the media, and also in terms of announcing a series of investments to help build women’s capacity.

One evening, there was a small panel of women that opened with one of them saying, “Please look on us as the leaders we are, not as the victims.” They understand, deep down, that they need to be part of the change that has to come to that country. Afghanistan was once a great agriculture producer, and women and men worked together. There’s no reason why they should be importing some of the food that they’re importing. Women are pleading to be part of animal husbandry, part of agricultural development, and part of improving the lives of the country. That is our goal and we’re making a number of investments. We’re currently trying to bring the same kind of evaluation to what is going on in Pakistan, because women have to be part of the economic program and education is an absolutely critical, bedrock issue as it is in Afghanistan.

35 PANEL THREE SUMMARY

Hilton Humanitarian Prize Laureates: Greater Than the Sum of the Parts

At the 2005 Hilton Humanitarian Symposium in Geneva, the Hilton Humanitarian Prize Laureates discussed informally the idea of fi nding ways to work in collaboration, to learn from each other and share lessons learned. Jo Luck, President and CEO of Heifer International offered to host the fi rst meeting in Little Rock, Arkansas. As of 2009, Heifer International has already formed partnerships in the fi eld with fi ve Hilton Humanitarian Prize Laureate organizations. Jo Luck outlined seven objectives that emerged from that fi rst meeting in Little Rock:

• Provide an opportunity for Hilton Humanitarian Prize Laureates to meet in a collaborative environment; • Build team spirit and expand commitments to a collective purpose; • Create a venue for critical discussions on how collaboration can increase the collective global impact of Laureate organizations; • Explore specifi c opportunities and raise awareness of humanitarian needs and effective responses; • Add value to the Hilton Humanitarian Prize and the participating organizations; • Explore opportunities for long-term networking and collaborative efforts in order to achieve greater overall impact; and the fi nal objective, • Discuss repeating the roundtable—initially to be convened each decade but so far held annually— for updates and a review of the lessons learned.

The Conrad N. Hilton Foundation has recently awarded Women for Women International (WfWI), Heifer International, Partners In Health and International Rescue Committee, a grant to launch a two- year monitoring and evaluation capacity initiative. Karen Sherman of WfWI said, “We feel that, as high- performing organizations, we can bring some expertise particularly at the fi eld level, where we can talk about strengthening monitoring and evaluation efforts, compile some best practices, and disseminate them among the other Laureates and within the broader development community.”

Examples of collaboration among Laureates to improve health systems and train humanitarian workers were presented.

Jo Luck of Heifer International commented on its partnership with Women for Women International: “The skills Heifer brings are farm management, animal well-being, agro-ecology, improved nutrition and increased income. We’re working in Kosovo and in Bosnia with Women for Women and, of course, they bring to this partnership the training of women in skills…Livestock [offered by Heifer] helps to improve nutrition and increase income, while the important technical skills, training, education and emotional support from Women for Women helps to instill hope and self-suffi ciency into the lives and families of the affected women. One of the women’s projects that we collaborate on…works to heal war wounds by getting people to work together for a brighter future.”—Jo Luck, President and CEO, Heifer International

“Tostan [is] working in eight African countries…In 2008, Operation Smile decided to come to Senegal [for the fi rst time.] I’ve [Molly Melching] been there 35 years and Tostan has been active in all regions of Senegal and in all of the sub-regional areas, [so] we decided to collaborate. Tostan helped to 36 fi nd them an adequate hospital where they could operate on children with cleft palates in the city of Thies. Tostan has a training center next to the hospital, so we housed all 50 members of their team, while the Peace Corps provided housing for all the families that came with their children from all over Senegal. We even had one desperate young man who walked all the way from Guinea to be operated on. Tostan did radio programs to inform the populations of this amazing opportunity and we put up posters everywhere. Something like this had never really happened in Senegal before, so people did not quite understand. Despite that, we had 70 patients come on the fi rst day.”—Molly Melching, Founder and Executive Director, Tostan

“For these collaborations to work, we have to be very proud of what we’re good at, and want to be the best at it. But, we also have to be humble enough to understand what we’re not good at, and enjoy the fact that other people are…With Tostan, many people were involved in that community activity to get those people there, to do everything that was necessary…[another example] There is Dr. Mary May, who is a general surgeon and now works half-time for Partners In Health [in Haiti] and half-time for us, so collectively both organizations share that resource. We both save money, we both win… Partners in Health’s infrastructure [in Rwanda] allowed us to immediately start taking care of 300 children.” —William P. Magee, Jr. D.D.S., M.D., Co-Founder and CEO, Operation Smile

“This is a brand new…partnership we’re starting with International Rescue Committee (IRC) in Congo to address gender-based violence, which many of you know is a huge and pervasive problem there. Women for Women has been working on the ground there for many years, and we work with about 8,000 women in a given year…We’re thrilled to be aligning with IRC to be able to expand the reach of our services to many more women in these communities. Both of our organizations are working with the most socially excluded populations there, so this will probably double, even triple the number of clients we can serve with this program. IRC is the lead on this project and we’re providing the core program of rights awareness, leadership training, vocational skills training and a particular focus on how we can enable economic empowerment for those women who have been victims of gender-based violence.”— Karen Sherman, Executive Director for Global Programs, Women for Women International

“In just four years we’ve had some incredible successes…with Operation Smile in Haiti and with Heifer in Rwanda…I want to highlight two partnerships because they focus on nurses…The training that Operation Smile and Médecins Sans Frontières provide is fantastic. We’re allied with Harvard, which many people know doesn’t have a nursing school, so partnerships that actually focus on nurses and nursing skills and will empower the nurses to do better work and are critical to the success of all the projects that we do. [Also], even before PATH [this year’s Hilton Prize recipient] was nominated, we signed a memorandum of understanding with them to start focusing on women’s health issues and looking at some of the most serious problems in women’s health in Haiti, like cervical cancer, and working with them on solutions for protection and treatment…That’s the wonderful thing about the partnerships that we’ve developed with all the Laureates—we’re able to look at a person or a community as a whole. We’re not just looking at health, or food and nutrition, we’re not just making sure there’s clean water. But in fact, in partnership with these groups, we’re able to look at a person as a whole and fulfi ll all the human rights.”—Donna Barry, Advocacy and Policy Director, Partners In Health

37 Jo Luck, President and CEO, Heifer International

Jo Luck began her Heifer International career as the Director of International Programs. In 1992, she became president and CEO. Since that time, Heifer has grown from a $7 million organization to over $100 million, thus increasing its programmatic impact. Jo Luck has received numerous awards, including Arkansan of the Year, the International Women’s Forum “Women Who Make a Difference,” Rotary International’s “Service Above Self” and the Forbes Executive Women’s Forum “Trailblazer Award.” Additionally, Heifer International has been recognized with several awards including the Martin Luther King, Jr. Commission “Salute to Greatness”; Fast Company’s Copernican; the Phoenix Award, and the Conrad N. Hilton Humanitarian Prize. Most recent 2007 awards include the American Institute of Architects Top Ten Green Projects Award; the National Garden Clubs’ Award of Excellence; the Elizabeth Craig Weaver Proctor Medal, Garden Club of America, May 2007; and the Humanitarian Award, Bon Appétit, September 2008. Jo Luck is the recipient of several honorary degrees in the humanitarian area. She currently serves as Chair of InterAction’s Board of Directors, the largest alliance of U.S.-based international development and humanitarian nongovernmental organizations.

We’re going to share the stories of our collaboration and my colleagues will tell you of some very exciting partnerships. I have the assignment of explaining some of the history of how we got to this point, and I’m honored to do that. Just to let you know, we’re a diverse group in this room, and our Laureates are a diverse group from all around the world, doing many kinds of work.

We were honored with the Hilton Humanitarian Prize for our impact in this world—an impact that is signifi cant, sustainable and successful. But just think, if we take those skills and that passion and put that capacity together in a partnership, how much greater that impact might be. That is why, in 2005, as we gathered for the Hilton Humanitarian Symposium in Geneva, we began discussions on why we were not collaborating more. We wanted to explore the possibilities and talk about it in depth, so I offered to host the fi rst meeting. There we were, sitting in Geneva, and I invited everyone to come to Little Rock, Arkansas, in the United States. People looked puzzled. “Where’s Little Rock?” But, within less than a year’s time, Heifer International was honored to host the meeting in Arkansas where we had a delightful and meaningful gathering.

After considerable discussion and facilitated group work, the Laureates articulated our purpose: “This Roundtable will be a unique opportunity for humanitarian organizations that represent various sectors of social and humanitarian work to come together and develop multisectoral approaches that will advance holistic development throughout the world. The Roundtable will provide a venue for the Prize winners to learn from each other and share lessons learned, building upon experiences. The Roundtable will also forge a special bond between each of the organizations, unifying and strengthening the ties created by being a Hilton Humanitarian Prize recipient.”

When we came together at our initial meeting, nine of the 10 Laureates were in attendance. Since then, of course, we have added four more prize winning organizations and, as of today, PATH has joined the list as well. I will highlight two or three objectives that we have set as Prize Laureates.

During the 2005 meeting, we identifi ed our objectives: We want to provide an opportunity for Hilton Humanitarian Prize Laureates to meet in a collaborative environment; build team spirit and expand 38 commitments to a collective purpose; create a venue for critical discussions regarding how collaboration can increase the collective global impact of these organizations; explore specifi c opportunities, and raise awareness of humanitarian needs and effective responses; add value to the Hilton Humanitarian Prize and the participating organizations; explore opportunities for long-term networking and collaborative efforts in order to achieve greater overall impact; and the fi nal objective was to continue participating in the roundtable gatherings.

The 2005 objectives created the foundation for a rich discussion, during which we explored different ideas and talked about a myriad of topics such as ending poverty, health care issues, sustainability, volunteerism, youth issues, generational growth, human rights, advocacy, how to make collaboration happen in this busy world—connecting virtually, linking websites, focus on youth groups and joint messaging. After hours and hours of discussions with resource individuals and facilitators we collectively authored our Laureates’ Declaration of Purpose:

“Inspired by each others’ outstanding work alleviating human suffering, we today announce our shared commitment to expand current and explore collaborative projects that combine our dedication, passion and recognized competency in addressing humanitarian tragedies. We seek to inspire people everywhere to join us in supporting this historic effort, to capitalize on the synergies inherent in partnership… We will work together at the grassroots level in developing countries to explore new ideas for collaborative work in education, health and youth development. Specifi cally, we intend to target improving health systems and training local humanitarian workers…The collaboration will be ongoing and expanded, and we will welcome participation by future winners of the Hilton Humanitarian Prize.”

We emphasized that the purpose was not to dilute the beauty of an organization’s work but rather to build on it. Today’s panel entitled “Greater Than the Sum of the Parts” is a perfect description of who we are. We have increased partnerships, networking and information sharing through our collaborations. While our diversity increases, our commitments unite.

Partners In Health hosted a Laureates’ meeting in Boston in May 2007—our second one—and, in July of 2008, the Hilton Humanitarian Prize Laureates’ retreat was held in Washington, D.C., at which time the Laureates reaffi rmed the joint declaration. Since then, opportunities have been discussed for bilateral collaboration; planning, monitoring and evaluation strengthening; and possibly articulating standards and core values we all share that allowed us to win the Hilton Humanitarian Prize.

Heifer International has been very fortunate. We have partnered with Partners In Health, International Rescue Committee, Operation Smile, Women for Women International, Tostan, and we’re in conversation with many others.

In closing, I’m going to tell you quickly about one partnership we share with Women for Women. The skills Heifer brings are farm management, animal well-being, agro-ecology, improved nutrition and increased income. We’re working in Kosovo and in Bosnia with Women for Women and, of course, they bring to this partnership the training of women in skills, including handcrafts, embroidery, carpet weaving, continuing education, leadership development and civil rights awareness. Livestock helps to improve nutrition and increase income, while the important technical skills, training, education and emotional support from Women for Women help to instill hope and self-suffi ciency into the lives and families of the affected women. One of the women’s projects that we collaborate on is called “Healing

39 the Past for the Communities with the Same Fate and Together Working for Peace.” The project works to heal war wounds by getting people to work together for a brighter future. It’s a beautiful thing to witness fi rsthand, as you all know from the work that you do, and from the images that you will be seeing as we share our stories.

It is my privilege to say Thank You to Steve Hilton and the Conrad N. Hilton Foundation, and to Judy Miller, who helps us with our work, enabling us to do our best—not for the Prize, but for our respective missions that fi t with the late Conrad Hilton’s vision of a better world. Thank you for encouraging us to continue working together in seeking to take our impact to a higher level. While we’re just talking about Laureates today, we’re really working in partnership with you all—many in this room, and many not here today, in order to achieve a better quality of life for others. We’re not an exclusive group, we’re just trying to fulfi ll this great privilege we have in serving as Hilton Humanitarian Prize Laureates. And fi nally, to the Laureates, it is a great honor for me to serve on your team.

40 Molly Melching, Founder and Executive Director, Tostan

Having lived and worked in Senegal for over 32 years, Molly Melching has dedicated her life to the empowerment of communities at the grassroots level. She has created two original basic education programs for women, adolescent girls, and their communities. Molly is highly regarded for her expertise in non- formal education, human rights training, and social transformation. Her work with Tostan, the NGO which she founded in 1991, has brought her international attention for cross-cutting results in many areas of development—including reductions in infant and maternal mortality, wide-spread school and birth registration, the emergence of female leadership, the abandonment of female genital cutting (FGC) and child/forced marriage by over 3,869 communities in Senegal, Guinea, and Burkina Faso, in addition to many other positive results. Molly received the Humanitarian Alumni Award from the University of Illinois at Urbana-Champaign in 1999 and the Sargent Shriver Distinguished Award for Humanitarian Service in 2002. In 2005, she was awarded Sweden’s Anna Lindh Award for Tostan’s work in human rights.

Thank you, everybody. I’m also very honored to be here today. Tostan has a basic education program which lasts for three years and prepares communities for leading their own development. We are currently working in eight African countries.

We were very open to new partnerships with other Prize Laureates, because our program really lends itself to working with other partners in communities. I have the honor today to talk to you about one of the collaborations we’ve been able to develop with the wonderful organization, Operation Smile. I’m particularly happy because it was very meaningful to me personally.

In 2002, when we were working in the rural village of Keur Thione Sarr, a village participant came to me in distress and said, “Come to my house and look at my daughter. What can you do? How can you help me? I know that Tostan works on health education, but we need more than just health education for our daughter, so what can you do?”

Little Mbayang Diouf had a cleft palate and her face was horribly disfi gured. I did everything I could. I really did not know where to go, but I tried to fi nd someone who could help this child. Unfortunately, I found no one.

When we won the Hilton Humanitarian Prize in 2007, we started discussions with other Laureates on potential partnerships. We began a partnership with the Heifer Foundation in 2008 and started discussing with others also. Then, in 2008, Operation Smile decided to come to Senegal. Now, they had never been to Senegal, but, because I’ve been there 35 years and Tostan has been active in all regions of Senegal and in all of the sub-regional area, we decided to collaborate. Tostan helped to fi nd them an adequate hospital where they could operate on children with cleft palates in the city of Thies. Tostan has a training center next to the hospital, so we housed all 50 members of their team, while the Peace Corps provided housing for all the families that came with their children from all over Senegal. We even had one desperate young man who walked all the way from Guinea to be operated on. Tostan did radio programs to inform the populations of this amazing opportunity and we put up posters everywhere. Something like this had never really happened in Senegal before, so people did not quite understand. Despite that, we had 70 patients come on the fi rst day. 41 When I found out that Operation Smile was going to come to Senegal, I immediately went to Mbayang’s village to see how she was doing and to announce to her that she would undergo a radical change in her life. I told her family to take very special care of her and be sure she not get a cold, because then they wouldn’t be able to operate. That December, Mbayang was the fi rst patient for Operation Smile. To this day, she still wears her bracelet from the hospital. After the operation, Tostan invited one of the team members, Dr. Peterson, to come and see how thrilled the community was to welcome back one of their children who had never before been able to leave the village because of her disfi gurement. Although she had been well accepted by community members, she had never been outside the village, so as you can all imagine this made a huge difference in her life. The entire village came out to sing and dance for Operation Smile, and for the work they had done in transforming in Mbayang’s life.

I went back before I came here so I could tell you what she looks like six months later and learn about her new experience within the community. She looks normal, just like everyone else, and she is thrilled. We continue to get phone calls from all 70 patients who came for that Operation Smile visit and we are told repeatedly that all of us involved in this partnership are assured we will go to heaven! So, I want to thank Operation Smile and the other Laureates for this and the other partnerships that we are working on establishing in the future.

I want to leave you with a proverb from Senegal: “If 10 people dig, but 10 people fi ll in, there will be lots of dust, but there will be no hole.” We Laureates have started by collaborating to dig together in harmony and have achieved important goals. If we continue, all of us, to dig together, I’m sure we will achieve a better world for everyone.

42 William P. Magee, Jr. D.D.S., M.D., Co-Founder and CEO, Operation Smile

Dr. William P. Magee Jr., is a leading plastic and craniofacial surgeon who founded Operation Smile in 1982 with his wife, Kathleen S. Magee, and serves as the organization’s Chief Executive Offi cer. Operation Smile is a worldwide children’s medical charity whose network of global volunteers are dedicated to helping improve the health and lives of children and young adults. In 2007, UNICEF presented the Magees with a special recognition on behalf of Operation Smile. To date, Operation Smile has treated more than 135,000 children worldwide and currently has programs in 51 partner countries, and Dr. Magee has trained thousands of physicians worldwide. A featured guest on many network television programs, Dr Magee is also a keynote speaker at many corporate and national meetings. Dr. Magee received a D.D.S. from the University of Maryland, M.D. from George Washington University Medical School, served his general surgery residency at the University of Virginia Medical School and received his plastic surgery training in Norfolk, Virginia. Awarded the Hays-Fulbright Scholar Grant from the Franco-American Commission, he studied in France with Dr. Paul Tessier, the father of craniofacial surgery. He has been published in numerous medical journals and medical texts, and was honored by the American Medical Association and the American Plastic Surgery Society. He has been awarded honorary doctorates from six universities and the American Medical Association honored him with its 2000 Pride in the Profession Award; and he received the Distinguished Service Award from the American Society of Plastic Surgeons. He maintains a private practice in Norfolk and is Co-Director of The Institute for Craniofacial and Plastic Surgery in the Children’s Hospital of The King’s Daughters. He is a Professor of Plastic Surgery at the University of Southern California and an Associate Professor at the Eastern Virginia Medical School.

