Helene Gayle: CARE priorities and services here and abroad

>> Susan Collins: Hello everybody.  It is very nice to have you with us this afternoon.  I'm Susan Collins, the Joan and Sanford Weill Dean here at the Gerald R. Ford School of Public Policy and we are extremely pleased to see you here for our lecture this afternoon.  I wanted to thank our co-sponsor which is the Ford School's International Policy Center and in particular, Allan Stam our new director for that center for their support in both planning the events for today but also in co-sponsoring the lecture.  As those of you who are interested in international policy issues may know there are a wide variety of new initiatives and activities that the IPC is sponsoring and initiating and I hope that you will follow those and perhaps become involved in some of those as well.  Al, I'd also like to thank for helping to field questions in the afternoon discussion part of the session along with one of our students, Andrew Ridgeway.  So, we will get to that part later on in our session today.  Today's event is our annual Citigroup Foundation lecture and this series is one that the school is particularly proud of because it enables us to bring some of the most impactful policy leaders to campus and to the Ford School to interact with our students and our faculty and to share their perspectives.  It is also a personal pleasure for me to be able to welcome our speaker today.  We are delighted to be hosting Helene Gayle who was as many of you know recently recognized by foreign policy as one of the world's top global thinkers.  Dr. Gayle, of course, is the President and CEO of CARE USA, which is one of the world's both largest and oldest humanitarian organizations, humanitarian aid organizations and I encourage you to look at the longer bio of her that we have in our program.  But you will see that she has held a number of key positions both within the private sector and in public service and just to highlight a couple of things she directed the HIV, TB and Reproductive Health Program at the Bill and Linda Gates Foundation and she chaired President Obama's Advisory Council on HIV/AIDS.  The impact of her work has been both global but also personal.  And in so many places throughout the world where poverty and disease threaten lives the work that the CARE organization does and Dr. Gayle leads over 11,000 CARE employees to really move forward their unshakable commitment to improving the lives and to strengthening human dignity throughout the world.  So, I am particularly pleased as well to recognize that she spent quite a bit of time talking to our undergraduates this morning and a number of our graduate students this afternoon as well as having a discussion with a number of faculty.  Dr. Gayle we really enjoyed all of those conversations.  We appreciate your time and your perspective both in the small groups but also look forward to what you will be sharing with us this afternoon.  So, welcome to the Ford School and the University of Michigan.
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>> Susan Collins: We have structured today's event as a conversation and it will essentially be an interview with two of my Ford School colleagues and Dr. Gayle.  And so, I would briefly like to introduce those two faculty colleagues to you.  First, Professor Marina Whitman; Marina is a renowned international economist who has a particular expertise on global and corporate responsibility.  She among a number of other involvements in both the public and the private sector served as a member of President Nixon's Council of Economic Advisors and so we very much look forward to your part in the conversation.  We are also delighted to have our faculty member Sharon Maccini, who will be joining us in the conversation as well.  Sharon is a health economist and has taught courses at the Ford School in public health as well as in microeconomics.  And so, her research has centered on econometric evaluation of public health policies in developing countries, and Sharon we're delighted that you are part of our conversation as well.  Marina and Sharon have come up with a series of questions that we thing reflect some of the most important challenges that confront both CARE and humanitarian aid more generally.  We do want to make sure to leave time for questions from the audience and so our staff will be collecting the cards, which we invite you to write your questions on at around 4:40 and you can also tweet whether you are here in the room or you are watching us through the online streaming and the hashtag is policy talk so again we invite your questions whether through the handwritten card or through a tweet to the policy talk's hashtag.  And as I mentioned Professor Al Stam will select questions along with our student and I should have mentioned a former CEO intern, Andrew Ridgeway.  So, with no further ado I am now extremely pleased to turn the floor over to Dr. Gayle and Marina Whitman and Sharon Maccini. 
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>> In the middle.
>> Sharon Collins: The middle one.
>> Well, let me just echo again how really pleased we are to have you here and to have these many interactions that you've been having with our community.
>> Helene Gayle: It's been a full day.
>> Yea.
