Richard Greene

IMPACT: Nutrition is a key component of four Millennium Development Goals (MDGs): reducing poverty and hunger; reducing child mortality; improving maternal health; and combating HIV/AIDS, malaria and other diseases. How have the MDGs helped motivate the U.S. government to make child nutrition programs a top priority?

RICHARD GREENE: The MDGs have helped put global health development on the map by setting clear targets and documenting progresses that have been achieved. Nothing persuades people that health is a good investment more than documenting successes.

IMPACT: USAID Administrator Dr. Rajiv Shah has stressed the important role that innovation should play in achieving America’s global development objectives. What are some of the promising innovations in your program areas?

RG: If you look at neonatal mortality, we have a number of innovations such as the Gentamicin antibiotic used by community health workers and the cream Chlorhexidine that can be put on the umbilical cord to prevent infection. For pneumonia, we have a birth dose of vitamin A that can reduce mortality in newborns. We continue to develop and scale up these innovations in countries in order to reduce the burden of disease and mortality.

IMPACT: Much of the reform efforts underway at USAID seek to promote local capacity building. What are examples of programs that are markedly moving local organizations toward full ownership?

RG: In our malaria program, PMI, we work with more than 140 faith-based and local organizations. Sometimes they help deliver services or run health clinics in Africa where there is no formal public health system. Other NGOs will do information and advocacy. Almost any development activity that USAID supports can be done by local organizations if their capacity is present.

IMPACT: You’ve noted the American public’s skepticism of funding development programs overseas when there is need at home. How do you make the case to Americans and to Congress in the face of budget cuts that funding for health programs in the developing world is critical?

RG: First, the public thinks that we spend about 10 to 15 percent of our budget on international development when we only spend about 0.3 percent of 1 percent. Second, investments in programs such as avian and pandemic influenza and tuberculosis (TB) will prevent these diseases from spreading to the U.S. And third, I think we all believe that producing allies and helping developing countries develop is good diplomacy.

IMPACT: How do you see approaches like social marketing and social franchising fitting into the U.S. government’s strategy to provide affordable health products and services in developing countries, particularly in regard to cost-efficiency?

RG: Almost any low-cost public health intervention where people are willing to pay a few cents can be socially marketed. Particularly in urban areas, [social marketing] can be a very good development tool.

IMPACT: USAID values integration and collaboration in order to more efficiently meet global health goals. In what ways does your division collaborate with other agencies’ leadership, working to prevent and treat nutrition, maternal and child health, and infectious disease?

RG: We can’t achieve anything without collaborating with other development partners. When we go into a country, we may be the biggest donor but we depend upon the Global Fund. We depend on other governments. We depend on the World Bank to provide investments. Our ability to establish coalitions and collaborative work and activities is critical to our success.

IMPACT: Malnutrition exacerbates the burden of infectious diseases, such as TB and HIV/AIDS. Thus, improving nutrition interventions is vital to the success of infectious disease programs. What is the role of education and behavior change in preventing malnutrition and subsequently infectious disease?

RG: Behavior change is critical. Children are malnourished because mothers do not understand the need of dietary diversity, frequent feedings, exclusive breastfeeding for the first six months, good weaning practices or the need for micronutrients. It’s not enough to give a mother an insecticide-treated bed net. She has to understand that everybody has to sleep under the net, not only during the rainy season when there are a lot of mosquitoes, but also during the dry season when the mosquitoes aren’t so apparent. Behavior change and education are critical to all of our health programs.

This interview has been edited for length and clarity.

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