I’d really like to thank Ralph and all the individuals, the Laureates, and the Hilton Foundation for the incredible opportunity to be here with you. Collaboration is important; it requires trust and it requires a lot of basic concepts that need to be internalized in individuals for it to work. Being a surgeon, I am focused on the fact that a chance to cut is a chance to cure, period. But I am blessed with a wife, Kathy, who has a much bigger view of the world than I, and Operation Smile would not be what it is 27 years later without her constant, 80-hours-a-week presence.

We are now in a position, with about 6,000 medical volunteers, to go out and do things. But we can’t do everything, and I thought I’d just use some basic examples of individuals that I’ve met along the way to tell the story of the importance of collaboration. Who is the hero in this process? When someone gets changed, a life gets changed, a life gets saved. The bottom line is it’s awfully diffi cult to fi nd out who the hero is. So, let me tell you about a little girl named Baby Sharon, who came down to see us in Kenya a number of years ago. This child was born fi ve days earlier, and her mother was told that the only way she could live was to take the bus ride down to see the Operation Smile team. It was dusk one evening when the mom and this little child were wandering aimlessly around the hospital complex. My wife was with two individuals who had recently won $186 million in the lottery in Chicago. They had come over because they wanted to help Operation Smile, and so, as the sun set that evening, the three of them saw this poor woman and said, “Can we help you?” The woman took the blanket off this little baby’s face and what they saw was a child with a very signifi cant problem. They knew they couldn’t do anything to help the child at that moment, but the people who won the lottery said they would leave $5,000 for her to make sure that she got good health care. “When the child gets big enough, we’ll bring you to the States and make sure you get care.” 43 However, the story really doesn’t begin there. The story begins with a fellow named Pete Colletti, who was a dental student with one of our sons. He got a dental degree and moved to Chicago, where he hap- pened to be the dentist of this particular family. One evening, I got a call from Pete Colletti, who’s your classic Italian-American kid from New York City, and he says, “Hey, Doc, I’ve got this lady in the chair; I’m working on her. When the time is right, I’ll tell you more.” I said, “Thanks, Pete.” Two weeks later, he called me again and said, “Doc, the time is right. This lady and her husband won $186 million in the lottery and she wants to work with Operation Smile. Give her a call.” I got on the phone and said, “This is Bill Magee. I’m a little embarrassed to talk to you because I’m sure hundreds of people are calling you right now, so if you want to hang up, it’s OK.” She said that no, she really wanted to be involved and so she got involved in Kenya.

We ended up bringing Baby Sharon back to the States and operating on her. In the recovery room, her mom took a look at her bracelet to be sure it was the same child after a 14-hour operation. The couple who won the lottery came in from Chicago to be at her bedside, because they were invested not only fi nancially, but emotionally, in this little kid who they felt a very special bond with. The beauty of it is that this child is now seventh in her class of 27 kids.

Who is the hero? It’s easy, as a surgeon, to stand up and think that people say, “What a great operation,” but the truth of the matter is the surgeon is only a very, very small part of it. If there wasn’t a great an- esthesiologist who kept that baby alive for 14 hours, this would never have happened. If it wasn’t for great nurses, it wouldn’t have happened. If it wasn’t for great equipment in the hospital, a great hospital system, it wouldn’t have happened. If it wasn’t for a great Intensive Care Unit staff and pediatricians, it couldn’t have happened. If it wasn’t for that couple, the lottery winners, it wouldn’t have happened. And if it wasn’t for Pete Colletti, it wouldn’t have happened. So who’s the hero?

The reality is that the Hiltons have given us the privilege to be together. Humility is very important in any organization. For these collaborations to work, we have to be very proud of what we’re good at, and want to be the best at it. But, we also have to be humble enough to understand what we’re not good at, and enjoy the fact that other people are. If you take a look at the collaborations that we’ve had the opportunity to be included in, we can’t even begin to count the number of human beings involved— with Tostan, how many people were involved in that community activity to get those people there, to do everything that was necessary? By the time you start counting everybody, there would be hundreds, if not thousands of people who were responsible, in one way or another, to make that happen. The reality is that we need each other, and we need to be humble enough to understand that.

I just want to thank Tostan, Partners In Health, the Conrad N. Hilton Foundation, and all the Laure- ates that we work with, because, in the end, if you take a look, it’s about win-win situations. There’s a fellow named Dr. Josue Augustin who, unfortunately, passed away about two weeks ago. He was a signifi cant member in Partners In Health. He was incredible in every way. Although I never met him, I’ve heard innumerable stories about him and he was the kind of spiritual head, if you will, of Partners In Health down in Haiti. And it was he who allowed us to take care of children with cleft lips and cleft palates. Even though his primary vocation was internal medicine and the beautiful work that Partners In Health does in Haiti, he had the ability to know where these kids were and where to bring them, and the humility to know that he and his colleagues weren’t surgeons. Why recreate something if you don’t have to?

44 There is Dr. Mary May, who is a general surgeon and now works half-time for Partners In Health and half-time for us, so collectively both organizations share that resource. We both save money, we both win. She’s an incredible individual. As we do our screening, we fi nd a kid with a cardiology problem. We’re not good at cardiology, but we have a cardiologist there with the Partners In Health staff, who can help, and, as they screen patients, Partners In Health staff might come across a kid with an encephalocele, and, because of their relationship with Harvard, they can save that kid’s life. And then there’s the nursing training that we run with the American Heart Association; we’re able to bring those programs down to Haiti to help the nurses there. It is a win-win situation, it goes both ways. When it’s right, it’s right.

To listen to the stories that now come out of Rwanda—that just last week 300 children showed up for care—and to understand that it was Partners In Health’s infrastructure there that allowed us to create the trust to almost immediately start taking care of these kids, and our ability to take care of them while Partners In Health was able to make sure their condition was followed up properly. All of these things couldn’t happen without each other, and they would never have happened without the Hiltons.

Let me close with a thought that I think is important. It comes from an experience that I recently had in Ethiopia. We were in Addis Ababa. About a thousand kids showed up for surgery at a hospital that held 2,000 patients, in a place where literally people come to die. You would be hard-pressed to fi nd a bathroom or a shower in that place. In that setting, a family came up and I met them on a second-fl oor landing. The story that I was told was that the mother had died two years before and the father had remarried. There were three boys, two with cleft lips, one 17 and the other seven years old. When the father remarried, he felt that they were a curse to the family and he ostracized them. The older brother took them under his wing to bring them in and get them some care. As I met them, the 17-year-old had totally lost his spirit. The seven-year-old still had his spirit, but the 17-year-old had his cap pulled down over his eyes with a mask on his face. As I walked up to him, I said, “Shake my hand.” And he limply shook my hand. I said, “No, squeeze my hand.” He held it a little tighter. I said, “Really squeeze my hand.” After about 30 seconds, he fi nally held my hand fi rmly. Then I said, “Now look me in the eyes,” and as he did, his hand went limp. So I said, “No, look me in the eyes and squeeze my hand at the same time.” After about another 30 seconds, we got that move down. Then I said to him, “Let’s try to look at things a little differently. I can promise you that tomorrow we can fi x your lip, but I can’t promise you that we can fi x your spirit. You’ve got to do that. So let’s start looking at life differently. Let’s start looking at your cleft lip as your gift. You’ve been given the gift of a cleft lip, and if you understand that it’s a gift, you can use it to help other kids in your country and in your community to understand the gift that they’ve been given. So we’ll make a deal. I’ll promise you that we’ll fi x your lip if you promise me that you’ll use your gift to help other people for the rest of your life.”

The bottom line is that all of us up here and all of you out there, every one of us, has a gift. The ques- tion is, are we using our gift to work together with others to make signifi cant change in our world? The challenge is an exciting one. We’ve got to be humble. We’ve got to know what we’re good at, be proud of it. We’ve got to know what we’re not good at and rejoice in the people who are. I thank every single one of you, the Hiltons, every single one of the Laureates, because your gifts have helped us become a better organization today.

45 Karen Sherman, Executive Director for Global Programs, Women for Women International

Karen Sherman is the Executive Director for Global Programs at Women for Women International (WfWI). She provides dynamic leadership and strategic oversight of Global Programs and is responsible for the development and execution of the organization’s programming in accordance with WfWI’s mission of serving women survivors of war and confl ict. She spearheads efforts to enhance the impact, depth and scale of WfWI programming and advises the CEO, President, Board, and senior colleagues on global issues and trends. Her passion, vision, and creativity are pivotal in achieving the organization’s goal of affecting lasting change in the lives of women, their families, and communities. Ms. Sherman has 25 years of multi-faceted international development experience spanning a wide variety of development contexts and challenges. She possesses a comprehensive understanding of the issues affecting countries in transition. Ms. Sherman specializes in the design, implementation and management of technical and fi nancial assistance programs, and over the course of her career, has managed a diverse portfolio of economic, social and civic development programs targeting women, entrepreneurs and non-governmental organizations.

Good afternoon and thank you very much. I’m thrilled to be here, as is Women for Women International, and to be among such a distinguished group of Laureates, not just the ones sitting up here but the entire community.

If I may, a little about Women for Women International. As some of you know, we work with women survivors of war in confl ict and post-confl ict zones around the world. We’re a 16-year-old organization, which is a lot younger than some of the organizations sitting up here, but we’re scrappy. We’re working for four key outcomes. First, that women are well—meaning they have a basic level of physical and psychological wellness. That they have rebuilt social networks and safety nets—this is especially important post-confl ict when a lot of women have been isolated because of war, shamed because of mass rape and atrocities—and that they are able to come together in groups again both as participants in our program and afterwards, in their economic activity. Also, that women can contribute to family and community decisions. This is so important for women to have a voice in their family and community decision-making. Around the world, most women do not contribute to decisions and are kept away from decision-making tables. And, fi nally, that women can sustain an income—important because, when women are contributing economically to their communities, they are treated differently by society at large. As a result, what we fi nd is that there’s less violence against women, there’s more stability and—as we’ve heard from the panel earlier today—that women are more likely to invest in the health, education and nutrition of their families.

A little bit about partnerships. Because we’re a smaller organization, we tend to partner to increase the scope and reach of our services. This is so important because, in areas where we can’t lead or offer our programs on a large scale, we can link with organizations that can offer that scale for us, and have a greater impact with our programming. Also, we’ve started a lot of training programs in areas like sustainable agriculture, because that’s what women are asking for and the market demands. It’s not something that’s a core area of expertise for Women for Women, so we look for partners who can help us expand our expertise, and increase the market access for our clients, in areas like micro-credit and access to market partners where we’re able to negotiate those kinds of relationships on behalf of the women we’re working with. 46 Women for Women has been involved in many types of partnerships over the last few years. We obviously have funding partners, but, most importantly, we have implementing partners. Some of these partners are among this Laureate group and some are not in this room but are equally as valuable. There’s a whole chain of relationships that we establish in the fi eld that advances our work collectively, and those kinds of partnerships are what allow us to do that. We’re negotiating with partners at local, regional and international levels to help provide greater opportunity for the women we are working with.

I’d like to describe a couple of new partnerships. Our partnerships are, in some ways, just getting off the ground with some of the Laureates but we’re really excited about the potential for them. You already heard from Jo Luck about the partnership we have going in Bosnia and Kosovo with Heifer International, which we’re actually expanding to Rwanda in the next year. There is also a brand new, hot-off-the-presses partnership we’re starting with International Rescue Committee (IRC) in Congo to address gender-based violence, which many of you know is a huge and pervasive problem there. Women for Women has been working on the ground there for many years, and we work with about 8,000 women in a given year. Compared with IRC, that’s a drop in the bucket, so we’re thrilled to be aligning with IRC to be able to expand the reach of our services to many more women in these communities. Both of our organizations are working with the most socially excluded populations there, so this will probably double, even triple the number of clients we can serve with this program. IRC is the lead on this project and we’re providing the core program of rights awareness, leadership training, vocational skills training and a particular focus on how we can enable economic empowerment for those women who have been victims of gender-based violence. It’s a very diffi cult thing to do in a place like Congo, where you still have violence in a lot of places. Women feel very insecure, and that insecurity has a direct impact on their livelihoods. It requires a special level of effort to create economic opportunities. This work with IRC offers greater potential to reach scale and impact more women.

The project’s three objectives are to enhance the quality and treatment of women affected by gender- based violence; to improve the capacity of the local infrastructure to respond to gender-based violence; and to improve integration and recovery activities, particularly at the economic level. Women for Women actually just completed a study with 2,000 respondents in the Democratic Republic of Congo and what we were able to show is that, when women are earning money, the violence level goes way down in the family. We’re hoping that this tandem approach makes a huge difference in addressing women’s security and women’s economic empowerment.

Another new partnership which we’re just effectively launching at this meeting is something that we’re thrilled about. The Conrad N. Hilton Foundation has just awarded us a grant, with our wonderful partners Heifer International, Partners In Health and IRC, to launch a two-year monitoring and evaluation capacity initiative. It’s a unique collaboration, the fi rst multilateral initiative of its kind, and it’s really a timely and important topic. For Women for Women—and I’d venture to say for a lot of the other organizations in this room—monitoring and evaluation is probably one of the most critical issues that we deal with. How do we become better at, not just monitoring, but evaluating our impact qualitatively, quantitatively, with external evaluations? How do we use technology to increase our monitoring and evaluation efforts? There are many opportunities around this that haven’t been explored, and we feel that, as high-performing organizations, we can bring some expertise particularly at the fi eld level, where we can talk about strengthening monitoring and evaluation efforts. We can talk about monitoring and evaluation efforts and compile some best practices around this, at this level, and how we can disseminate them among the other Laureates and within the broader development community.

47 I think we can enhance fi eld-level expertise on monitoring and evaluation. We have struggled with this as an organization when all our fi eld offi cers are saying, “Why do we need this data and who’s asking for this data?” and “How is this data going to be used?” We can raise the bar. “Why are we doing this in the fi rst place?” Not because donors are asking for it—although donors are very important—but because we need this to improve the quality of our work and the effectiveness of our interventions and it’s data that we need to know ourselves.

Some of the key benefi ts of this partnership will be this joint development of an impact framework. I think the plan is to have several meetings and trainings where we can enhance our expertise and bring in some additional resources—there’s actually a lot of expertise around the table already. This isn’t just about having outside people come in, but us having a chance to learn from each other and bringing some of those best practices to the table.

There are areas where we can look to create greater effi ciencies and scaling around our monitoring and evaluation efforts. A lot of us, for example, are working in Rwanda, so there are many opportunities where we can come together, join our resources and look at how we can impact our programming through impact evaluations more broadly.

I think creating an infrastructure for monitoring and measuring capacity building is going to be hugely important. We don’t analyze ourselves very much and say, “OK, we’re collecting all this data, now how will we use this information to retool our programming and our thinking and our strategies?” This will provide an opportunity to be able to do that. Most exciting, I think, is to be able to share this information more broadly.

There’s a lot of opportunity for partnership, increasing the impact on your target population, the chance for greater linkages to markets and other resources, and just to be able to facilitate dialogue on a larger scale. Some of the challenges that we have with partnerships—and this is more historical, not Laureate- specifi c—have been making sure that everybody is on the same page and that we are partnering for strength. Sometimes when organizations come together, you have to leave your organizational ego on the side because it’s important that you say, “What are the goals of this partnership? How can we work together? How can we be most effective?” Sometimes it means that you’re not the lead, sometimes it means that you don’t get the most attention, but it often means that you have a more effective program. Also, you have to be very clear about your goals and objectives for that partnership, and look for ways to minimize those competing interests where possible.

Finally, some of the best practices—from our experience—around partnerships are ones that are not one-off kinds of partnerships, which is what I love about working with the Laureates here. These, I know, are going to be strategic and lifelong partners of the organization. So, it’s important that it’s long- term engagement, and you must be goal-oriented. What is it that you want to achieve, individually and collectively? Make sure you’re aligned; that’s not always the case. Make sure you’re communicating regularly, that you’re not going your own way. That can easily happen when people are too busy and not talking and sharing strategies. Make sure that everybody knows who’s responsible, who’s doing what. And fi nally, make sure that there are resources available to actually implement the partnerships. I’ve seen partnerships that have been under-resourced from the beginning and those happen to be the ones that are not the most effective. Knowing where the resources are going to come from and being able to apply those resources to your outcomes is very important. Thank you for your time.

48 Donna Barry, Director of Advocacy and Policy, Partners In Health

Donna Barry, NP, MPH, is currently the Director of Advocacy and Policy at Partners In Health (PIH) as well as a clinician who provides support to all PIH’s reproductive health programs. Previously she led the Partners In Health project to treat multi-drug resistant tuberculosis (MDR-TB) in Russia and worked on women’s health programs in Haiti. She is guiding PIH’s advocacy and policy efforts related to health and hunger, socio-economic development in Haiti, increasing the pool of funding for global health and the health care worker shortage. She has participated in briefi ngs and hearings in the U.S. House of Representatives on Haiti debt relief, MDR-TB and reproductive health. Barry is a nurse practitioner with certifi cations in women’s and adult health. She earned degrees in Political Science and Russian at Saint Louis University, and then went on to Columbia University in New York, where she earned Masters’ Degrees in International Affairs and Public Health. Barry is very active in local and national Democratic Party organizing and is a long-time member of the American Public Health Association’s International Health section. She currently represents this section on APHA’s Advisory Board.

Thank you to the Conrad N. Hilton Foundation and family and staff who are here, for giving us the opportunity to talk today and to share some of our experiences.

I represent Partners In Health and I’m in the lucky position that some others have identified the partnerships that we’ve engaged in with other Laureates, so I’m not going to spend a lot of time on specifics other than to say that we’re thrilled with the partnerships that we’ve been able to establish with the Laureates. In just four years, we’ve had some incredible successes as you’ve seen—with Operation Smile in Haiti, and with Heifer in Rwanda where 90% of the families who got goats are sharing them with their neighbors, which is the whole purpose of this partnership. We’re targeting nutrition and agriculture with Heifer there. We’re working with Women for Women in Rwanda as well to start a partnership.

I want to highlight two partnerships because they focus on nurses, and because I’m the only nurse on staff in Boston and I really want us to focus on the nurses in all the places where we’re working. The training that Operation Smile and Médecins Sans Frontières provide is fantastic. We’re allied with Harvard, which many people know doesn’t have a nursing school, so partnerships that actually focus on nurses and nursing skills and will empower the nurses to do better work are critical to the success of all the projects that we do. We actually have new partners—even before PATH was nominated, we signed a memorandum of understanding with them to start focusing on women’s health issues and looking at some of the most serious problems in women’s health in Haiti, like cervical cancer, and working with them on solutions for protection and treatment.