>> I'm quite sure that everyone in the room knows that CARE is a worldwide philanthropic organization, but partly because you-- CARE's mandate is so broad I think that people would like to know you know how CARE started out and how its mission and its focus or foci have evolved over time.  
>> Helene Gayle: Great well good, thanks.  And again I just want to say how pleased I am to be here.  It's been a really great day and not being somebody who is in the university setting on a daily basis it's always wonderful to be among students and faculty and people who are grappling with so many interesting issues.  So, I've had a really great day and I really appreciate the opportunity here.  So, CARE, we've been around for about 70, almost 70 years.  CARE started right after World War II.  It started actually as a cooperative of a lot-- several NGO's that came together as part of the effort to rebuild Europe after World War II.  So, we started out by giving food and basic essentials to people in Europe who had been devastated by that war.  And a lot of people don't know that care packages actually derived from our roots and our origins. We gave out care packages.  I spent a little time on the origins because I think it really speaks in many ways to our legacy as an organization.  You know it was an opportunity for Americans who at one point the day before were on one side of the equation and the next day were able to say you know the war's over, we forget that and the people who, some of the countries that were our enemies today are our friends.  It really saw this as a way of building peace and so you know our real roots are using our outreach to communities around the world as not only just a way of providing basic resources and basic needs to people, but actually hopefully being part of a broader effort to build a more peaceful and stable world.  Obviously Europe was rebuilt and CARE then used the organization to really start focusing on helping communities around the world that were facing poverty more broadly.  And a lot of our roots were in emergency relief and we continued to do emergency relief, but eventually emerged from and evolved from primarily focusing on short-term immediate and emergent needs to really how can we work with poor communities around the world to do what we can to eliminate extreme poverty?  So, our focus really now is broadly working to-- in the effort to eliminate extreme poverty, working with the poorest communities around the world to build their capacity and to also put in place the kinds of policies that support that.  So, we work very much on programs and the whole range of things that reflect people's basic needs, whether it's health, education, access to income and financial services, improving agricultural output, access to clean and safe drinking water, all the things that we know are so critical for people's basic survival.  But how do you do that in a way that actually builds capacity along the way and also helps to look at the underlying issues of inequity, poor governance, lack of citizen's abilities to exercise their rights and doing this in a way that really hopefully creates long-term sustainable social change and not just short-term fixes for immediate needs.  So, we try to work on both, as I think about the consequences of poverty but also the underlying causes.      
>> Let me just say before we move on to the next question, I don't know how many of you have ever talked about sending a care package to a child away from home or whatever.  And that phrase comes from the fact, and I still remember my parents came here from Hungary before World War II, we sent care packages back to relatives in Europe after World War II.  And just as Kleenex has come to stand or tissue so a care package has come to stand for any package that is sent to someone or to people, which includes things that they would find helpful, useful, enjoyable.  So, it's really entered our vocabulary.
>> Helene Gayle: Right, right.  
>> So one of the focuses of CARE that I'm particularly interested in is this sort of idea of empowering girls and women as a way to you know encourage sustainable social change.  And I'm just wondering if you can talk a little bit more about the sort of genesis of that, the reasoning behind that and maybe give a couple examples of how you operationalize that on the ground in particular programs.
>> Helene Gayle: Yes, good point.  You know in our mission to eliminate extreme poverty over the years, you know we really have increasingly put a focus on empowered girls and women.  So, you know if you read our literature we will talk about how important it is to make sure that we have that focus on girls and women throughout our work.  Two reasons:  First of all, girls and women bear the greatest brunt of poverty.  And so if you look at the people who have least access to education you know two thirds of those who are illiterate are women or two thirds of children who don't have access to school or complete school are girls.  If you look at health indices and the unacceptable rates of maternal mortality, for instance, or the fact that girls are less likely to get access to health services when they are sick, etc.  So, if you look at any measured income you know women work most of the work hours, but get only 10 percent of world income, do more than 50 percent of agricultural productivity, but own only 1 percent of the farmland.  Whatever, whatever, you can keep looking at the statistics but clearly girls and women bear the brunt of poverty around the world and make up over 60 percent of those who live in extreme poverty less than $1.00-1.25 a day.  The flip side of that is if you have an impact on the life of a girl or woman, you have an impact that is really catalytic and you really are able to make intergenerational change.  So, a girl who is educated more likely to marry later, have fewer children, send her children to school and you can really create that virtuous cycle of change.  So, we know that if you can have an impact on the life of a girl or woman, she will put that into her family.  Her family's outcome will change and you know ultimately you bring greater benefits for whole societies because you can't keep 50 percent of a population behind and expect that that same population is going to have the same progress.  I was just in Benin, West Africa a couple of weeks ago talking to the President and he was saying you know how-- how for him this issue of empowering girls and women just makes sense, because he recognizes as a country that it is limiting poverty.  If you're keeping back 50 percent of those who could be productive you're not helping the whole society.  So, any way you slice it numerically or if you look at what happens when you change the life of a girl or woman, you have a huge impact on families.  And you know one of the programs we put a lot of focus on is microsavings and lending and we have a program that really help women pool resources together, save resources so that they can then make small loans and help them start business.  And you know you hear over and over what a two dollar loan can do for a woman who then is able to start a business, now has the ability to access clean water so that-- send her children to school.  The children don't get diarrheal diseases so they stay in school and finish school.  She has an income that allows them to as a family have a greater outcome.  Her husband respects her more because she's no longer a burden.  She's actually contributing.  It decreases gender based violence, so there's this whole cycle of change that happens as you put this focus on girls and women and we know even in our own society now there's evidence that you know and you probably know this from your corporate board engagement, you know if you have three or more women on a board the outcome of that corporation is improved and that's you know their profit indices.  So we know that this value of including women whether it's in poor communities or in our own country has this impact that you know has been far too long not utilized.  
>> I mean there's clearly an infinite portfolio of problems and issues you-- CARE could tackle.  How does care select the programs and the projects that it will, in fact, engage in and also how does it deal with the unintended consequences that are bound to accompany any project?  
>> Helene Gayle: Well, yea you know for any organization that lives off of other people's money [Laughter] there is always a dance between what resources are available and what the greatest needs are and I think we try to make sure that we're doing as much as we can to harmonize those.  So, when we work in a country and we're in over 80 countries around the world in Africa, Asia, Latin America, the Caribbean, Middle East, etc. and so you know we've had longstanding roots in most of the countries in which we work, so we've been there for decades.  And often times we will come into a country because of an emergency but then stay long-term so that we're really helping to build capacity and build past just an emergency situation but look at how do we develop long-term sustainable change in that we work with communities to look at what are their greatest needs?  What are their highest priorities?  Where are their other organizations?  And then look at where are their resources and how do we put those together.  But it really is by trying to make sure that we're doing what makes the greatest difference for those communities and that there's real engagement in those communities around the programs in which we work.  Often times that means a somewhat long process and sometimes you know the work takes a while to get to that point.  But it means if we are able to get communities engaged and really feel ownership of the programs and the priorities than they're going to have a much longer term impact than if we're coming in with some cookie cutter approach and saying you know here are the programs we want to do.  So, you know, I think that's how we try to work and you know again it's a dance between what resources are available and where the needs are greatest.  How do you put those together and hopefully put those together and hopefully do that in a way that really can have the greatest impact?  
>> And the other half was how do you try to minimize the unintended consequences that come out of any project that brings about any kind of change?
>> Helene Gayle: Yea, you know it's a good question and you know back to the point about empowering girls and women, one of the questions I get asked all the time is so what happens to the men and boys if you're focused on girls and women?  And you know we believe strongly that if-- that empowerment of girls and women can't happen if you're not also having change occur in boys and men, because you can't change the way women feel about themselves and then have them back in a situation where men and boys ideas about women haven't changed.  So, I think the way we try to have-- minimize unintended consequences of any change is working on both sides, making sure that as we're empowering communities we're also working with governments to recognize their responsibilities.  So you can't keep-- teach citizens their rights without helping to make sure that governments understand their responsibilities.  So I think that we try to make sure that whatever we're doing on one side we're also working on the other side of the equation so that if progress occurs it's happening together.  
>> So, you've mentioned that CARE invests in-- through a bunch of health specific programs and then also a bunch of economic programs like our finance programs.  And I'm just wondering if you can comment on the sort of lots of evidence on the dual relationship between health and well and the sort of two-way link between those two and it seems to-- that seems to complement your sort of dual focus as well. And I'm wondering if you could comment on that.