Partners In Health tries very hard not to just focus on health. We also look at all of the other poverty indicators and problems of poverty like food, water, housing and education, etc. As our name implies, we have to do this in partnership. With the humility that Bill Magee talked about, we know we can’t be experts in every single thing that families need. That’s the wonderful thing about the partnerships that we’ve developed with all the Laureates—we’re able to look at a person or a community as a whole. We’re not just looking at health, or at food and nutrition, we’re not just making sure there’s clean water. But in fact, in partnership with these groups, we’re able to look at a person as a whole and fulfill all the human rights. And that’s part of everything we do as Laureates, and also what everyone here is involved

49 in. We need to be working together on the ground so that we’re serving communities and all their needs, not just focusing on small, individual issues. These are critical, no question about it. We all need to be the best at what we’re doing and the services we provide, but it’s the partnerships that we are able to engage in that make up the whole and make it a success.

Over the past two years, since we met in Little Rock, we have looked at some of the things that Jo Luck already listed. Where can we, as Laureates, be successful? How can the sum of our parts be greater than any one organization can be? And one of the things we’ve started doing together is engaging in advocacy activities. As was pointed out earlier, political and financial will is going to be critical in the next five, 10, 15 years in global health. Global health has reached a high level of interest in this country and around the world. What we need to do is sustain that and grow it; we can’t be satisfied with where we are right now. It’s through philanthropic partners, but also government partners that we are able to do the work that we do. We’ve got to keep that engagement and grow it.

I think we’re actually at a perfect opportunity here in Washington, where both Houses on Capitol Hill, the White House, and the State Department are all rethinking our foreign aid strategy. They’re all rethinking how to do this better, hopefully with more resources, and how to have more impact. So groups like ours, who are coming at it from different directions, have a lot of valuable information to share with them on the way that we’re implementing. There’s a lot of talk about how vertical everything has been and we’ve got to do better integration. We’re actually the perfect example of how collaborating on the ground can actually take all those vertical resources and combine them into a total integration on the ground. I think that’s one area where we can have a huge impact and bring in all of you as partners as well.

50 PANEL THREE—QUESTION AND ANSWER SESSION

Q: Begleiter. How many of you, representing your own organizations, have thought about a collaboration with another organization? Just those who have thought about it. A good group of people here have their hands raised. How many have already done it? OK, lots. Last question, I’m curious to see how this works. How many of you initially thought in the back of your head that you’d like to do it, but you didn’t know how good these other guys would be? Would you be risking your group’s reputation, your skills, your connections on the ground? How many of you have had that nagging worry about who the other guys are? Not as many as I thought, but some. Turning to you, the Hilton Humanitarian Prize Laureates now, is that something that you didn’t have to deal with because you knew, “These are all Laureates, they’re the best, we have other worries but that’s not one of them?” Is that a fair characterization? That’s something that illustrates the idea that you are greater than the sum of your parts. By being associated with a Laureate, by being involved in this sort of collaboration, you can overcome that hurdle right at the beginning. I think you were hinting at that, Karen, in you presentation? It’s a sense of mutual confi dence you start out with, without having to spend years to develop it.

My question to you is, now you’ve all put your toes in—in some cases you’ve done more than put in your toes, you’re doing a lot of work—is this something that is sustainable and expandable? Do the experiences that you’ve had suggest that: a) this works, b) it can be scaled up, and c) let’s build up, we’re missing a piece, where’s the missing piece?

A: Jo Luck. We’ve found that it can be really enriching. It’s hard to fi nd partners; it’s hard to be sure you have the same values and the same ethics, but with that hurdle taken care of, we’ve jumped into it. We’re looking beyond the Laureates now, if there’s someone or a need that none of us are involved in, to say “Here’s how we work, here are our standards, here’s our accountability.” I think it’s very sustainable; I think it’s the future. The economy has been tough; we have to partner with others to have a greater impact. I think it’s the future and I think government ought to look at it, not just with contractors but with NGOs around the world who are doing that work and are on the ground and have the expertise.

A: Magee. One of the most important things to understand is that this doesn’t happen overnight. Trust isn’t something that you acquire from anybody. When we go into a country, we don’t just send a team into the country. We make three or four trips getting to know the business community, the political community, and the medical community. So, too, with other Laureates, we work on programs together to make sure we fi nd a win-win situation. I don’t know of any situation we’ve gotten into that we aren’t happy with. It augments so much of what each of us can do. The Laureates have taken three or four years to mature into that. It’s not something that happens overnight, and it was the vision of Steve Hilton and Judy Miller that kept driving us.

Q: Begleiter. Let me ask you about the monitoring and evaluation project, which a couple of you mentioned. How can we establish a set of standards and have some objective measures of these things, so it isn’t all just storytelling, which we’re all pretty good at? You need to be able to demonstrate standards. Is that something that has promise? I don’t know how far along you are with that project.

A: Sherman. I think it has great potential for standard-setting, and I think that’s exactly the hope of this two-year partnership. We’re taking these high-performing organizations who have all pursued different

51 strategies around monitoring and evaluation internally and externally, and we’re overlaying that with some additional technical support in areas where we might be weak. For example, some of the things we’re all talking about are: How to better use technology? How do we use control groups? What does an external evaluation mean for how we do our work? How do we actually take the information we’re learning and plow that into enhancing our program interventions? All the lessons learned around these types of things will be the subject of a set of guidelines, principles that are going to be benefi cial not only to us, but to the broader NGO/nonprofi t community. It’s an evolutionary process and we’re all learning about it. I think it demonstrates a level of commitment to making sure that we’re delivering the best products and services possible with the resources that we have. That’s just good stewardship.

A: Jo Luck. Yesterday we talked about a phase two, where we might expand and ask all the Laureates and maybe a greater circle to come and join us in the monitoring and evaluation project, because the four initial organizations don’t have all the answers; that is just a beginning. We may want to expand the project, because it is something that’s important to everybody—quality and documentation. We also talked about growth. How do you grow and maintain quality? We all want to grow because it means better lives for people. Heifer is an example; it’s been lucky to grow, but how do you keep that quality as you grow?

Q: Begleiter. I want to ask one last question. This idea of setting up the monitoring and evaluation system doesn’t come out of thin air. None of you wants to take the money for that or the time for that or the personnel for that out of what you do on a daily basis for the people you’re serving. Is that an area where the Laureates can make a demand; in effect, saying that we want to be able to do this, but somebody has to support that mission and it goes beyond supporting what each of our groups does? Is that an issue, and have you been thinking about how you make that political statement?

A: Jo Luck. Actually, the Conrad N. Hilton Foundation is helping the four initial Laureates and beyond that we’ll need to have more resources. They are planting that seed and seeing the value of what we might do, so that’s a beginning. But Ralph, you’re right and as you said, Karen, we have to fund it.

A: Melching. The monitoring and evaluation project is not just for the donors, it’s also for the communities—to monitor their own progress, and I think we tend to forget that. They should be the ones, in the beginning, who are envisioning where they want to go and what their goals are, and they should be involved in the whole process. I think that’s part of the initiative and it’s something interesting that will come out of this project. It’s not just from the outside-in, it’s also from the inside-out.

Q: Begleiter. I have one more question. Without naming names, are there any groups that you have suggested a partnership with who have said, “We’re not interested.” Is there a reason why a group would say they’re not interested?

A: Sherman. I won’t name any names, but there’s an organization that is not a Laureate, whose work we admire. Our strategy is to cherry-pick organizations for the reasons that I mentioned in my presentation. We need to supplement certain areas, and we fi nd that there’s valuable expertise among some other groups. For some reason, after two years, we haven’t been able to make that happen, so at some point you have to ask, is that organization equally as committed to having a partnership as you are? That’s what I mean about having shared goals and shared levels of effort, because if there isn’t that kind of mutuality at the get-go, you have to wonder what it’s going to be like upon implementation.

52 A: Barry. I think the fl ip side is that we’ve all been put in the position where we’ve had to refuse partnerships with groups that have come in and approached us, maybe because we felt that the goals were mismatched. I want to throw in something that Bill Magee brought up in our meeting that I think is really important, to the Laureates and to all people who are involved in global development and aid. That is, really trying to build a larger movement to change policies and change lives, and to try and get some equality in this world. Without young people, we can’t do that. I think we all—through internships, through fellowship programs, through programs like that—are trying to work a lot more with young people. There are a lot of groups who come and say, “We want to send you a student for a week; we want to send them to the farthest place we can possibly get to for a week.” It’s so hard to say no to that. But what a young person actually can do and can experience in a week is very little. We need to work on partnership, matching goals and matching needs but also on keeping the young people involved.

A: Melching. In my experience of 35 years in Senegal and working with various partners—government, UNICEF, local and national NGOs—I have found that the best way to achieve successful partnerships is to focus on what we do best—our basic education program which we have developed over a 20- year period—and work with others to cover areas that are not our expertise. So, in areas like health services, we prefer to partner with other NGOs. In Mali, for example, we have partnered with a Malian organization that provides basic health services to the community (Project Muso) and this partnership really completes our program. We provide the basic education, the human rights education that’s necessary to get the community organized and mobilized to be able to request, use and manage the services. And with the Heifer Foundation, for example, we’re talking about a further collaboration because they do small animal fattening projects that are really not in our area of expertise.

Q: Muriel Glasgow, MG Associates, Inc. I have two comments and two questions. My fi rst question: I attend many awards ceremonies and I always wonder who made the awards possible. How do the nominees participate in the award, not just fi nancially but energetically and emotionally? Because they were part of it. Mr. Magee spoke of a bracelet and I said to myself, those kids value a bracelet from a hospital so much how much more would they value a bracelet that says Hilton Foundation, Tostan—all of your people get bracelets? And then you partner with a bracelet-making company, who could help you provide them? That’s one question.

The second one is about gender-based violence. Mr. Magee, thank you very much for the inspirational speech. All of you are very good, but some of you really touched me. When you spoke of the 17-year- old who lost his spirit, and you said, “look me in the eyes and squeeze my hand,” I wonder how many boys have lost their spirit, who need someone to say the same thing to them. Gender-based violence seems to be focused on the woman, the victim, but not the perpetrator. I’m wondering to what extent we can help the little boy who was born free of any problems, who had a creative and joyful spirit but lost it as he grew up? Some become rapists and violent people; in the Congo there’s so much of that going on.

Q: Begleiter. How does a community participate in your success? Do the communities you work in realize some benefi t as a result of having won the Prize?

A: Jo Luck. I’ll tell you right away, everywhere we work they know how prestigious this award is; they know it’s their award. When we had the announcement at the press conference, I had a great visit with Steve Hilton. We fi lmed that and sent it all over the world to our team. They talked about what it was

53 they had done in their community that had made the difference to give us that value and respect. It’s very important to include that and I appreciate that good question.

Q: Begleiter. And how about gender-based violence? Turning it around the other way? It is focused mostly on women. Are any of you aware of anyone who’s looking at the psychological aspects from the men’s side? How do they become perpetrators?

A: Melching. We work on that issue a lot. This morning, in the second panel, when we discussed these issues, we talked about the importance of legal norms but I think that, in truth, social norms are often more important than legal norms. When you introduce human rights education, it is an amazing experience to witness people—men, women and adolescents—learning about their human rights, coming together, often discussing together for the fi rst time. The understanding of human rights helps them realize that they can write a new script for their lives, using human rights as an alternative to long held social practices; as a group, they come to a consensus around new social norms. This has made a real difference in changing gender-based violence in communities, not only in Senegal but now in Mauritania, Guinea, The Gambia, even in Somalia where we’re now preparing two declarations for the abandonment of female genital cutting by inter-connected communities. Two years ago when we went to Somalia, I never dreamed this would happen. I think it’s really human rights education and understanding social norms that has made a difference. Tostan has found that it does not work to accuse the boys and men and make them feel badly because they are male. Because they have grown up surrounded by these attitudes, they are merely following what their model and experience has been for many years. So at Tostan we try to present an alternative for a better future—giving them new hope that things can be different and they can make a change that will lead to a better world. But they have to make these decisions together, as a united community. I think it helps to create positive movements for social transformation and avoid the blame and shame method. Approaches that bring people together, unite them and get them moving towards a better future are ones that have been successful!

Q: Josie Everett, Heart to Heart. Our work is somewhat analogous to Dr. Magee’s. For 20 years, we’ve been training teams of cardiac specialists in Russia to perform open-heart surgery on babies and children. We generally stay at a specifi c site for fi ve to ten years, but we’ve heard a lot today about scaling up. I’m wondering if someone could comment on what that experience was like for you and what advice you could give.

A: Magee. I can tell you that we all have a certain potential within our organizations, and you know what that potential is inherently, but unless you’re willing to stretch your organization and take risks to get it to the next level, you’re not going to get it to the next level. Daniel Burnham, one of the architects of the city of Chicago, said, “Dream no small dreams. They have not the power to stir men’s blood.” To some extent, you have to think bigger than you are. Once you think bigger, then you’ll attract bigger people because they get excited by that. For our 25th anniversary, for instance, we knew we had the capacity—with 6,000 volunteers—to do something unique. We decided that, instead of blowing out 25 candles, we’d go to 25 countries simultaneously, 41 sites, all landing on November 7, 2007. With 1,900 volunteers—1,200 of whom were from 43 other countries that we’d been training all this time—we decided to operate on over 4,000 children in 10 days. Now that was a huge endeavor. We knew we were stressing the organization, but we also knew that by doing that we were preparing ourselves to get to the next level. Risk is in relationship to reward and you can’t be afraid. Winston Churchill said, “Success is the result of failure after failure with no loss of enthusiasm.” So you know, you’ve just got to go for it. 54 A: Sherman. I’m not sure any of us work on the national scale, but I think in order to do that you have to work with the local public sector and be working with the systems within the countries themselves, rather than setting up independent agencies. Now, there’s a huge role for civil society to play in many different ways, but I think when we’re looking at nationwide services, whether it be education, health care, or agriculture, we’ve got to be working on a national scale in order to provide services. Eventually, I like the long-term idea that you’ve been there fi ve or ten years. It’s important to keep in mind as well, very little can be solved in three years and we’ve got to keep the long-term nature in mind but also keep the advocacy up for funding and support.

Q: Begleiter. When you’re speaking of scaling up, are you talking of scaling up in-country or are you talking about scaling up by duplicating in a far-fl ung place that’s quite different? Or duplicating in a neighboring place? I would think all of those aspects would have to be taken into consideration. It might be possible to double your operations in a neighboring country—logistics are that much easier and so on—but it might be more dramatic to do it in fi ve different countries on fi ve different continents. I would think you’d have to take that into account in terms of what your goals are and what expertise you have on the ground.

Q: Steve Crane, Crane International, Inc. I wonder if any of you could speak to your experience with corporate funding partnerships that offer benefi ts to the company that go beyond just the refl ected glory of your good work.

A: Sherman. We’ve had some pretty good success with corporate partnerships. We didn’t negotiate those partnerships with the foundation side of the corporation, we negotiated with their marketing team, because that’s about partnering for mutuality. If it’s just about giving charity to an organization but doesn’t meet the corporation’s business objectives, it’s not really structured as a win-win. Just to give you one example, we’ve been working with Kate Spade, the great retail designer, for a couple of years. Our women in Bosnia have been making hats, scarves and other items for them. This year, dog sweaters—very exciting. The women in Bosnia say, “We’ll make anything,” and you have to appreciate that. Just this year, we signed a co-branding agreement with Kate Spade based on actually putting our brand together in store window displays. They’re getting employees to sponsor women in our program; they’re scaling up products for multiple countries, which has the potential to create thousands of jobs for our women, and also putting some cash up front for each of those two years. This was three years in the making; it wasn’t something that just happened and you can say, “OK this is what I want to do.” With these big corporate partnerships, and even partnerships more broadly, you have to be prepared to be in for the long haul and really work toward that evolution. Some people give up too early, before it matures and gets to that spot where it’s really what you want to achieve.

A: Magee. One of the things that all of us in this room have to understand is that we’re in the business of humanitarian care, and it is a business. To take it as anything less demeans it, because it’s very serious. If you have a relationship with corporate partners, it has to be a win-win relationship. It has to meet the needs of that corporate partner and your needs as well. For instance, we have a great relationship with Johnson & Johnson, which has provided us with all of our sutures for many years. At the same time, we’re not afraid to talk about that relationship with them. Stryker provides educational fellows for us. We just signed a big deal with Pepsico, with an outlet of their new branding. In all of these things it’s incredibly important that individual goals are clearly stated—where you’re going. It can work extraordinarily well.

55 Q: Begleiter. Are there any pitfalls that you could call attention to? Karen, you mentioned that you’re putting your brands together in the Kate Spade store and all of a sudden I’m thinking, “Oh, great, Operation Smile and Pepsico. I can see one of those kids holding a can of Pepsi.” What are the pitfalls when you get involved in this?

A: Sherman. I think you have to make sure that there’s brand alignment from the get-go. There are certain partners, for example, that we know from the start we’d never partner with. There’s also something to be said for having piloted it on a very small scale for a couple of years before rolling it out in a much bigger kind of partnership. I mean, just like any kind of partnership relationship, you have to pick and choose very carefully. Obviously, we are as concerned about our brand as a nonprofi t as they are concerned about their brand in the marketplace. As Bill said, unless there’s that mutuality up front it’s not going to go anywhere. More than that, it could be damaging to one or both of you.

A: Jo Luck. We actually sit down and negotiate what our core values are, what our principles are, things that we wouldn’t be comfortable with because of our mission and the way we work. Sometimes it’s not even monetary, like Green Mountain Coffee. We provide the farmers in a Latin American area with the quality beans that they want for their coffee, and we can assure them that they’re environmentally friendly and so on. They have great coffee and our farmers have great sources for selling their coffee. In something like that, we’ve developed a Heifer Hope brand that can be sold. It’s not always monetary, but we’re still in negotiation with some partners that we’re just not sure are going to work. We’re very upfront about that and we respect what they do and, hopefully, they respect what we do.

Q: Alexandra Garcia, Fabretto Children’s Foundation. I’m with the Fabretto Children’s Foundation; we work in Nicaragua with kids on kids’ health. I’d like to go back to this idea of collaboration and the assets, the intangible assets that the Conrad N. Hilton Foundation has, and all of you have as the Laureates. I know the fi rst thing I’m going to do tomorrow at the offi ce is to give one of my interns the list of all the participants that were here, and have them start looking up your organizations. I know that because you were here, you’re at a certain standard for me. You’re here for a reason; you may have been semi-fi nalists like us. Has the Hilton Foundation considered perhaps creating a web site where you might give us—the organizations that the review committee has looked at—an opportunity to connect with other organizations that are looking for partnerships? When you write a grant, you’re trying to highlight your strengths; you say, “You should give us money because we’re really good at this.” It’s hard to approach organizations, or funders, and say, “We want you to help us with this because we’re not that good at it.” It’s the complete reverse…we’re all dealing with poverty. Whatever our area of strength is in the community, those communities probably have issues on multiple levels—water, power, education, health. We can’t be all things to all people. I’m wondering if the Hilton Foundation would consider being a clearinghouse for organizations that have passed a certain level and are looking for partnerships? You could look and say, “We want a partner that can do this, in this immediate geographic area,” and there would be a standard of knowing these are good organizations.

A: Begleiter. Those of us who are a little older would call it a kind of “Good Housekeeping Seal of Approval.” It sounds like something technology could help with, and where the standards and evaluation could also be useful. I’m sure the Hilton Foundation will take it into consideration. Q: Danielle Klainberg, Amnesty International. As you can imagine I really appreciated Molly’s remarks about the need to integrate human rights education with Tostan’s other work in order to get the

56 communities mobilized. Donna, I believe you touched on this, too. I wanted to build on the discussion around partnership. Amnesty International is launching a major campaign on poverty and partnering with organizations working directly in communities is certainly a priority. As a human rights organization, however, we are also focused on addressing the systemic and political changes necessary. Most of your organizations do fabulous work in terms of direct service. How much do you think about, or do you think about at all, the systemic change you can effect? And what kinds of partnerships or partners do you look for?

A: Barry. Are you referring to the countries we’re working in, or globally, or any of the above? I think, because I’m the advocacy and policy director at Partners In Health, one of the things I’ve been very involved in is collaborating with other organizations to look at systemic issues. I’m going to talk more globally than in-country. I know PATH is doing some terrifi c in-country advocacy training which we’re hoping we can partner with them on.

Just to make a really long story short, while global health aid has actually skyrocketed in the last decade, it’s mainly because of initiatives like PEPFAR and the Global Fund to fi ght AIDS, Tuberculosis and Malaria, which are very disease-specifi c. So, we, as an organization—our patients and communities— have benefi ted greatly where we’ve been able to use these resources, but there’s no doubt in anyone’s mind that some of the other health issues that are hugely prominent in the world—like maternal mortality or child mortality—have been under-funded for a long time. What we try to do is bring together groups from all the health worlds to start working together on tasks—domestically as well as globally—on what the real needs are. If you’re treating someone and they don’t have food, that’s one thing, but if you’re treating a woman who’s pregnant and HIV-positive for her HIV, but she has nowhere to deliver her child or care for herself, you’re not treating the whole person. We’ve started on a global level and local level to bring the health groups together, but also some food and water groups and started looking at real global policy issues related to projects.

A: Melching. We feel like systemic change is possible on a large scale if done with the right approach. For example, in Africa, if you go into a community and want to work on issues like child marriage or female genital cutting (FGC) or other entrenched traditions that have created health problems for girls and women for centuries, you cannot do it by working in one community alone. You have to reach out to the other communities that infl uence and are important to that village. And so we have actually—and this is new to Tostan—reached out to work with diaspora groups now, because we’ve found that villages in Senegal are very closely connected to relatives in other villages, cities and even other African and European countries. It is important to reach out to the entire group if you want to make lasting and systemic change. The people concerned need to come to consensus around changing long-held socials norms—ending FGC and child marriage, ensuring that people will go to health centers, and pay the money needed to send girls to school. But the education needs to be an empowering education, giving people the confi dence and information they need to really change their lives—these aspects are so critical, but we haven’t had much time to talk about them today. Again, it’s not about just any education, but an empowering education. At Tostan, we feel this is a critical element for creating positive social transformation.

57 PANEL FOUR SUMMARY

Open Dialogue on Future Trends in Global Health

There were no presentations at this last panel—rather, there was a very interactive conversation among Dr. William H. Foege (Bill & Melinda Gates Foundation and Global Health Council), Professor Muhammad Yunus (Grameen Bank, pioneer of micro-credit and Nobel Peace Prize Laureate), and Dr. Christopher J. Elias (CEO of PATH). The three men focused on innovation—past, present and future. For all the serious problems facing the world and discussed at the symposium, this was a very optimistic dialogue. No one minimized the seriousness of the challenges, but there was a defi nite “we can do it” spirit—and one that was rooted in examples of successes that have already happened. Thinking about changes in global health over the past 10 years, Dr. Foege described himself as struck by a change in attitude as perhaps the biggest change of all. When he began his career, there was no “career track” in global health, no resources and a humble acceptance and common frugality on the part of those in the fi eld to do the best they could with very little money. No one thought that some day global health would be on anyone’s agenda, much less the agenda of the world’s richest couple.

Today the attitude is that everything is possible. That is certainly the attitude of Professor Yunus, whose common sense, pragmatic approach to the future boiled down to his comment that “if you can identify the problem, you can solve it.” Yunus always starts with a local approach. “Can we develop a health program so that we can eliminate this and that for 10,000 families? If you can develop that, then you have a structure which can be repeated for another 10,000 families and another 10,000, and so on.”

Dr. Christopher J. Elias looked to innovation and the explosion of technology to resolve seemingly intractable problems. But technology innovation is getting ahead of systems innovation. “I think we’re progressing more in the technological product innovation than we are in the systems innovation. In the last decade we have not put as much energy, intelligence, and resources into the other types of innovation—we’re lagging.” The shortage of doctors and nurses in the developing world, especially in remote rural areas, is not likely to change. It is easier to change tasks, to use technology to train health workers or pharmacists to take on tasks once reserved for doctors, and to consult by imaging and technology with remote specialists. Innovation, he reminded people, does not only mean “invention,” it means thinking of new ways to use existing resources.

“I think if you ask what has been the greatest scientifi c development in the 20th century, it wouldn’t be a particular product. It would be that we have found that even non-scientists can use medical science. So the fact that, during the 20th century, the average American had their life expectancy increase by seven hours every day, is because people were stopping smoking, doing exercise programs, wearing helmets on motorcycles, wearing seat belts in cars—a lot of prevention.”—William H. Foege, M.D., M.P.H., Senior Fellow, Bill & Melinda Gates Foundation; Chairman Emeritus, Global Health Council

“There has been an under-appreciation of the growing pandemic of chronic diseases. While we’re fi ghting childhood illnesses and setting MDGs for reversing AIDS, TB, malaria and maternal health, there’s no Millennium Development Goal about dealing with the emergent epidemics of diabetes, heart

58 disease, obesity-related problems, or tobacco-related problems. There’s a next wave of morbidity and mortality coming as globalization leads to the adoption of unhealthy lifestyles around the world.” —Dr. Christopher J. Elias

“[At] the village level or rural level—what we call health medical centers, where the mission is to keep the healthy people healthy—[it’s] all about prevention, so you don’t deviate into sickness. If you do for some reason, there’s early detection. There are diagnostics to identify what’s wrong, and, as soon as you do that, you receive treatment. So, our focus is on keeping healthy people healthy. I talked about nutrition. This is one of the things we want to build up so you don’t get sick. Since most of our diseases are water-borne diseases, if you can take care of water, you can solve the problem. Sanitation is another complement of that.”—Professor Muhammad Yunus

“There is a need to reinvigorate the attention of program and policy leaders toward diarrheal disease, including water, sanitation and hygiene interventions.” —Dr. Christopher J. Elias

“When schools of public health were fi rst developed, water and sanitation were some of the oldest things we looked at…people think in short terms now. They’re not thinking in terms of 50, 100 or 200 years… This is what happens globally also. We’re not thinking long-term.”—Dr. William H. Foege

A question was raised from the audience about the dilemma in the developing world when nurses and doctors leave their countries to fi nd jobs in the developed world. Professor Yunus saw it as an opportunity: “it means there’s a market for them…it’s a question of expanding educational facilities, that’s all…How many nurses do you need? Just keep on expanding as a social business [to provide them]. The government has a limited budget, so if you can produce only this many…of course they will leave. But, if you can produce as many as you want, the problem is solved.”

Dr. Elias pointed out that health care providers may leave countries because they are not allowed to practice what they have been trained to do in areas where there are limited facilities—few drugs, no electricity, etc. “Some countries now are looking carefully at the skill set they need and training different kinds of health care workers who have the competencies to meet the needs in their system…basically segmenting the market…and not producing as many who are marketable in other countries.” Professor Yunus agreed that people needed to be trained for the environments in which they will be working. “Your training has to be appropriate to the context you’re working in; then you become an expert.”

One participant asked: “What worries you?” Dr. Elias responded:

“We have had an incredible decade in global health—increased resources and commitment and increased successes…Soon we are going to have new vaccines, drugs, diagnostics, and medical devices that have tremendous potential to improve people’s lives and are affordable even in a tight budget, but what we don’t have is the system ready to adopt, scale and sustain the use of those innovations. In the last decade we have not put as much energy, intelligence, and resources into the other types of innovation…We, as a global health community, are running a risk that we’ll succeed in the technological innovation faster than we are prepared in our systems innovation to deliver these results, particularly in the poorest countries of the world.” —Dr. Christopher J. Elias

59 Dr. Foege recalled lessons learned from the successful eradication of smallpox and pointed out that the fi rst lesson was that “It didn’t happen by chance…It took people deciding that this was worth doing, coming up with a global program, organizing and then making it happen.” His second lesson was “to know the truth” before you can change things. “We still have some very big problems in global health, and I think two of the biggest ones are: number one, how to deliver all of these new tools that we have, and number two, how to attract the best minds—after they develop skills and knowledge—to return to their countries?”

60 “Open Dialogue on Future Trends in Global Health”

William H. Foege is an epidemiologist recognized for his work in the successful campaign to eradicate smallpox in the 1970s. He is Chairman Emeritus of the Global Health Council and Senior Fellow to the Bill & Melinda Gates Foundation. Dr. Foege became Chief of the U.S. Centers for Disease Control (CDC) Smallpox Eradication Program, and was appointed director of CDC in 1977. In 1984, he and several colleagues formed the Task Force for Child Survival, a working group for the World Health Organization, UNICEF, The World Bank, United Nations Development Program, and the Rockefeller Foundation. He joined the Carter Center in 1986 as Executive Director, Fellow for Health Policy. He resigned in 1992, but remained a Fellow and Executive Director of the Task Force. In 1997, he became Presidential Distinguished Professor of International Health at the Rollins School of Public Health at Emory University. In 1999, Dr. Foege became Senior Medical Advisor for the Bill & Melinda Gates Foundation. He retired from both Emory University and the Gates Foundation in December 2001; however, he remains active in both organizations as Emeritus Presidential Distinguished Professor of International Health and as a Gates Senior Fellow. Dr. Foege received his medical degree from the University of Washington and his Master’s in Public Health from Harvard University. A recipient of many awards and honorary degrees, Dr. Foege is the author of more than 125 professional publications. Dr. Foege is a former member of the Conrad N. Hilton Humanitarian Prize jury.

William H. Foege, M.D., M.P.H., Senior Fellow, Bill & Melinda Gates Foundation; Chairman

Dr. Elias is president and chief executive offi cer, leading PATH’s work in more than 70 countries in the areas of health technologies, maternal and child health, reproductive health, vaccines and immunization, and emerging and epidemic diseases. Dr. Elias represents PATH at domestic and international forums, both as a spokesperson for PATH and as an advocate for innovative responses to global health challenges. He serves on the boards of the Global Alliance for Improved Nutrition, the Medicines for Malaria Venture, and the Washington Biotechnology & Biomedical Association, among others. Dr. Elias was honored as the Schwab Foundation’s Social Entrepreneur of the Year for the United States in 2006 and named Global Health Research Ambassador by the Paul G. Rogers Society for Global Health Research in 2007. Before joining PATH, Dr. Elias was a senior associate in the International Programs Division of the Population Council, where he served as the country representative in Thailand, managing reproductive health programs throughout Southeast Asia. His early career included two years in Thailand working with refugee assistance programs, fi rst as a physician supervising a large pediatric ward in a refugee encampment and then as a medical coordinator for the American Refugee Committee at the Thailand–Cambodia border.

61 Professor Muhammad Yunus, Founder, Grameen Bank Professor Muhammad Yunus, founder and managing director of Grameen Bank and Nobel Peace Prize laureate, has been instrumental in lifting people worldwide out of poverty with the pioneering use of microcredit—supporting income generating activities by lending small amounts without collateral to the poor. Dr. Yunus received his B.A. and M.A. in Economics at Dhaka University in Bangladesh. A Fulbright scholar, he earned his Ph.D. in Economics from Vanderbilt University, and became an Assistant Professor of Economics at Middle Tennessee State University in 1969. Inspired by an independent Bangladesh emerging in 1971, he returned to join the Economics Department of the University of Chittagong. His active involvement in poverty reduction, spurred by the famine of 1974, led to the establishment of the Rural Economics Program. Despite the lending practices of the time, which either preyed upon or simply ignored the poor, Dr. Yunus strongly believed that, given the chance, the poor would repay borrowed money, put it to good use and even rise out of poverty. What started as Dr. Yunus’ own small business loans to Bangladeshi villagers grew into the full-fl edged Grameen Bank (which means Village Bank). Grameen Bank now has 7.5 million borrowers, 97% of whom are women, and has lent over $7 billion with a near 100% repayment rate. Dr. Yunus has founded several other companies in Bangladesh to abate poverty and aid development, including mobile phone services, energy, education and health care. He is also the founder of Grameen Trust, which extends the Grameen microcredit system all over the world. Together with Grameen Bank, Dr. Yunus was awarded the 2006 Nobel Peace Prize for his efforts to create economic and social development, the fi rst Bangladeshi and the third Bengali to be so honored. He has won a number of other awards, including the Ramon Magsaysay Award, World Food Prize and Sydney Peace Prize, and is the author of the bestselling books ‘Banker to the Poor’ and ‘Creating a World Without Poverty: Social Business and the Future of Capitalism.’ In his home country, he has received the President’s Award, Central Bank Award and Independence Day Award, the highest national award. He is also a member of the Legion d’Honneur and one of the founding members of the Global Elders, chaired by Nelson Mandela.

Emeritus, Global Health

Christopher J. Elias, M.D., M.P.H., President and CEO, PATH

Q: Begleiter. Bill, from your perch at the Bill & Melinda Gates Foundation, looking out at the landscape of global health trends, maybe you can lay out for us what the big issues are that we need to be concerned about now.

A: Foege. During the last panel, we went through some of the things that have changed in the last decade, which are pretty tremendous. We left the 20th century with historian Arnold Toynbee having said at one point that the 20th century would be the time when we would see global health equity, and we saw at the end of the 20th century that things had gone even farther adrift. But the last 10 years have given us some hope—we talked about the tools and the political interests, and so forth. I think going forward, the biggest difference that I see in global health may be our attitude.

When I got into global health, there was no real career track, and there were no resources. We ended up with shoestring budgets and it’s only in retrospect that I understand that we adopted the mentality of poor people. We somehow didn’t think that we deserved any more than that, and so we were frugal and 62 did very well with a small amount of money. We didn’t think we were worth more, and it never entered our minds that some rich person might become interested in global health. Even if it had, we never would have thought that the richest couple in the world would be interested, and if that had entered our minds, we never would have thought that they might get the next richest person interested. It’s changed everything. The attitude that people have now is that it’s possible to do things.

I recently had the chance to return to India and talk about the lessons of smallpox eradication. The fi rst lesson is that it didn’t happen by chance. Stephen Hawking’s book A Short History of Time says that the history of science is a gradual realization that things do not happen in an arbitrary manner. Smallpox wasn’t eradicated by chance. It took people deciding that this was worth doing, coming up with a global program, organizing and then having it happen.

The second biggest lesson is: know the truth. You can’t really approach things unless you know the truth. We still have some very big problems in global health, and I think two of the biggest ones are: number one, how to deliver all of these new tools that we have, and number two, how to attract the best minds—after they develop skills and knowledge—to return to their countries?

However, I think these are solvable, and I think we now approach these things with a new feeling of hope. Jonas Salk once said that evolution will be exactly what we want it to be, and we have PATH telling us what they believe evolution should look like in the future. So we no longer confuse destiny with bad management.

A: Yunus. My approach is something very local, although a global approach is very important, too. I try to see about 10,000 families in a cluster of villages and ask, “Can we develop a health program so that we can eliminate this and that for 10,000 families?” If you can develop that, then you have a structure which can be repeated for another 10,000 families and another 10,000, and so on. I like to start at that local level and focus on that, rather than focusing on the whole country, with some success and some failure.

Q: Begleiter. With all due respect, you’re known for your modesty, but even your model is predicated on the idea that we start with this kernel, but it’s got to be a kernel that is replicable, duplicable, reproducible—you’re thinking global. After your lunch talk I really wanted to ask you, could models that you have pioneered and developed so successfully be used in the developed world? There are places in the developed world where those models seem to make sense.

A: Yunus. Health care is not economy specifi c, because if you can do it in one country you can repeat it. If you’re trying to save people from one disease and you’ve found a way—sometimes it is the medicine, sometimes it is the technology, or delivering it, sometimes it’s a way of fi nancing it—you can repeat it elsewhere. The basic thing that we have learned is how to fi nance it, make it self-sustainable. For example, if I was doing it here in the health sector, I would look into how I could develop health insurance as a social business.

Q: Begleiter. But you wouldn’t call it a social business in the United States, would you? You would, and it would suffer political defeat. (Laughter)

A: Yunus. I am not a politician, I’m a social business man. Out of the 47 million people who do not have health insurance, maybe we could start with one thousand, and then ask if they like the service that

63 we provide. If you’re successful with one thousand and it works out as a social business, I’d say “OK, I can do it for 10,000 people or 100,000”—that’s it, the business grows. Is it affordable? Do you like the service that we provide? If so, then you’ll buy it.