>> Helene Gayle: Yea, so you know I think-- we try to look at less about our-- think of our work less in terms of sectors, health and economic development or water or agriculture and more looking at how do you have a comprehensive hold that allows communities to develop.  So, we might have a program that starts with microfinance but then links that to being able to access health services so that as people are able to develop income streams, pooling those together.  For instance, I was in a program not too long ago where the Village Savings and Loan Program that's our microfinance savings program, village savings program, also while they make loans to individuals they also pool resources so that they have the ability to send women to the hospital when they are in labor and if they have a complicated pregnancy they aren't stuck in the village without a way, a means of transport to the regional health center.  So, we really look at that holistically.  How do you make sure that we're building on programs so that it's not just a project at a time, but really looking at what is it, what are the comprehensive needs of a community?  How are we going to have an overall long-term impact and not looking at it as health or economic development, but it's really community development.  And what are the things that you need to do that really make that a comprehensive picture and not a sector focus program.  
>> One thing that one hears from a number of development experts is the importance of a rigorous evaluation process for projects in order to allocate funds efficiently.  And how do you decide how much of your funding should go into such an evaluation process as opposed to actually funding programs?
>> Helene Gayle: Well again you know some of that is dictated by donors and funders themselves and for many programs that we have there is a certain amount that's allocated for program evaluation.  And I think evaluating individual programs is often times not as much as a challenge as really being able to look longer term at what kind of impact you're having because funding of impact, first of all impact measurement is difficult.
>> Yea.
>> Helene Gayle: Looking at how are you having an impact on something as complex as poverty is not simple.  Secondly, you know again while a lot of donors want impact measurement there aren't a lot of donors who are funding impact.  And so I think you know for us we've tried to look at how do you take the resources that you have and put together different pieces of information that will give you some understanding of the kind of impact that you're having more than just short-term projects.  Because again, I think for so long the aid industry was based on being able to do projects that you're paid for a donor that provides short-term success after two or three years, but it's not looking at long-term.  Are you actually creating change?  That's a lot more difficult to do and it's also a lot more difficult to measure.  We, like so many other organizations, are just grappling with that, are really trying to look at how do you get some proxy measures for what will really end up being long-term impact.  We'd love to do something with the board school on impact measurement.  So, you now it's a good area; I think it is very much an evolving area.  
>> So, switching gears a bit, there's been increasing involvement of PPPs, these sort of public, private partnerships particularly in global health are the ones I'm most familiar with.  But I'm wondering and this had come up earlier in some of our sessions of sort of thinking about ways that the public sector and private sector can kind of coordinate and be very useful in terms of various aid projects.  And I'm wondering if you can talk about that in the ways in which CARE works with the private sector and those--
>> Helene Gayle: I think it's actually a very hopeful trend that has happened a lot recently.  You know I think there was a time when you know there was the public sector and the private sector and neither, the two never meet in between.  And I think nowadays the distinction between what's public and private is blurring a little bit more.  I think you know there's a lot more that we're learning you know as a not for profit from the for profit world.  I think there's a lot more that for profits are learning and taking away from the way not for profit's work.  And I think there's a lot of opportunity for much greater collaboration.  We've really in the last few years developed some very, very strong partnerships, particularly with some of the large multinational corporations.  They recognize that the very communities that we work with are going to be their future markets.  So, there's a business incentive.  They also realize that from a social good perspective they have a lot to offer as well.  So, I was giving an example earlier of a project that we're involved with with General Mills.  I was thinking of GM, your GM.
>> Sorry.