A: Elias. The only thing I would say by way of introduction is to repeat a conversation. I was invited to join the jurors last night at dinner and one of them asked, “What worries you?” As I told them, we have had an incredible decade in global health—increased resources and commitment and increased successes—but I think we’re progressing more in the technological product innovation than we are in the systems innovation. Soon we are going to have new vaccines, drugs, diagnostics, and medical devices that have tremendous potential to improve people’s lives and are affordable even in a tight budget, but what we don’t have is the system ready to adopt, scale and sustain the use of those innovations. In the last decade we have not put as much energy, intelligence, and resources into the other types of innovation—we’re lagging. Just to put it in perspective, the global health community had to introduce two new vaccines in the last 25 years of the 20th century. This decade and next, we’re going to have between six and eight. It took those vaccines back in the late 20th century 15 to 25 years to go into widespread use. We can’t tolerate that kind of delay in the application of our new innovations. I worry about that at PATH, because PATH accomplishes what it does through public-private partnerships with biotech, medical device companies. We’re often incenting them on their margins to participate in this great goal of improving global health. If they join us and we succeed in developing new products, and they don’t get deployed, they won’t answer the phone the next time we call, and rightfully so. We, as a global health community, are running a risk that we’ll succeed in the technological innovation faster than we are prepared in our systems innovation to deliver these results, particularly in the poorest countries of the world. That, I think, is a key challenge that we have to face in the next fi ve years or we’re going to start seeing some negative feedback from that bumpiness in the pace of our innovation.

Q: Begleiter. Dr. Foege, I didn’t hear you make any reference to the business models these two gentlemen have been talking about. Is that something that’s anathema to the Gates Foundation, especially since you made reference to how rich they are?

A: Foege. Not at all. In fact there are many associations between the foundation and corporations where we actually guarantee supporting the production of a vaccine, which they don’t like to risk their own money on, if they will deliver it at a reasonable cost. I’ve actually worked with corporations since the late 1980s, when I chaired Merck’s Mectizan committee for 12 years. Merck gave away Mectizan for river blindness in people in West Africa, and I went to West Africa to celebrate the 250-millionth treatment with Mectizan and they’re now up over 400 to 500 million.

There are some real lessons there. The question came up at the last session, what do corporations get out of this? Merck was expecting to get two things: a tax break on what they donated, and some good publicity. What they actually got was so much better than anything they had anticipated, which was a work force that likes working for a company that does this. When you think of what’s happening with corporations, where employees don’t think of this as a lifetime job—they go back and forth—you need that kind of loyalty. Merck found it was so important that other companies—for example, SmithKline Beecham before they merged with Glaxo—asked President Carter if there was something similar they could do. It ended up that they gave a drug called Albendazole for lymphatic fi lariasis, and there’s now

64 a global program on that. One by one, the big corporations have found it’s worth being involved in this just because of how their employees feel about them.

Q: Karla Shepard Rubinger, Assistant Vice President, Mary Ann Liebert Publications. My question is in the context of thinking about the 21st century. Why do we still forget about prevention? Focusing on technology and development is important, and I’m glad to hear this panel and the previous one focus on the need for systems and delivery, but no one focuses on prevention. What comes to mind is one of our journals, which is a peer-review journal on breastfeeding—how basic, how simple, but how much research do we have and continue to have which shows its prevention effects related to cancer, breast cancers, female cancer, brain development, obesity, the immune system, and all kinds of intestinal issues? The birth of a baby must be THE teachable moment. Breastfeeding is free, universally available, no contaminated water, no drugs, no tech, no delivery system and used worldwide for centuries. There’s no question any more, as the Surgeon General said in a meeting a couple of months ago in Washington: “the debate is over,” but it’s not happening.

A: Elias. I’d say that we do a lot of work on prevention and there is a fair amount of attention to prevention, although it doesn’t get nearly as much attention as it should—most vaccines are prevention- oriented. We have a large infant and young child nutrition program supported by USAID that does include extensive breastfeeding promotion as a proven intervention. We don’t need to be researching that, as you say.

So the question is, how do you get broader interest in communities? I think that’s where there has been a challenge and, you know, it’s inherently harder to get healthy people to pay attention and change behaviors than it is to intervene when someone is ill and feels like they’re in need of treatment. That’s true in this country as well as in developing countries. I guess I would challenge the notion that prevention isn’t on the radar. I think it’s actually where much of the resources of global health are spent. It’s not what makes headlines. The technologies do sometimes make headlines, the new vaccines and that type of thing, but you’re right, there’s much more attention on treatment programs. The rollout of antiretroviral programs, which has been a very important accomplishment in the last decade—we’re not all the way there, but we’re much further than we were 10 years ago—has gotten a lot more attention than any of the prevention interventions.

The other thing I’d say is that we need to get beyond either/or thinking in prevention and treatment. HIV is a good example where there’s a tremendous amount of synergy between prevention and treatment programs. Treatment programs—the availability of treatment for those who need it in places like sub-Saharan Africa— become the reason that people get tested. Going to get tested and the counseling associated with it becomes an important moment—because most of the people tested are negative—for reinforcing preventive medicine. So we have to think about synergies between prevention and treatment rather than set them up as either/or options, which was part of that dynamic of the 20th century, when our horizons were lower and we thought we had to do one or the other—“let’s do prevention for this and we’ll do treatment some other year.” I really think we have to get beyond that and think about how we integrate them.

Q: Begleiter. Muhammad, how much of your operations are aimed at education and preventive care rather than rehabilitative?

A: Yunus. As I mentioned during my lunchtime presentation, the village level or rural level—what 65 we call health medical centers, where the mission is to keep the healthy people healthy—is all about prevention, so you don’t deviate into sickness. If you do for some reason, there’s early detection. There are diagnostics to identify what’s wrong, and, as soon as you do that, you receive treatment. So, our focus is on keeping healthy people healthy. I talked about nutrition. This is one of the things we want to build up so you don’t get sick. Since most of our diseases are water-borne diseases, so if you can take care of water, you can solve the problem. Sanitation is another complement of that.

Thalassemia is a big disease in Bangladesh: 15% of the population of Bangladesh—150 million people— are carriers of thalassemia. Nobody knows about it, and that number is expanding because of close relationships—such as people getting married to each other—that expands the carrier base. If two carriers get married, then you have the problem and nobody knows whether you are a carrier or not. We want to let people know that if you are a carrier and are not married yet, make sure your partner is not a carrier. This test—we’re looking for simple testing, to make it easy so people don’t get scared—costs a lot of money and nobody told me I have to do it. With 15% of the population as carriers, you have an obligation—a law should even be passed so you make sure you don’t pass on this problem to your children.

These are the areas we’re paying a lot of attention to and preparing people to make sure that they understand what the situation is. So the health management centers are geared toward awareness— how to keep you healthy by taking care of sanitation, water, etc.

Q: Begleiter. I hear a collaboration in the making here. PATH has that Lab-on-a-Card, diagnostics tool, and we need a new one for this quick test in Bangladesh, so that’s on your to-do list.

A: Foege. The single biggest program at the Gates Foundation is a program called GAVI, the Global Alliance for Vaccines and Immunizations, that’s totally about prevention—a vaccine where one or two or three doses protect people for life. I think if you ask what has been the greatest scientifi c development in the 20th century, it wouldn’t be a particular product. It would be that we have found that even non-scientists can use medical science. So the fact that, during the 20th century, the average American had their life expectancy increase by seven hours every day, is because people were stopping smoking, doing exercise programs, wearing helmets on motorcycles, wearing seat belts in cars—a lot of prevention. But the interesting thing is that, with all of our health care debate right now, you’re absolutely right, the prevention part of this is being lost. What I don’t understand is, you go through medical school hearing over and over, “Do no harm,” and then a patient comes in to see you and—because you are not compensated for prevention—you don’t give any advice on prevention. So you’re doing harm every day, and I don’t understand this. All it would take in the health care debate, is to change so that we have health outcome measurements, and that Blue Cross and Blue Shield would get a premium if they could show an improvement in health outcomes. Once that happens, it’s to their benefi t to enroll sick people rather than well people, because they will show improvement. And, it’s to their benefi t to include smoking cessation clinics, Weight Watchers, to have exercise programs, to have blood pressure and diabetes control programs. Now, suddenly you have what Chris is talking about—the integration of prevention into health care delivery.

Some years ago, when the U.S. government did not pay their dues on global health, I did an editorial about this and quoted Dolly Parton who said, “You’d be surprised how much it costs to look this

66 cheap.” What we’re seeing with the health care debate is how much it costs to be so cheap.

Q: Arlene Samen, Executive Director, One H.E.A.R.T. As I’ve heard all the speakers today, over and over again what keeps coming back to me is that what leads women down the road of maternal/newborn mortality, poverty, lack of education is really a lack of infrastructure in many of these developing countries. I don’t know what’s being done in that area, but maybe Muhammad Yunus can talk about that or Dr. Foege. No matter what we do as nonprofi ts in these areas, unless there’s an infrastructure to deliver the services, deliver the education, deliver the health care, we’re just spinning wheels.

A: Yunus. It’s not as formidable as it sounds. People communicate very easily now, you pick up the phone and you’re there. You don’t have to go and spend the time, just pick up the phone. If you want to talk to several people, you can do that too. Communication is becoming the easiest thing, if you want to do that—text messages, Internet connectivity, everything is there. It’s a question of using it; it’s our fault not theirs. People don’t need to have a degree to fi nd out why they’re sick. What do I have to do? I have to wash my hands or whatever. So they understand that; it’s a question of communicating to them when possible. I wouldn’t say that, just because it’s a poor country, it’s impossible to do things. Things have changed completely.

Q: Begleiter. You’re suggesting that the mobile phone, at least in the developed countries, serves as the surrogate for Internet connectivity. Does it actually accomplish that? Is it capable enough of supplying what’s needed?

A: Yunus. Whatever it is, use it. Don’t say that, “unless it’s 100% I’m not going to use it”—use what’s there.

Q: Begleiter. One of the things I do in my classes is to look at Internet availability, and my students—of course they are connected 150% every minute of every day—are appalled at the number of people, say in the Middle East, who never use the Internet. You’re saying that we could look at mobile phones as an alternative to that.

A: Yunus. Mobile phones didn’t exist 10 years back. Today they’re universal.

Q: Begleiter. Is there enough work being done, perhaps by the Gates Foundation or organizations like Grameen, about how to use that technology?

A: Yunus. I don’t know. We do whatever we need to do. I’m not familiar with what others are doing, but I’m saying that this is available and it’s a very powerful technology in the hands of every single person in the country—why aren’t you using it? Maybe it’s too slow, so start with slow transmission. Broadband is not too far away, it’s coming. There’s a fi ber-optic network all over the country in Bangladesh. The phone companies are connected to it but they are not using it. That’s infrastructure, very powerful infrastructure.

A: Elias. There are many things going on that use this evolving information and communications technology to help strengthen various components of the health system. For example, in our cold chain equipment management system, we have equipment now where, if a refrigerator goes out, it sends a message to somebody to come and fi x it before the vaccine gets damaged. One of the challenges of health care delivery is one of those problems that, when you fi rst look at it, it seems so big that it’s hard to understand how to get your arms around it. We fi nd it helpful to take apart various sub-components of the health care system, the basic health information system architecture that supports people having 67 information about health care, electronic health records, etc. That’s going to be greatly enhanced by information health care technology. The management training, again, will be enhanced with distance learning and being able to train people and having a doctor or trained health care worker who’s in a city—and doesn’t want to live in a rural area—available by video conference.

The biggest challenge, I think, is the human resources component in the health care system. This is where we really have to think differently. If the only way we think about it is that we have to train doctors and nurses in the way that we’ve historically trained them, we’re going to wait a long time before we have enough doctors and nurses in most of the world. We have to think about task shifting, about the minimum set of competencies that a health care worker in rural areas needs, how to support their performance so that they don’t do harm but rather good things, by linking them with this evolving information and communication technology. That’s the part where we need the most innovation. How do we solve the human resources challenge? To some extent, it’s different in different places, but it shares the commonality that there are not enough doctors and nurses in the 75 poorest countries in the world. Yet, there’s a lot of innovation happening there. Frankly, I think it’s easier to innovate in technology than it is to change the system and behaviors—there’s often resistance.

We do a lot of work, for instance, with pharmacies, because if you look at really poor countries like Cambodia, where do people go when they’re sick? They go to the pharmacy, because there’s not a doctor or other skilled worker available. We’ve been training pharmacists, or, more appropriately, we give the people behind the counter in the pharmacy simple training so they can provide management of the most common problems, and refer the most serious problems to the medical care system.

When we started that, there was a lot of push-back from the medical doctors. There may only be a hundred of them for the city but they’re threatened by devolving their responsibilities to some other health cadre. Those are the kinds of policy and regulatory processes you have to get through in order to unlock the ability to innovate with the people who are actually there. Brian McLaughlin in our Cambodia offi ce started by interviewing people and asking, “Where do you go when you’re sick?” The health care system in Cambodia doesn’t work very well, yet people do something—they don’t just sit around and be sick. That’s why we started working with the pharmacies and other outlets. That’s the part of the system, I think, that needs the most attention and innovation now.

A: Foege. Regarding the question on cell phones and how they can be used, in the last session I mentioned a contest for student entrepreneurs that was held in Seattle, and one of the ideas came from two students in Ghana. A third of the drugs sold in Africa are considered to be adulterated or placebos. At any rate, they don’t do what they were intended to do. So they came up with the idea that manufacturers would put a number on each vial that is covered up, and you scratch it off when you buy the vial, then you enter a number on the cell phone and you fi nd out whether it’s a legitimate or an adulterated drug. Now this seems so simple, cell phones could suddenly solve this problem in Africa.

Q: Ma. Cecilia Flores-Oebanda, President and Executive Director, Visayan Forum Foundation. Thank you very much for your overwhelming insights in the discussions. As I listen, I’m wondering what the chance is of the Filipino people receiving good health care—most of the health care workers like nurses, doctors, even caregivers go to other countries to fi nd jobs. So I don’t know if this is a phenomenon only happening in the Philippines or if it’s also happening in other parts of the world, but

68 it’s created a lot of crises in our countries in delivering health services.

A: Yunus. I think that’s a happy situation: it means there’s a market for them. When I talk about nursing colleges, there are millions of young women. How many nurses do you need? Just keep on expanding as a social business. If you keep it as a kind of education that has to be run by the government and the government has a limited budget, so you can produce only this many, of course they will leave. But, if you can produce as many as you want, the problem is solved. The fact that there are attractive jobs outside attracts more students to come and get educated, because they know there are jobs waiting, and then you fi ll up the demand and you have more coming to do the job. It’s a question of expanding educational facilities, that’s all.

A: Elias. There are two things I would say. It is a problem in the Philippines, a problem in many other countries, and if you talk to the health care workers who are going to other countries, often they say that they’re going for opportunities, but they’re also going because they couldn’t do what they were trained to do in the system where they were trained. So they go through medical school or nursing school, and then they go to a health post that doesn’t have any drugs or doesn’t have electricity—they can’t actually practice the skills they were trained in—so they get discouraged and have other opportunities. It’s very hard to prevent people from pursuing those opportunities.

Some countries now are looking carefully at the skill set they need and training different kinds of health care workers who have the competencies to meet the needs in their system and who, frankly, don’t have the higher level training that would qualify them for positions in the U.S. health care system or the UK health care system. So this idea of perhaps training more people faster to meet the needs of the country—basically segmenting the market so that you’re meeting the market needs locally and not producing as many who are as marketable in other countries—is an approach that a lot of people are using.

A: Yunus. This would be one way, and I’m saying that you can saturate the market, produce as many as you want, continue to do so and at the same time you’ll still have people who will not work out, who have family problems or whatever. Some will stay on and some will come back. In today’s or yesterday’s newspapers, I was reading that the problem in the U.S. is that a lot of professionals are going back to their countries. This is also the truth, not just a fancy idea. People will come back, so it’s a question of producing them—as many as you can. Having a limited number of people is no solution, because you train them and they go away.

You mentioned that they don’t have these facilities and so on, so then your training is wrong. You are training people for someplace else. If your environment is that you have no electricity, no roads, then train them to cope in that situation. Don’t train them to say, “Everything is perfect.” Your training has to be appropriate to the context you’re working in; then you’ll become an expert. Bangladesh doesn’t have electricity practically—even in the capital city it goes on and off, there’s a brown-out all the time—so you have to be ready for that. The whole system in Grameen Bank is computerized, so we have to live and learn with this failure of electricity. The further away from capital city you go, the more hours without electricity, but you run your system because if you don’t, the whole bank will collapse. You can’t say, “Sorry I can’t run the computer because there’s no electricity, sorry but nothing can be done;” then the whole bank doesn’t exist. So you have to cope with the system as it is. You complain about it, but you carry on as you are required to do. The training should be appropriate to do the job in your environment.

69 Q: Anuraj Shankar, Senior Research Scientist, Harvard School of Public Health. I’d just like to raise some issues. In the last 50 years, we’ve had good success improving health globally, especially with vaccines and antibiotics and so forth. Now, as we move on toward trying to achieve the Millennium Development Goals (MDGs), the health of pregnant women is coming into focus. Being able to deliver children in a healthy way and save the lives of those kids at the time of birth—most of the deaths in children occur at the time of birth or in the fi rst 72 hours—is still the goal, so those indicators really haven’t changed much in the last 40 years or so. Perhaps because these issues are related to an actual system approach, maybe as alluded to earlier, there are a number of factors that have to work together to successfully impact on a problem that requires quality decision-making and quality of care in a short period, right around the time of the birth of the child.

I guess the thing that I’m asking about is, what do you see as the key things we can do now to take a different, more comprehensive approach to tackle those problems that may not be amenable to the types of solutions we have used in the past?

A: Elias. I think the fi fth Millennium Development Goal on maternal mortality reduction is, in some ways, an indicator, as is the fact that we haven’t made as much progress on that as we have on the others. Even in Bangladesh, that’s the one where we’re lagging. It’s because you really do need a system. You can identify high-risk births, but most complications aren’t predictable. So you need to have emergency obstetrical services, you need to be able to intervene on an otherwise healthy woman who has a complication that’s urgent and emergent. There are some parts of that that will be facilitated by cell phone technology. The delays in transportation, in recognizing and going to a health care facility when there’s not a lot of time, those delays that often result in loss of life, can be shortened by having better communication technology, by having better transportation systems and social insurance schemes that provide that there will be somebody to transport.

Sometimes I think of maternal mortality like a house burning down—you can do a lot to prevent it but you can’t completely prevent it, and when it happens you need to be able to move very quickly. That requires a community investment. The family, the woman and her husband need to be informed, but the community has to respond. It’s like maintaining a fi re department, and so the kinds of approaches that Grameen and others have pioneered have tremendous promise in helping us build what, essentially, is a social safety net. We then have to think about how to train people who can provide the lifesaving interventions. A Caesarean section is unavoidably necessary in a small but signifi cant percentage. There are some cases of maternal mortality that can only be prevented by that operative intervention. If you have to train an obstetrician/gynecologist to do every C-section in the country where currently you have 20—some African countries have fewer than 100 doctors trained to do C-sections—the answer isn’t going to be training hundreds or thousands of OB/GYNs, it’s just not going to happen. You’re going to have to train other health care providers to be able to do that relatively simple, lifesaving operation and build them into a community response and social network that can get to them or get that person to them when the time is needed.

I think the reason that particular MDG is lagging is that it’s a much harder thing to solve than reducing child mortality with a vaccine that, as Bill says, takes two or three doses to be protected for life. I think the test of the next fi ve or 10 years—because we’ll probably globally miss that MDG—is going to be whether we can mobilize an innovative response to that. Progress today is showing us that it’s the

70 toughest one, and it’s the one where we need to apply our innovation.

Q: Begleiter. Muhammad, you talked about this at lunch, but you’re obviously not able to apply your standard formula for solving that problem. What other ways are you looking at?

A: Yunus. I’m not a professional qualifi ed to give the answer, but I’m saying that if you can identify the next level of problem—building the fi re department or whatever it is—you can solve it. So many cases are like that: you build emergency operating rooms right there, because it is something that can be done and a nurse can be trained. If you can identify the problem, you can solve it. It’s a human thing. I keep addressing it: nothing is beyond solution.

Q: Begleiter. Bill, has the Gates Foundation been able to identify any problems that it hasn’t been able to solve?

A: Foege. I think there’s an important thing there about knowing the truth, and it increases your chance of being able to solve this. Some countries have tried different approaches. Mozambique has actually trained health workers to do C-sections. Chris, can you say something about if that works, is this something you can replicate?

A: Elias. Mozambique and Ethiopia are both trying this model—training others than highly-trained doctors in order to reach rural communities where these events happen—and there are some promising preliminary results. I think we’ve only recently started to experiment with these approaches and I’m not aware that it’s been done at a signifi cant scale yet. That’s part of what we need to do. If you think about 10 years ago in diarrheal disease control, we had successful projects and now we’re successful at a greater scale.

This kind of approach in Mozambique and Ethiopia, training these auxiliary health workers to do this lifesaving work and these operations, is clearly the way we need to go. Now we need to invest in understanding the curriculum, the model, the quality, the linkages via teleconferencing. We’re going to be facilitated by an emergent communications technology infrastructure that will assist us in that task. That, I think, is a challenge for the next decade but I certainly would agree that it’s solvable.

Q: John Haller, Program Director, National Institutes of Health. One thing I wanted to mention is that there’s a meeting, a summit coming up for mHealth (mobile health) and the use of cell phones in global health. That’s October 29-30 at the Reagan Building and International Trade Center here in Washington, D.C. My question is for Chris. Do you have any examples, or have you thought about ways of re-engineering existing technologies that might have an impact on global health? I’ll give you two examples that I have in mind. For example, X-ray technologies have been around since the beginning of last century, yet they’re not widely used in developing countries. Ultrasound technologies could address some of the problems in maternal health that you described and, combining that—for example, a $100 ultrasound device—with a cell phone might do exactly what you described, which is identify women who need special care. Or glucose monitors are ubiquitous in this country but not in developing countries, yet diabetes is widespread around the world. Are there technologies or examples that you’ve thought about along these lines that might be re-engineered at lower cost to provide these kinds of services?

A: Elias. This is part of how we innovate. My colleague, Michael Free, who has been with PATH for 71 more than 30 years, says that we invent as a last resort. We’re constantly scouring the world for other people’s innovations that we can re-engineer. One of the exciting ones we’re working with now is a new refrigerator technology developed in Japan for the RV, tailgating crowd. It’s a highly effi cient motor without a compressor and it operates in brownout conditions in a way that traditional compressors in refrigerators don’t, because it can tolerate tremendous variance in the voltage and amperage. It’s a technology that was developed for a very high-end market in Japan, but adapted and perhaps combined with better insulation technology that the military has been developing, you might actually be able to develop a much better refrigerator for protecting vaccines than the cold chain.

Certainly, some of the low-cost technologies that are being applied to infectious diseases could be applied to glucose monitoring or other disease management tools. There has been an under-appreciation of the growing pandemic of chronic diseases. While we’ve been fi ghting childhood illnesses and setting MDGs for reversing AIDS, TB, malaria and maternal health, there’s no Millennium Development Goal about dealing with the emergent epidemics of diabetes, heart disease, obesity-related problems, or tobacco-related problems. There’s a next wave of morbidity and mortality coming as globalization leads to the adoption of unhealthy lifestyles around the world.

Will we be able to re-engineer some of the tools we have for that? Yes. Is there interest yet in most countries or among most funding organizations in doing that? No. Part of it is that we need to advocate for that adaptation. I think we’ll be able to do it less expensively with chronic diseases because there’s a tremendous amount of innovation from fi rst-world markets that we’ll be able to adapt.

Q: John Sauer, Communication Director, Water Advocates. The water, sanitation and hygiene-related diseases remain the developing world’s most serious public health threat. We’ve heard a little from Muhammad Yunus about water and sanitation, but I’m particularly interested in the perspective of doctors on how we’re going to provide safe water, sanitation and hygiene throughout the world. In my opinion, it’s key that the doctors really start to think about this and strategize about this, so I’m keenly interested in that. Maybe one way we can think about water, sanitation and hygiene diseases is as “no- plumbing diseases,” a term we can coin so they’re a little more tangible.

A: Elias. Our diarrheal disease group recently did a study of policy and opinion leaders and found that they would rank priorities. Diarrheal diseases rank at the top of causes of death in children, yet they ranked much lower, in terms of policymakers, partly because of the misconception of the success of the oral rehydration solution, which has greatly reduced these diseases. People thought that this problem has been taken care of. In fact, it’s still a very prevalent cause, the second most common cause of death. There is a need to reinvigorate the attention of program and policy leaders toward diarrheal disease, including water, sanitation and hygiene interventions. We’re working on some lower-cost technologies for households—water treatment and storage—a component of a broader set of problems around how to solve water, sanitation and hygiene health. It’s an important problem; we’re working on some of it and trying to partner with the groups in the water area that have been working on it much longer than we have.

A: Foege. This was, of course, one of the subjects when schools of public health were fi rst developed. Water and sanitation were some of the oldest things we looked at. One of the problems is that people think in short terms now. They’re not thinking in terms of 50, 100 or 200 years. My wife and I had dinner with a hydrologist in Tucson, Arizona a few months ago, and he can predict when Tucson will have to start a ration scheme for water, yet he can’t get anybody’s attention until that actually happens. This is what happens globally also. We’re not thinking long-term. But you also raise, for me, the subject 72 that, while we are looking at these specifi c interventions, it’s still the social determinants of health that are so important—poverty, lack of education, lack of water, bias, joblessness, homelessness and so forth—and that we have to be thinking of. The world is so complex that we have to have these things in mind, and water and sanitation surely should be at the top of the list.

Q: Hans Herren, President, Millennium Institute. Coming back to the last few statements that have been made, the problems of health are really the problems of underdevelopment, poverty and inequity, so it seems to me that we have to address the causes much more. You just mentioned, Bill, some of these causes. My question is, how much are you, in your area, trying to help others prevent? You spend a lot of money on looking for vaccines or doing bed nets, when actually the problem of malaria is mosquitoes. Who is trying to get rid of mosquitoes? Very few people. I just wonder how much you are working with others, and maybe trying to support activities which would reduce the needs for your technologies, vaccines and other things, because the environment would be healthier and people would be healthier. Just as an example, in Mozambique, we found out by doing some system modelings, that it’s better to invest in agriculture than in health because, at the end of the day, people make money and can help themselves get healthier. So you can save money in health if you invest in agriculture because people can help themselves. I’m wondering where you lie in all of this, and are you actually trying to promote the more causal activities rather than just treating the symptoms?

A: Foege . Hans, I think we agreed to take questions, not necessarily answer them. (Laughter) Absolutely good point, and I’ve actually been on the WHO committee that has just published the report on the social determinants of health, so I’m very much aware that one has to go back to these very basic things.

I think back to 1903—and I almost can (Laughter)—when W.E.B. DuBois said that the problem of the century was the color line. Later in the century, people said that the problem of the century was the poverty line. And now what you’ve pointed out is that the problem of the 21st century in global health is the combination of the color line and the poverty line. Yes, we have to get back to very basic things.

A: Elias. It’s very hard to follow that. We’d love to put ourselves out of business, but at the same time you have to maintain a focus from an organizational perspective. What we’ve been increasingly doing is partnering with other organizations throughout the global development spectrum and seeing how we can fi nd synergy. We have a very interesting example where we’re working with a micro- fi nance organization in Nicaragua with Pro Mujer and Global Partnerships to see how we can use the infrastructure built through micro-fi nance to help deliver what we’re developing for health. We can’t be everything for everybody, but we can partner with groups that are involved in micro-fi nance and agriculture and water. We aren’t going to be able to comprehensively solve the problem unless we join forces.

A: Yunus. At Grameen Bank, right from the beginning, we got involved and worked with the poor and poor women specifi cally, so all those health problems came with it. Often people don’t use any latrines at all, they just go out in the open and it spreads disease. There’s a rule that if you want to join Grameen Bank, you have to dig a hole and use it as a latrine, in a fi xed place. Unless you can show a demonstration that you have that, you are not eligible to come to us. Then we started giving loans for sanitary latrines, a simple thing with three holes and concrete. We ended up gradually seeing that the poor families have sanitary latrines while middle-income families and others still don’t, because we could fund it and resource it. They’re borrowing the money, paying it back, paying interest. Just

73 because they’re poor, don’t dismiss them. That’s the message.

Then we started giving loans for wells, because they have to line up in front of a well that’s owned by a rich person and sometimes they don’t even get any water. So we said, “Why line up? We’ll give you a loan,” and they loved it. This created the next problem: arsenic. All of Bangladesh is fi lled with arsenic. We did our promotion for clean water, but, since we didn’t have the solution for arsenic, we had to learn from others about fi ltration, which reduces the arsenic content but doesn’t completely eliminate it. The big problem came with disposal of the arsenic. Where do you dispose of it? So we are looking for other solutions. Continuous research is going on in Japan and other countries to see how to make this fi ltration easy, simple and disposable without any trace. One Japanese university came up with a recent solution that we’ve been experimenting with. You collect the arsenic in a fi lter and dry it out, then you can literally take the dust out of it—which is the arsenic content—and collect it and use it for medical purposes, sell it in a market to those who want to buy arsenic. It’s an important chemical, too. We have not tested it, but that’s what they’re claiming, so we’d like to test it out.

Again, there are continuous processes of that kind—how to make things happen. On the water side, on the sanitation side our clients are ahead. Then we introduced health insurance, and clinics that we built up on the basis of this health insurance program, and our clients are the ones who are buying health insurance. Even this can be achieved, provided you produce something specifi cally for them. You can’t just give up on those people. They come in big numbers for immunization, so you can organize them, remind them of the date, when to show up. The system has to be in place, that’s the most important part of it.

Begleiter. Thank you to our three panelists for the inspirational conversation. On a personal note, I guess we’ve reached the conclusion of the last Hilton Prize Symposium and, as your moderator all these years, I want to say that I’ve learned something important myself. Each of you—both the people on the various stages and in all of your organizations—is supremely dedicated to serving the people around the world who need the services that you provide, and I think these symposia have made a valuable contribution to your work by introducing you to equally capable other people and accomplished humanitarians, by inspiring you to meet and exceed the Hilton Humanitarian Prize goals of service, and by enabling you to discover tools, techniques and methods to improve your own delivery of services. It’s been a privilege to be with you. I wish all of you continued success on behalf of the people you serve.

74 CONRAD N. HILTON HUMANITARIAN PRIZE LUNCHEON CEREMONY

The Capital Hilton Hotel Washington, D.C.

PATH Recipient of the 2009 Conrad N. Hilton Humanitarian Prize

75 Winner Announcement - November 12, 2009

“Whether or not you’re healthy and survive to be five years old shouldn’t be an accident of where you were born.”

Christopher Elias, MD, MPH, President and CEO, PATH

Imagine a powerful, entirely new dimension in global health. A single-use, disposable syringe that ensures the correct amount Imagine a new skill set, with a highly un-medical vocabulary— of drug administered and can’t be reused. “packaging, reconfiguration, affordability, A monitoring sticker for vaccine vials scaling up”—that can break the historic that tells the health worker if the medicine cycles of poor health in the developing world. has been spoiled by exposure to heat. Imagine medical delivery systems of enormous A low cost lab-on-a-card diagnostic tool technological sophistication on the inside, and that detects diarrhea-causing bacteria. utter simplicity on the outside, so that safe, Revolutionary new vaccines for malaria, affordable, effective, often self-administered meningitis, pneumonia and other medical intervention can reach the poorest neglected diseases. communities. Imagine that…someone did.

The $1,500,000 Conrad N. Hilton Humanitarian Prize for 2009 is Awarded to PATH

www.path.org Conrad N. Hilton Foundation, 10100 Santa Monica Boulevard, Suite 1000, Los Angeles, California, USA 90067-4011 Telephone:(310) 556-4694 Facsimile: (310) 694-9051 E-mail: [email protected] Website: www.hiltonfoundation.org

76 LUNCHEON KEYNOTE ADDRESS

Professor Muhammad Yunus, Founder, Grameen Bank

Professor Muhammad Yunus, founder and managing director of Grameen Bank and Nobel Peace Prize laureate, has been instrumental in lifting people worldwide out of poverty with the pioneering use of microcredit—supporting income generating activities by lending small amounts without collateral to the poor. Dr. Yunus received his B.A. and M.A. in Economics at Dhaka University in Bangladesh. A Fulbright scholar, he earned his Ph.D. in Economics from Vanderbilt University, and became an Assistant Professor of Economics at Middle Tennessee State University in 1969. Inspired by an independent Bangladesh emerging in 1971, he returned to join the Economics Department of the University of Chittagong. His active involvement in poverty reduction, spurred by the famine of 1974, led to the establishment of the Rural Economics Program. Despite the lending practices of the time, which either preyed upon or simply ignored the poor, Dr. Yunus strongly believed that, given the chance, the poor would repay borrowed money, put it to good use and even rise out of poverty. What started as Dr. Yunus’ own small business loans to Bangladeshi villagers grew into the full-fl edged Grameen Bank (which means Village Bank). Grameen Bank now has 7.5 million borrowers, 97% of whom are women, and has lent over $7 billion with a near 100% repayment rate. Dr. Yunus has founded several other companies in Bangladesh to abate poverty and aid development, including mobile phone services, energy, education and health care. He is also the founder of Grameen Trust, which extends the Grameen microcredit system all over the world. Together with Grameen Bank, Dr. Yunus was awarded the 2006 Nobel Peace Prize for his efforts to create economic and social development, the fi rst Bangladeshi and the third Bengali to be so honored. He has won a number of other awards, including the Ramon Magsaysay Award, World Food Prize and Sydney Peace Prize, and is the author of the bestselling books ‘Banker to the Poor’ and ‘Creating a World Without Poverty: Social Business and the Future of Capitalism.’ In his home country, he has received the President’s Award, Central Bank Award and Independence Day Award, the highest national award. He is also a member of the Legion d’Honneur and one of the founding members of the Global Elders, chaired by Nelson Mandela.

I’m honored and privileged to be the fi rst one to offi cially congratulate Chris Elias and PATH. Let’s give them a big, offi cial applause. And also to your co-workers around the world, on behalf of all of us, we congratulate them for the wonderful work they have done. It’s not easy to get here to get this medal. I was on the jury for eight years. I know how diffi cult the choice is, and making it really means something. It makes what you have achieved distinguished, and it inspires many, many people. You are seen in a very different way after receiving this award, because everybody else wants to learn from you. They see it very differently now, because you have been put on a pedestal. It’s something not just in Seattle, it’s all over the world. I’ve known you for a long time, Chris, and I’m a great admirer of yours, because a lot of things we’re trying to do in Bangladesh, you’ve already done in a big way in many different countries. So we’re trying to pick up how we can benefi t from that.

Health is a problem everywhere, but it’s a special problem in Bangladesh where the service is totally absent. You build a whole machinery because health is supposed to be a government delivered service. When you don’t have an offi cial machine, an effi cient government, you run into problems. You build

77 the machine, you spend a lot of money to run the machine and at the end of the day you fi nd out that all the money is used just to keep the machine there, rather than deliver services. We see this a lot in Bangladesh. The poor, particularly the bottom half of the population, miss out on everything in terms of health services. Then you encourage the private sector to get involved, because people are going to Singapore, to India, to Bangkok for simple things since they can afford the treatment, but a lot of people cannot do that. So the private sector got involved and built facilities for them. They did a good job, but at the same time they’re serving the people at the top, not the poor people. This is another big issue: how do you reach the poor people with health services?

While I’m complaining about all this, I should mention that Bangladesh has done wonderfully in the health area as a nation. In the health indicators, Bangladesh was the lowest country within the South Asia region—below India, Pakistan, Nepal, and Sri Lanka. Over time, Bangladesh gradually started overtaking one country after another. By now, it has surpassed all the countries in the region—India, Pakistan, Sri Lanka and so on. This is a great achievement for Bangladesh.

If you look at the Millennium Development Goals, Bangladesh again takes pride that they are on track to achieving Millennium Development Goal #1—reducing poverty by half by 2015. Despite all the shocks and all the troubles we have had—all the cyclones, all the fl oods, all the fi nancial crises, all the political turmoil—we’re still on track to achieve Millennium Development Goal #1, and we expect to achieve all eight Millennium Development Goals by 2015. This is no small task for Bangladesh to achieve. But we are slightly behind the schedule on maternal deaths and infant deaths, so this is where we’re trying to focus. Can we do a little better so that we can have all eight Millennium Development Goals done by 2015?

One big contributing factor was the empowerment of women in Bangladesh, and that has impacted many, many areas including population birth rate. The number of children per family used to be 6.1 per mother. Now that has come down to three per mother, which is quite a difference in the last 25 years. So we see a lot of optimism in the health system to build upon. Micro-credit soon got involved with health issues because poverty and health are not too distant issues. If you are poor, by defi nition you are poor in health. So it has to go together. If you’re trying to get out of poverty, you have to get out of poverty along with health improvements, so we got involved with that—clean well water, vegetation, nutrition and so forth. Today you mentioned that PATH began in 1977—1976 and 1977 seem like magical years, because Grameen was born in 1976. A lot of things have happened since then.