>> Helene Gayle: General Mills who recently bought Hagen Das.  Well we're working with them in Madagascar, which supplies 80 percent of the world's vanilla to incorporate for the poor small farmers into their global supply chain for vanilla that will end up one day on your grocery store shelf is Hagan Das vanilla ice cream.  So, we're working with poor farmers helping them to increase their agricultural productivity, better crop, higher quality also helping them to have greater access to a larger part of the supply chain, so they're actually learning how to do some of the production because a lot of the poor farmers would grow vanilla bean and then sell it to the processors.  And the processing part is actually the more lucrative part of the supply chain.  So, we're now helping them to be more productive, have a greater portion of the supply chain.  It helps Hagen Das and General Mills because they have a better a more sustainable, less expensive, dependable supply of vanilla.  It helps poor farmers in that country.  So, it can be a really huge economic engine and it's not like a grant that after two or three years the grant runs out the project stops.  This is something that's long-term and sustainable.  We have another great project, I think I was talking about it earlier that I visited earlier this year in Egypt or last year and it's with Danone, the milk and yogurt company.  And it's a project that takes you know women who may have one cow you know with four women who have a shack, a couple of children and a cow.  And that cow, they're taught what are the ways to increase the mild yield of the cow.  They take it to a community collection center that that community collection center has, you know was outfitted with all the clean hygienic techniques and that becomes part of their supply chain for that-- for Egypt for the country.  That was a project that started out a couple years ago and it started out producing about 4 percent of the nations-- the Danone needs.  It went to about 15 percent in six months and now they think that before long they're going to be producing 60 percent of all of their national needs for the company.  Huge income stream, dependable income stream for those women and it's a great local source of mild supply.  So, those are the kinds of projects that you know are really encouraging to see where the private sector and the social sector if you will are collaborating in ways that we couldn't have done before.  You've mentioned several times of the importance and sometimes the difficulty of bringing together needs and donors wishes.  Sort of what percentage, what proportion of all the money you get is unrestricted and the other side of it, how much of it is restricted to specific purposes.
>> Helene Gayle: Yea, so most of our funding is restricted and about 10 percent is unrestricted.  So, you know our funding, we really shifted our funding a lot over the last few years so we probably 10-15 years ago 70-80 percent of our funding would have come from the U.S. government from USA ID.  And then most of the rest of it would have come from individual donors.  Now about 30 percent of our funding comes from USA ID, another 25 to 30 percent from other governments like the DIFID, the UK, the European Union and some of our members, countries from European and other donor nations, Australia, Canada, etc.  Then the rest is from corporations, foundations and individuals.  Individual contributions are what makes up most of our unrestricted funding.
>> Um huh, um huh.
>> Helene Gayle: And that tends to be small donor's, people who give 10, 20, 25 dollars what have you, but with rest of it is the restricted funding that comes from larger institutional donors.  So, it's a challenge and anybody you know it's the same that the universities have the same sort of challenge.  People will give you funding for specific projects but not to support your infrastructure and I think it's very short-sighted, because ultimately it's that having-- maintaining that infrastructure, that platform to be able to do the programs.  If that's not strong and if that's not sound, ultimately we're not going to be able to deliver on doing good projects.  
>> So, you've mentioned so far a couple of times the importance of long-term sustainability.  And I imagine a big piece of that is sort of partnership with local governments as well as other NGOs that are on the ground.  And I also know you've mentioned before, and I'm not sure if in this conversation or earlier conversations, but that a lot of your employees in the countries where you work are local to the area and so I'm wondering if you can just talk about how all of those different factors work in terms of long-term sustainability of the projects that sort of-- that it is an important mission for CARE.
>> Helene Gayle: Yea, well, yea as you mentioned most of our staff, and we're about 10,000 people around the world, most of our staff come from the countries in which we work.  So, if you were to go to Ethiopia most of our staff would be Ethiopian.  If you go to Peru most of them would be Peruvian, etc.  So, our staff, our local they reflect the cultures and the communities in which work and we think that's very important.  That's a huge shift to you know 20 years ago most of our staff you know would have been European or American.  But we've really shifted to make sure that we really are increasingly focusing on building the capacity of countries in which we work being relevant, making sure that we have people who understand the cultures in which we work.  You know, I think the challenge of long-term sustainability is both you know being-- making a long-term commitment to a country, having staff and working with the community so that they feel real ownership of programs but it is also how you find the resources and looking more for being able to get flexible unrestricted resources so that you can have longer term and not so project related work.  So, you know I think that is key and it's always a challenge for an organization like ours to be able to have long-term funding.  And again, it's why some of the work with the private sector and creating longer-term sustainable projects that are based on actually generating income, I think offers a lot of opportunity.  We now have a part of CARE that you know, we're a 501 C-3 and not for profit.  They're our main organization, but we've now developed an organization that's actually a for profit arm of CARE so that we can actually do income generating activities that hopefully will lead to new revenue streams that will allow us to have that kind of long-term and more sustainable way of working. 