Whenever I see a problem to be solved, somehow without knowing exactly what I’m doing, I always try to fi nd a solution by creating a business out of it. Everything I have done—you mentioned 30 companies and more—was in response to a particular problem. The reason we created Grameenphone, which is the still the largest phone company in the country, was to bring information technology to the poorest people. That’s why the famous “telephone ladies” came into the picture, and that became a big thing. [Grameen Bank offers “telephone ladies” low-cost loans to set up business as a cell phone exchange in villages where there are few, if any, land lines.]

Today, health care is not looked at in the same old way as 30 years ago, because the world has changed so dramatically in the last 30 years, even in the last 10 years. In 1997, in Bangladesh there were only half a million telephones in the whole country. Today there are nearly 50 million telephones in the country, and growing. So the telephone is something that everybody—even low-income people—has access to

78 phones. With a population of 150 million people, there are 50 million subscribers—on average, three people to a phone, so every single family has a phone. This is a very powerful instrument. You can bring anything you want with the phones. So, we’re trying to look at health care through mobile phones.

How do we use this? We started doing things with mobile phones in other projects we were working on. In the meantime, we had created companies with a specifi c structure and started calling them social businesses; non-loss, non-dividend companies to solve a social problem. We tried to stay away from dependence on donor money. If you start a company it should run by itself, so that affected everything that we did, in health care and other sectors. It has to be a self-reliant company, otherwise you have no solution. You become dependent.

We used this idea in health care, and in the fi rst project,we created an eye care hospital because there are so many cataract patients in Bangladesh, and this is something we wanted to concentrate on. There are so many new cataract patients that if you had the entire medical capacity of Bangladesh, you still couldn’t treat them all. In the meantime, the number in the backlog would have increased. This is our fi rst hospital that performs 10,000 cataract operations per year, and, if this one works out as a social business and we see that we have succeeded, then we will launch a second one and a third one and a fourth one, and so on. If it’s a social business, you have no problem. It runs by itself.

We completed the fi rst one, and now it’s set for life. We’re going for economic self-suffi ciency. There are problems along the way—we don’t have the doctors, we can’t send the doctors to the villages—but still we managed to open a second eye care hospital. Now we’re getting ready for the third one. If it works by itself, what is the problem? You can treat as many patients as you want, improving the effi ciency of patient care. So, along with cataracts, other eye-related problems are treated at the hospital.

Then came the Dannon case. I happened to meet the chairman and during a discussion I proposed to create a social business based on yogurt. This was two years ago, and he agreed right away, so we created a company to bring nutrition to children. This is a fortifi ed yogurt, that includes all the micro-nutrients missing in the children’s diets. When I say nutrition in Bangladesh, it’s not a tiny issue in health care, it’s a big issue because almost half of all children in Bangladesh are malnourished. Half of that half are severely malnourished. You cannot build a health system leaving the children malnourished. They are the ones who become victims of all kinds of diseases, so we have to address that. So we built a small plant to produce the yogurt, which we were not sure we would be able to do successfully. Now, it’s very close to becoming operationally self-suffi cient and we’re getting ready for a second plant. I’m sure the second plant will be much more effi cient than the fi rst, because we didn’t know anything about producing or selling yogurt. Now we know a lot, so the second one will be better, and the third one will be better yet. We will have at least 50 plants all over Bangladesh as a social business.

Another issue that we’ve addressed is water. You know that Bangladesh has a bad water situation. As I mentioned previously, Bangladesh has a population of 150 million people. Half the population of Bangladesh drinks arsenic-contaminated water, and in some cases it’s an extremely high level of arsenic contamination. People literally drink poison every day without knowing it. Some say, “We know, but what can we do because this is the water that we have?” And you don’t see anything, it’s such nice- looking water. The government tried to paint red marks on all the wells producing arsenic-laced water beyond the limit acceptable for human consumption, but nobody cares. We have no solution. So we joined hands with another company, Veolia, which is the largest water company in the world—a French

79 company—to create a small water treatment plant in the village to sell clean water. Now we have the very clean Veolia-quality water in the village. If this one works out, then we can keep on repeating it, and in so many years pay back the investment money, because in a social business, you pay back the money.

We entered another partnership and another area. BSF from Germany came over, and the president took a personal interest in the idea of social businesses and asked if we could collaborate on a social business. Of course, I agreed. Two things came out of it. First, nutrition—making a sachet of 15 nutrients in a tiny sachet, at a very affordable price that can be sprinkled on food or something. This is our fi rst project together. The plant is under construction now.

Second is bed nets. Bangladesh has pockets of malaria but, more than that, Bangladesh has mosquitoes everywhere. Just to enjoy peaceful sleep, you need something to cover yourself. So this topic came up and we thought, “Why don’t we do bed nets?” Now we are setting up a plant to produce bed nets so that we can give or sell bed nets to everybody, and make it very cheap and affordable. Those poor people who cannot afford it will get a loan from us to buy the nets on credit and gradually pay the money back, and save their children from dengue, from malaria, from every mosquito-borne disease one can have. We have already manufactured bed nets and people love them, seeing that mosquitoes don’t come near them. Using mosquito foggers, fumes get into your lungs and you breathe it all night long with closed windows, particularly in winter. You continually breathe these fumes and it’s a health hazard, but those who are selling those products make a lot of money and they love mosquitoes because they bring them millions of dollars in profi t. This is no solution at all; it’s a very diffi cult thing.

I’m very happy with the response I get from health people. I’m getting a lot of responses from the USA. Many companies like Kaiser, Johnson & Johnson, and General Electric are cooperating with us and building village-level structures. We have tried in the past to bring health care to the village level by setting up clinics. We did well as a social business, but doctors did not want to stay in the villages. So, now we are redesigning the whole thing. We are designing what you would call health management centers. The objective of these centers would be to keep healthy people healthy—that’s our number one goal. And number two would be early detection. If somebody deviates from good health, it should immediately be detected and then treated early on so that the problem doesn’t go too far. On the corporation side, we’re focusing on women, our number one priority, children, our number two priority and adolescent girls, our number three priority. These are the most diffi cult segments of the population to reach, so we thought that if we can reach them, we can solve all the problems.

What we are doing instead of asking the doctors to come to us is bringing the technology to them and working with General Electric to design new diagnostic treatments—very simple, hand-carried house- to-house rather than patients or pregnant mothers coming to the clinics, which is very diffi cult for them and something they don’t want to do. So the Grameen workers go around house-to-house, connected to wireless phones and transmitting all the images and information to the specialist doctors sitting in Dhaka, so that they can see it and at the same time talk to the patient. Someone who is delivering a service there can immediately deliver the treatment. This is the idea that we want to carry out.

Another social business company that we created in cooperation with Intel Corporation is Grameen Intel, using the mobile phone to screen for risky pregnancies. Infant and maternal mortality is where we are deviating from the path for the 2015 Millennium Development Goals and we have to bring these numbers down, so we are concentrating on reducing these rates to the lowest number possible, even

80 below the target that is fi xed for 2015. They have software with about 30-32 questions and the answers from pregnant mothers are fed into a mobile phone. With these answers, they can classify the status of the mother’s pregnancy—whether it’s a normal pregnancy or whether it’s a risky pregnancy. We have outreach, we have networks, and we can do it in a business way and change the whole situation, the whole picture we have in addressing this issue.

We are creating new social businesses and creating nursing colleges. Nurses are rare persons in Bangladesh. For every three doctors, we have one nurse, so you can imagine what the problem is. So we thought, “Why don’t we approach the Grameen borrowers who have been educated and have graduated from high school before they get married and have children?” There’s nothing else to do. Why don’t we pick them up, train them as nurses and fi ll this gap? There’s an international demand for nurses; they will become professional young people. This is a tremendous change in the status of women.

We’re very happy that many universities have been supporting us, like Glasgow Caledonian University. The fi rst Grameen nursing colleges were built with the collaboration of Glasgow Caledonian, and the Nike Foundation is investing in it. Each one will be a social business and continue expanding with their own money. The second and third ones are starting up. Emory University is supporting us in the second one, and we are in discussion with other universities. The University of Pennsylvania has been very supportive and are coming next month to discuss details. Others include Harvard University, Johns Hopkins and so on.

You see how we can connect the village level with civil level offi cials and address health issues in a completely different way than we have done in the past? The basic thing would be how to design it as a social business—non-loss, non-dividend company—to solve the social issue. Each one is a separate piece. We’re not putting everything in one company. Each one is separate; if it succeeds it goes up, if it fails it goes down and we get another to replace it. We know exactly what is happening.

Lots of new issues come up along the way. About three days ago, I received an email from Japan, regarding something very close to our heart in terms of social business. Here’s a rich Japanese businessman who became very excited about the idea of social business. He came to Bangladesh and discussed ideas with us, went back and has sent me a few emails. In the last one, he said there’s an issue that he’d like to share with us. We had talked about homeless people, but to him a more important issue in Japan is suicide—30,000 people commit suicide there every year. And now, with the fi nancial crisis, that number is increasing. They commit suicide because they have lost their jobs. They jump in front of trains, they hang themselves, they use all kinds of methods to commit suicide. Nearly 3,000 a month are committing suicide. We’d like to have a social business to solve this problem.

I said, yes, it can be done. We can do it. I gave him some suggestions. If we can save one life with this social business, it’s worth it. If you know how to save one life, you’ve found a solution to saving 30,000 lives because you have developed a seed. In social business, the most important thing is developing a seed. Once you do that, all you need to do is to replicate it. If you have one yogurt plant that’s really working, your problem is solved. You go on expanding it, you repeat it. The Shaklee Corporation, an American company, is coming to see how this can be done, too.

There are many ways; there’s a tremendous technology today that didn’t exist yesterday. We should be looking at health care completely differently, because we are in command of this technology. The

81 only thing this technology is in command of is businesses, where they make use of this technology to make money. If you can open a door, this technology can also be used to solve problems. In a social business, all these problems can be solved completely. That’s when our creativity and the young people’s creativity comes in. That’s when the company’s creativity comes in. They know how to use this technology for a particular purpose, but once they open up the door—and say “Yes, we would like to have a social business”—you go from there.

So this is the challenge for us. It is now 2009. By 2015 we must conquer this whole health care issue, because we have come a long way. We can’t go on saying, “OK, mothers die, what can you do? OK, children die, what can you do?” We can do a lot. One individual can do a lot to change the whole world. That’s the challenge we face. Thank you very much.

82 2009 HILTON HUMANITARIAN PRIZE RECIPIENT

Christopher J. Elias, M.D., M.P.H., Founder and CEO, PATH

Dr. Elias is president and chief executive offi cer, leading PATH’s work in more than 70 countries in the areas of health technologies, maternal and child health, reproductive health, vaccines and immunization, and emerging and epidemic diseases. Dr. Elias represents PATH at domestic and international forums, both as a spokesperson for PATH and as an advocate for innovative responses to global health challenges. He serves on the boards of the Global Alliance for Improved Nutrition, the Medicines for Malaria Venture, and the Washington Biotechnology & Biomedical Association, among others. Dr. Elias was honored as the Schwab Foundation’s Social Entrepreneur of the Year for the United States in 2006 and named Global Health Research Ambassador by the Paul G. Rogers Society for Global Health Research in 2007. Before joining PATH, Dr. Elias was a senior associate in the International Programs Division of the Population Council, where he served as the country representative in Thailand, managing reproductive health programs throughout Southeast Asia. His early career included two years in Thailand working with refugee assistance programs, fi rst as a physician supervising a large pediatric ward in a refugee encampment and then as a medical coordinator for the American Refugee Committee at the Thailand–Cambodia border.

Thank you, Steven, and thank you to the Foundation’s Board and the Prize jurors for recognizing our work at PATH. I’d also like to thank Judy Miller and Shaheen Kassim-Lakha from the Hilton Foundation staff, who through thoughtful engagement throughout the selection process, really helped us to understand more fully the impressive breadth of the Foundation’s activities, and the Hilton legacy. I’d like to thank Congressman McDermott for his recognition, and greetings from all of us back home. Thank you, Sister Joyce, for your beautiful invocation. I’m honored to be in your distinguished company. And fi nally, Professor Yunus, sharing this venue with you is truly humbling. Your work in bringing economic empowerment to the poor and your appreciation of technology’s role in global health and development is an ongoing inspiration to all of us at PATH and to everyone here today.

Earlier this month, The New York Times ran a story on a UNICEF report which noted that, for the fi rst time since UNICEF started measuring it, the mortality of children under fi ve dropped below nine million last year. For those of us familiar with the state of global health, UNICEF’s report of a continued decline over many years in child mortality is quite uplifting. It seemed, for a moment, like we should celebrate. But of course, the death of 8.8 million children is nothing to celebrate. Rather, that story, like today’s Prize celebration, provides an important moment for us to refl ect on the progress we’ve made and then to redouble our efforts. The facts are that the global community’s efforts to reduce health inequity have made great strides. The trends are encouraging, and we should take a measure of pride in that achievement.

But meeting the fourth Millennium Development Goal of a two-thirds reduction in child mortality by 2015 is still not a given. Meeting the fi fth Millennium Development Goal of reducing maternal

83 mortality by 75% seems more distant. Despite signifi cant recent progress, the broad coverage of prevention and treatment programs that will be needed to reverse the course of epidemics like AIDS, TB and malaria is still not securely in our grasp. So, while we note the metrics of progress, we also note that we’re living in a time when most economies are at the nadir of a global recession that is wreaking untold havoc for the poor—a time when philanthropic entities are challenged as never before to redefi ne their roles and do even more with the resources at their disposal. And a time when innovative approaches are required both for those who provide the dollars to alleviate suffering and for those who put the dollars to use.

So, the question I want to pose today is, what is it going to take to realize our goals for global health? How, exactly, are we to contribute effectively to meeting Conrad Hilton’s charge to alleviate human suffering? From where I stand as CEO of PATH, I think that realizing our goals requires three main ingredients. The fi rst—and you heard something about this this morning from the panels—is innovation. The second is creative partnership. And the third is political and fi nancial commitment.

PATH’s vision is of a world where innovation brings health within reach for everyone. You saw the video clip and heard about the vaccine vial monitors which protect vaccines from heat damage due to a disruption in the cold chain. Two decades ago, we found a promising indicator technology for monitoring temperature with a company that was making food-related monitors in New Jersey. With support from USAID, PATH formed a public-private partnership with this company and adapted the use of the technology for vaccines. Today, this very useful technology—which lets even semi-literate health workers know when vaccines have been spoiled—has been used in over three billion vials of vaccine. As a consequence, it has reduced vaccine wastage and saved money, and, more importantly, saved tens of thousands of lives. Our model suggests that UNICEF’s requirement to use these monitors on every vaccine they use will save another 140,000 lives in the next decade.

Heat is not the only problem vaccines face. Innovations are required throughout the system. Recently, we’ve documented that the newer and more expensive vaccines are actually perhaps more vulnerable to freezing, and that’s why we’re working with a range of academic and technology partners to test a variety of affordable, comprehensive thermo-stability approaches. The pace of innovation in science and technology globally continues to accelerate, and our experience at PATH shows that it can be harnessed to benefi t all people, regardless of where they’re born. And so there’s signifi cant cause for optimism.

Product innovation alone is not enough. Introducing and scaling the use of new ideas as well as maximizing the use of existing tools requires creative partnerships. This year, PATH is involved in over 160 active collaborations. I’d like to share with you just one example. Since 2001, we’ve worked closely with the World Health Organization on the Meningitis Vaccine Project to take on the seasonal epidemics that threaten the lives of over 21 million people in sub-Saharan Africa every year. Through a partnership that includes the U.S. Food and Drug Administration and the Serum Institute of India, the Meningitis Vaccine Project has developed a vaccine specifi cally designed for the African epidemics at a guaranteed price of just 40 cents a dose. The regulatory fi le is currently under review in India. Once approved, the vaccine will be introduced next year in Burkina-Faso, one of the most heavily affected countries. Then, with the Global Alliance for Vaccines and Immunization, the World Health Organization and UNICEF will lead the scale-up of the vaccine use throughout the rest of the sub- Saharan African meningitis belt. Epidemiological models show that once 30% of the rural population is immunized, these annual epidemic cycles will stop.

84 My broad point is this: Around the world, scalable public health projects are being realized through creative projects between NGOs like PATH, the private sector, UN agencies, regulatory bodies, national governments and local communities. No one of those groups could do it on their own. As a consequence, the momentum is gathering to address some of the world’s toughest global health problems. But sustaining that momentum will require political and fi nancial commitments that are set for the long haul. Here, too, there is reason for cautious optimism. A recent article in The Lancet reported that development assistance for health has experienced roughly a fourfold increase since 1990. The increase was fueled by resources from wealthy nations, entrepreneurial philanthropy from institutions such as the Bill & Melinda Gates Foundation and the Rockefeller Foundation, and the corporate sector. It has been complemented by individual activism through millions of groups.

These increased commitments have allowed us to scale up the pursuit of one of our most important goals—ending the scourge of malaria. This parasite kills 3,000 children a day, more than a million kids a year. We’re working hard on the ultimate solution—a vaccine to protect children against the malaria parasite. But, until we succeed in developing an effective vaccine, we’re scaling up prevention with the tools currently at hand. Tools as simple as an insecticide-treated bed net can cut the incidence of malaria in half. Last year, with PATH’s assistance, the government of Zambia’s national malaria control program distributed half a million of those nets. Next year, 3.4 million more will be distributed, reaching 80% coverage of the targeted population. Survey results have shown that, since 2006, more people than ever are sleeping under bed nets. Two-thirds of Zambian households are protected and the prevalence of the malaria parasite among children has been reduced 50%. Another study showed a signifi cant decrease in mortality among children under the age of fi ve since 2002.

It took strong national leadership and a fi rm and sustained fi nancial commitment from a variety of organizations—the Global Fund to Fight AIDS, TB and Malaria, the U.S. President’s Malaria Initiative, the World Bank’s Malaria Booster Program, and the Bill & Melinda Gates Foundation—to produce the results we see in Zambia and several other countries. In the short term, the U.S. government’s commitment seems to be continuing with President Obama’s $3.3 billion health initiative over the next six years. This is the type of leadership—sustained political and fi nancial commitment for the long haul—that will allow us to complete the work needed to reach our goal.