>> Looking back over the last 10 years or so, what's your assessment of the successes and the disappointments of the millennium development goals and also looking forward and taking account of the fact that the economic recession and upheavals of the last few years have cut into economic aid.  How hopeful are you about the achievement of the 2015 goals?
>> Helene Gayle: Well, I think there's a lot of progress that has been made in the millennium development goals and you know I'm sure most people here know back in 2000 we-- the world through the leadership of UN and at that time Secretary General, Kofi Annan, put in place the millennium development goals with the goals of having poverty by 2015 access to education, some health goals around HIV and malaria and TB, maternal health, etc.  And so the whole set of I think it's primarily eight core millennium development goals and the progress is mixed.  You know in some parts of the world particularly in countries that are now middle income countries.  There's been huge reduction in poverty.  There's been a lot of progress in the education goal.  There's been you know progress in the water-- in some of the water goals.  There's been progress, considerable progress in some of the health goals, but it varies a lot and if you look region by region it's been incredibly variable.  There's a big push now starting April 6th to count down to the last 1000 days with a renewed vigor on part of the world community to really see what can we do in the last 1000 days if we can push towards that.  But also, with the recognition that we're not going to achieve all of the millennium development goals and what's the add-on?  How do we-- what should we be doing post 2015 to look at both making sure that we finish the job that we started and not say okay, let's have a whole new set of goals and forget that we didn't accomplish all the others.  Let's have a new set of goals.  Let's make sure that we're incorporating the things that we didn't finish, but also look at how the world has changed, and the world has changed.  You know the issue of climate change for instance is one that wasn't part of the previous millennium development goals and people really feel and the current secretary general particularly that we need to look at climate change, goals toward continuing to reduce the impact of climate change but also continuing to reduce the factors that lead to it; looking much more at the issue of equitable growth, because you know now more poor people live in middle income countries than in the poorest of the poor countries.  So, that means while overall economic conditions may be improving in many countries, inequity is becoming more of a problem within countries where they're actual you know kind of overall national economic picture has increased.  So, looking at this notion of equity more is a lens as well as absolute poverty so there are a lot of those sort of things that I think will be part of the dialog in looking at what's the follow-on, the add-on to 2015.  And a lot of you know a lot of discussion I think the add-on to post 2015 will be probably a more inclusive process because the millennium development goals before were developed kind of quickly.  So, I think you know in the next year or so moving into 2015 there's a lot of discussion around what should these goals look like and making sure that they are inclusive and creating a strong dialog around them.  But I think the millennium development goals have been incredibly useful because we had some goals and I think part of what we have lacked before around these issues is not having targets to actually shoot for.  And so, having those goals I think has been a huge mobilizer of resources and I think there has been such focus on it, such commitment that even in the wake of some of the economic downturn you know there still is a strong commitment to see what we can try to do to reach those goals.  
>> So, I think it's about time for us to shift to questions from the audience.  
>> Andrew Ridgeway:  I think this is on.  Yep it's on.  So, I'm Andrew Rideway.  I'm a second year MPP and I was an intern at CARE this summer and I'm still actually working part-time for CARE.  And--
>> Helene Gayle: Thank you. [Laughter]
>> Andrew Ridgeway: Well, I am looking for a job, so-- [Laughter] So, let's begin with the student questions.  Could you describe the specific program that you were especially inspired by or excited about?