As we collectively stretch to end the millions of deaths of young children, as we strengthen systems to ensure safe monitoring, and as we work to reverse the course of epidemic diseases, I personally believe that the next fi ve years are the most critical ever in the global health fi eld. With global health’s arrival on the world’s stage comes the responsibility to deliver health on a whole new scale. Along with our partners and fueled by your recognition, PATH is eager to play our part. So I’m pleased to announce that we will commit the $1.5 million Hilton Humanitarian Prize to form the foundation of a new and innovative funding effort at PATH. We are currently securing commitments from our board and individual supporters so that, over the next fi ve years, this $1.5 million will be leveraged by another $25 million to accelerate the development of innovations in new health technologies, to increase our fi eld operations particularly in Africa where the Millennium Development Goals are lagging the furthest, and to scale up proven interventions in infectious diseases and maternal and newborn health.

From the opening video, I hope you got at least an inkling of the energy and commitment that PATH employees bring to their jobs. You should have heard the buzz in the organization when the word got 85 out that we had won the Prize—there was sort of a crackling, electric sense of pride surging through the organization as these incredibly busy and devoted people took just a moment to refl ect on a body of 32 years of work. This honor is for them, and I accept it on their behalf and thank them from the bottom of my heart.

I also accept this honor with immense respect for the other nominees and profound admiration for the previous Laureates whose ranks we are joining, and with a deep sense of responsibility for the spirit and intent of the Conrad N. Hilton award. The Hilton Humanitarian Prize will do many things. It will open new doors of opportunity for us, it will raise the profi le of global health, and it will allow us to expand PATH’s ability to innovate, engage in creative partnerships and harness the global, fi nancial and political commitment to deliver results. So once again, Steve Hilton, thank you for this recognition and this Prize.

Let me close by thanking all of you. All of us have come here today to think about the challenging work inspired and invigorated by Conrad Hilton. Every one of us is here today because of our dedication to the immense task at hand. I’m genuinely thrilled to think about where we’re going to be able to go next. What will it take to realize the promise of global health? It will take the very best that each and every one of us has to offer. Thank you.

86 2009 SYMPOSIUM ATTENDEES

The Honorable Morton L. Abramowitz Mr. Patrick Barry Senior Fellow Patrick Barry & Associates The Century Foundation Ms. Donna Barry (SPEAKER) Mrs. Sheppie Abramowitz Policy and Advocacy Director The Century Foundation Partners In Health

Ms. Alexa Adam Ms. Wendy Batson Senior Development Offi cer, Foundation and Executive Director Corporate Relations Handicap International, U.S.A. Doctors Without Borders U.S.A. Mr. Ralph Begleiter (MODERATOR) Mr. Ahuma Adodoadji Distinguished Journalist in Residence President and Chief Executive Offi cer University of Delaware Plan USA Director, Global Agenda Program Former CNN World Affairs Correspondent H.E. Princess Salimah Aga Khan International Children’s Ambassador for SOS The Honorable Catherine Bertini Children’s Villages Professor, Syracuse University, Maxwell School of Juror, Conrad N. Hilton Humanitarian Prize Citizenship and Public Affairs Juror, Conrad N. Hilton Humanitarian Prize Ms. Ellen Agler Vice President, Latin America and Caribbean Region John Bowen, Ph.D. Operation Smile Dean and Barron Hilton Distinguished Chair University of Houston Ms. Serap Akisoglu Director, Major Gifts & Foundations and Dr. J. Barron Boyd Special Assistant to the President Founding Director TechnoServe, Inc. Center for Peace and Global Studies, Le Moyne College

Abdillahi Alawy, Ph.D. Ms. Juanita Britton Monitoring and Evaluation Specialist Executive Director Women for Women International BZB International

Mr. Iqbal Noor Ali Dr. Gro Harlem Brundtland Chief Executive Offi cer United Nations Special Envoy for Climate Change Aga Khan Foundation U.S.A. Juror, Conrad N. Hilton Humanitarian Prize

Sir George A.O. Alleyne Ms. Erica T. Burman Director Emeritus Journalist Pan American Health Organization WorldView (Peace Corps)

Ms. Gail Lowney Alofsin Mr. Francis J. Butler Volunteer President Hatian Health Foundation Foundations and Donors Interested in Catholic Activities, Inc. Mr. Marvin Baldwin President & CEO Mr. Edmund J. Cain Foods Resource Bank Vice President—Grant Programs Conrad N. Hilton Foundation Dr. Gerald Barney Chair Our Task, Inc. 87 Ms. Sonya Campion, CFRE Mr. Robert M. Davis Trustee CEO The Campion Foundation The Mountain Institute

Mrs. Therese Caouette Ms. Deborah De Santis President and Chief Executive Offi cer Andrea K. Capachietti, Ph.D. Corporation for Supportive Housing Humanitarian Aid Consultant and Educator Francis M. Deng, Ph.D. Ms. Barbara Sayre Casey Chairman & CEO Mr. Arthur E. Dewey Casey, Sayre and Williams, Inc. Former U.S. Represenatative, International Independent Group of Eminent Persons Ms. Wendy Chamberlin President Ms. Renee DiFlavio Middle East Institute Senior Vice President of Employment & Education National Statler Center for Careers in Hospitality Training Melvin L. Cheatham, M.D. Special Assistant to the President Ms. Lucy B. Dorick Samaritan’s Purse Director Merlin USA Mr. Ron Clemmer WASH Specialist, International Programs Group Ms. Rusty Dornin World Vision Senior Vice President NewsCertifi ed Exchange Mr. Julius E. Coles President Ms. Victoria Smith Downing Africare Founder IVEC Technologies Ruth B. Cowan, Ph.D. Senior Research Fellow Ms. Victoria Dunning The Ralph Bunche Institute for International Studies Vice President, Programs Global Fund for Children Mr. Larry Cox Executive Director Christine K. Durbak, Ph.D. Amnesty International President K. Kovshevych Foundation Ms. Maya Crawford Associate Director of Development Ms. Barbara Durr American Jewish World Service Sr. Director of Development, Foundations CARE U.S.A. Ms. Susan Crowley President Ms. Lisa Eakman Multilateral Consulting Senior Program Offi cer Chicago Council of Global Affairs Mr. David R. Curry Managing Principal Mr. Gary R. Edson David Curry Associates Chief International Offi cer and Senior Vice President The Case Foundation Ms. Susan M. Davis President and CEO Dr. Christopher J. Elias (SPEAKER) BRAC USA President & CEO PATH

88 Mr. Ray Empson Ms. Radha Friedman President and CEO Director of Global Communications Association of Hole in the Wall Camps Rural Development Institute

Mr. Robert A. Enholm Ms. Danielle Fuller Executive Vice President Program Offi cer, Domestic Programs Citizens for Global Solutions Conrad N. Hilton Foundation

Ms. Josie B. Everett Mr. James R. Galbraith Executive Director Member, Board of Directors Heart to Heart International Children’s Medical Alliance Conrad N. Hilton Foundation

Mr. Paul Faeth (SPEAKER) Mr. Will Galvin President Head of Operations and Advocacy Global Water Challenge Self Help Africa

Ms. Christina Falck Ms. Robin Ganzert Director of Development Deputy Director, Philanthropic Services Fabretto Children’s Foundation Pew Charitable Trusts

Amir Farmanesh Mrs. Alexandra S. Garcia Policy Fellow President National Academy of Sciences Fabretto Children’s Foundation

Ms. Valentina Ferrara Ms. Mimi Ghez Fundraising and Institutional Relations Offi cer Director of Development DARA (Development Assistance Research Associates) International Centre for Missing & Exploited Children

Ms. Barbara Ann Ferris Mr. Gannon Gillespie President and Founder Director of U.S. Operations International Women’s Democracy Center Tostan, U.S. Offi ce

The Honorable José María Figueres Olsen Ms. Muriel Glasgow, MPH Chief Executive Offi cer President Concordia 21 MG Associates, Inc.

Ms. Maria Cecilia Flores-Oebanda Ms. Priscilla S. Goldfarb President and Executive Director Executive Director Visayan Forum Foundation, Inc. WaterLife Foundation

William H. Foege, M.D., M.P.H. (SPEAKER) Mr. Mark Gorman Member, Board of Directors Director of Strategic Development Conrad N. Hilton Foundation HelpAge International

Ms. Stephenie Foster Mr. Ted Grant, Jr. Senior Vice President, Government Affairs Special Assistant to the President American Legacy Foundation Rockefeller Foundation

Mr. Frank Franke Mr. Steven Guy Journalist, AFRA-Press Communications/ Special Projects Manager Co-founder and Vice President, Aviation Without mothers2mothers Borders (Luftfahrt ohne Grenzen) Mr. Steven Hansch Dr. Michael Free Senior Associate Vice President & Senior Advisor for Technologies Institute for the Study of International Migration, PATH Georgetown University 89 Ms. Karen Hanscom Ms. Hawley Hilton McAuliffe Representative for North America Member, Board of Directors International Rehabilitation Council for Conrad N. Hilton Foundation Torture Victims (IRCT) Ms. Annette Hoegh Goelet Ms. Janet M. Harris Board Member Vice President of Development International Center for Clubhouse Development International Rescue Committee Mr. Rick Hoffman Ms. Ann Hassett Owner Documentary Film Producer Rick Hoffman & Associates Niemack/Hassett Productions Ms. Elizabeth Howard Ms. Kathy D. Hendrix Chief Executive Offi cer Vice President of Programs Ovarian Cancer Fund Vital Voices Global Partnership Mr. Zen Hunter-Ishikawa Mr. Bruce Henry Vice President Director, Covenant House Institute El-Hibri Charitable Foundation Covenant House Christian Isichei, M.D. Judith Hermanson, Ph.D. Founder & Director Senior Vice President Faith Alive Foundation CHF International Mr. Sam K. Jackson Hans R.Herren, Ph.D. (SPEAKER) National Director of Philanthropy President World Vision, Inc. Millennium Institute Mr. Scott Jackson Ms. Silvia Hidalgo Vice President, External Relations Director PATH DARA (Development Assistance Research Associates) Ms. Jan Jacobs Ms. Gracia M. Hillman Director, Donor Relations President and Chief Executive Offi cer PATH Hillman Group Mr. Frederick Johnston Mr. Eric M. Hilton Member, Board of Directors Ms. Jolie Jones Conrad N. Hilton Foundation Owner Juror, Conrad N. Hilton Humanitarian Prize JJ Productions

Mr. Steven M. Hilton Mr. Vidar Jorgensen President & CEO President Conrad N. Hilton Foundation Grameen America

Mr. Conrad N. Hilton III Musimbi Kanyoro, Ph.D. Member, Board of Directors Director of the Population Program Conrad N. Hilton Foundation David and Lucile Packard Foundation

Mr. William “Barry” Hilton, Jr. Shaheen Kassim-Lakha, Ph.D. Member, Board of Directors Director of International Programs Conrad N. Hilton Foundation Conrad N. Hilton Foundation

90 Ms. Susan LaVenture Ms. Jane Katz Executive Director Director of International Affairs & Programs National Association for Parents of Children Habitat for Humanity International with Visual Impairments

Edward J. Kennelly, Ph.D. Mr. Kevin J. Lessard Professor, Department of Biological Sciences Former Director City University of New York Perkins School for the Blind

Mr. Bernard Kibirige Ms. Calleen King Letaconnoux Executive Director Representative Saph Integrated Training Centre Catholic Near East Welfare Association

Mr. Jonas Kieffer Mr. Philippe Lizop Chief Speech Writer Special Advisor to Princess Salimah Aga Khan Rockefeller Foundation Dr. Jeremiah J. Lowney, DDS Mr. Randy Kim President Vice President and Chief Investment Offi cer Haitian Health Foundation Conrad N. Hilton Foundation Mr. C. Payne Lucas Ms. Suzanne Kindervatter Senior Advisor Vice President, Strategic Import All Africa Global Media InterAction Ms. Jo Luck (SPEAKER) Dr. Harald Kischlat President and CEO Secretary-General Heifer International Doctors for Developing Countries (Ärzte für die Dritte Welt) Ms. Kathy Magee Co-Founder and President Ms. Mary Kopper Operation Smile Senior Vice President for Development Vital Voices Global Partnership William P. Magee, Jr., M.D., D.D.S. (SPEAKER) Co-Founder and CEO Mr. Russell A. Kost III, CFRE Operation Smile Vice President for Development Desert Research Institute, Las Vegas Dr. Doris Lee McCoy Founder and President Ms. Diana Kutlow American Spirit Foundation Senior Program Offi cer University of San Diego Mr. Vincent McGee Senior Advisor Ms. Jennifer Lachman The Atlantic Philanthropies Executive Director Mines Advisory Group Mr. Kirk McKinnon Director of Foundations Ms. Rebecca Lake International Justice Mission Director, Foundation and Corporate Relations Plan USA Sister Janice McLaughlin President Mr. Mark Lancaster Maryknoll Sisters of Saint Dominic Director of Strategic Relationships The Global Footprint Network Ms. Molly Melching (SPEAKER) Founder and Executive Director Tostan Inc.

91 The Honorable Joseph H. Melrose, Jr. Ms. Elizabeth O’Connell Ambassador in Residence and Professor of Director of Development and Strategic Partnerships International Relations Global Water Challenge Ursinus College Mr. Olara Otunnu Sister Joyce Meyer, PBVM President, LBL Foundation Executive Director Juror, Conrad N. Hilton Humanitarian Prize Conrad N. Hilton Fund for Sisters Member, Board of Directors Professor William G. Ouchi Conrad N. Hilton Foundation Sanford & Betty Sigoloff Distinguished Professor in Corporate Renewal, Ms. Carolyn Miles University of California – Los Angeles COO and Executive VP Member, Board of Directors, Save the Children Federation, Inc. Conrad N. Hilton Foundation

Mr. Greg Millar Ms. Mary Pack Senior Private Sector Fundraising Offi cer for the Vice President, Domestic and International Affairs Americas International Medical Corps United Nations High Commissioner for Refugees Ms. Luzon Pahl Ms. Judy M. Miller Associate Director, U.S. Operations Director, Conrad N. Hilton Humanitarian Prize Tostan, U.S. Offi ce Vice President, Conrad N. Hilton Foundation Ms. Lynne R. Patterson Ms. Kelsey Moll Executive Director Media Relations Assistant Pro Mujer International PATH Heather Paul, Ph.D. Mr. Jean-Marc Moorghen CEO Senior Manager, Hilton Humanitarian Prize SOS Children’s Villages, USA Conrad N. Hilton Foundation Ms. Rosario Perez Mr. Richard Morford CEO Managing Director, Donor and Multilateral Relations Pro Mujer International Millennium Challenge Corporation Mr. Todd Petersen Mr. John Muir Managing Director Volunteer, Innovation Options Shake-a-Leg Miami Mr. Bill Pitkin Sister Lillian Murphy, RSM Senior Program Offi cer Chief Executive Offi cer Conrad N. Hilton Foundation Mercy Housing Dr. Julie Pulerwitz Mr. Ford Neale HIV/AIDS Program Leader Executive Director PATH Therapeutic Living Centers for the Blind Ms. Eileen Quinn Joyce Neu, Ph.D. Manager, Vaccine Development Global Program Founder PATH Facilitating Peace Ms. Regan E. Ralph Mr. John L. Notter Executive Director Member, Board of Directors Fund for Global Human Rights Conrad N. Hilton Foundation

92 Ms. Pam Rector Ms. Patricia Scheid Director, Center for Service and Action Director, Programs & Partnerships Loyola Marymount University Aga Khan Foundation U.S.A.

Ms. Stephanie Richard Mr. J.D. Scott Project Manager Photographer Health and Development International J.D. Scott Photography

Ms. Anne Richard Anders R. Seim, M.D., M.P.H. Vice President for Advocacy and Government Relations Executive Director International Rescue Committee Health and Development International

Ms. Kate Roberts Anuraj Shankar, Sc.D. USA Manager Senior Research Scientist, Department of Nutrition Students Partnership Worldwide Harvard University, School of Public Health

Dr. Judith Rodin (SPEAKER) Ms. Karen Sherman (SPEAKER) President Executive Director for Global Progrmas Rockefeller Foundation Women for Women International

Ms. Betty A. Rogers Ms. Jacqueline Sherris, Ph.D. Writer and Media Consultant Vice President, Global Programs PATH Ms. Nan Roman President and CEO His Excellency Sameh Shoukry National Alliance to End Homelessness Ambassador to the United States Embassy of the Arab Republic of Egypt Ms. Gail M. Romero Ms. Susannah Sirkin President and CEO Deputy Director MacKenzie-Romero Consulting Physicians for Human Rights

Ms. Carolyn Rose-Avila Mr. Tom Skelton VP of Policy and Public Engagement COO Plan USA Opportunity International

Mr. Eric D. Rosenthal Ms. Anne Sorensen Executive Director Director of Development Mental Disability Rights International Global Fund for Children

Mr. Steven M. Rothstein Dr. Matthew Spitzer President President, Board of Directors Perkins School for the Blind Doctors Without Borders

Ms. Karla Shepard Rubinger Ms. Sophie Stenbeck Assistant Vice President President Mary Ann Liebert Publications Remedee Foundation

David A. Sack, M.D. Mr. Wyatt Stewart Department of International Health President Johns Hopkins University Wyatt Stewart & Associates

Mr. Peter Schatzer Ms. Catharine Taylor Regional Director Global Program Leader, Maternal Child Health and International Organization for Migration Nutrition Global Program PATH

93 Mr. Mohan Jacob Thazhathu Mr. Sebastian Zacharia Chief Operating Offi cer Executive Director, International Studies Program Project ORBIS International Woodbury University

Mrs. Christina Safi ya Tobias-Nahi, M.A.I.R., Ed.M. Director of Public Affairs Islamic Relief USA

Mr. Robert Tobin Senior Consultant and President Williams Group

Ambassador Melanne S. Verveer (SPEAKER) Ambassador-at-Large for Global Women’s Issues United States Department of State

Ms. Norma Vogelweid US Development Liaison Biovision Foundation

Mr. Rudolph von Bernuth Vice President, Children in Emergencies & Crisis Department Save the Children Federation, Inc.

Ms. Elsie M. Walker President The Mountain Institute

Ms. Hellen Wangusa Anglican Observer at the United Nations

Stephen G. Wells, Ph.D. President Desert Research Institute

Ms. Rachel Wilson Director, Policy & Advocacy PATH

David Carl Wilson, Ph.D. Dean, College of Arts & Sciences Webster University

Mr. Samuel A. Worthington President and CEO InterAction

Ms. Pam A. Wuichet Senior Partner Project Resource Group

Professor Muhammad Yunus (KEYNOTE SPEAKER) Founder and Managing Director Grameen Bank

94