>> Helene Gayle: Well I named a couple.  You know this one that I often give this example of the project in Egypt, the Danone project, which is you know I think really spectacular when you literally go to a one-room shack and see a woman with her cow and realize that that cow is producing milk that is going to be on the grocery store shelf in that country.  So some of those I think are really incredible.  But one of the ones that I really-- that I have just seen create incredible change for people is our Village Savings and Loans Program.  And it's a pretty-- it's a really simple program.  It started in Niger, West Africa about 20 years ago and it really kind of built on a community savings sort of approach, where as opposed to a lot of the microfinance programs which started with credit, went and took out a loan from an institution.  This really started by first saving ones assets.  And you know when I think about simplistically most of us didn't start our banking life by taking a loan.  We started by putting pennies in a piggy bank and it got us familiar with money, with savings and first developing our own assets.  So, it's built on that approach and it's sometimes people taking what amounts to a few pennies and collecting that.  But it's giving people management skills along the way and it's often you know probably 70 percent of our Village Savings and Loan Programs are women and women who didn't have economic power within their family. And so they save, they put the monies together, they save, they make up-- the groups usually are about 10 or 15 people.  They make up their rules, how much interest they're going to charge for loans, what the repayment schedules are going to be and all the rest of this.  You know we give them management training, what businesses should they go into?  How can they use their resources most effectively?  How can it be used for a community wide benefit as well?  And so looking at what that small amount of money can do to change the lives of families and I give an example of one woman who actually came to a conference that we have every year in Washington, a woman from Burundi in Central Africa, never been out of the country, had never been out of Africa.  Came and spoke at this conference that we have and she told her story of how you know she started out with a $2.00 loan and how that loan, she was able to start a business.  From that business she then was able to develop a store and she became a merchant within her community and just the ripple effects that that had for her family as she is a woman who had basically been a prisoner in her own home, been a victim of domestic abuse and how it totally changed her whole life and the life of her family around because of a $2.00 loan that she was able to then use to start a business, develop a shop, send her children to school, totally change the dynamic of her and her husband who you know-- and did use to literally beat her, saw her as now you know this is somebody who has some value.  They became real partners and she talks about it you know just how different her relationship with her husband was, who you know now saw her as an equal partner and they talked about their children's life and their future together.  So, you know it's these things that as small and as simple as they may seem can really start a whole ripple effect of change and we see that over and over again of how these simple things can make such a huge difference in people's lives.  
>> Andrew Ridgeway: Next question.  How does CARE work with governments that are not as transparent and/or struggling with corruption?  What are the difficulties and how has CARE tried to overcome them.  What effect do these type of situations or partnerships have on long-term sustainability?
>> Helene Gayle: Yea, that's a great question.  First of all, as a non-governmental organization we're not obliged to work with governments or work directly with governments.  Our work is largely through other NGOs on the ground.  We do a lot of work implementing our programs with local and national NGOs and so, as far as the transparency of our resources, that's within our, you know essentially within our own management structures and our own control because we work with organizations.  We work with money.  We don't give money directly to the government.  That said because of the challenges in government that are corrupt or that are unstable, you know we are always working with govern-- we are often working with governments where you know there isn't transparency.  There may not be capacity within government and government structures and governments are often our partners even though we don't work directly through governments.  You know the issue of corruption in places that we work is as much an issue for the governments but also just he cultures in which we work where transparency and corruption can be a huge problem.  So, we even within our huge staff, often have issues related to corruption transparency and its one of the things that we work with constantly to make sure that our management and our management structures and the standards in which we hold our staff to our standards of transparency and no tolerance for corruption.  But it is an issue throughout and the instability of governments does mean that often times we're in situations.  I gave the example earlier of Mali, for instance, where we have had to shut down our operations in Northern Mali because of the instability there.  You know, or Somali, Sudan, you know lots of places, Pakistan, Afghanistan.  We had to close our country office in Iraq because our country office director was kidnapped and killed.  So, we work in you know very unstable situations throughout the world where the safety of our staff and security has to constantly be an issue that's on our mind.
>> Andrew Ridgeway: From your perspective of CEO of CARE how can the United States be a role model for women and girls abroad and where is the U.S. behind on this issue.  
>> Helene Gayle: Well, you know I think the fact that if you look around the world the United States is behind in many measures.  So, you know I think about 16 percent of our congress are women and in many countries around the world they have mandated the 30 to 50 percent of Parliaments or cabinet positions have to be women.  You take a country like Rwanda, for instance, you now because there's a clear correlation between percent of women in government and peace and stability, there are a lot of post-conflict countries that have actually moved to mandate that, in fact, a certain percentage of their top leadership government actually needs to be women.  So, Rwanda has a higher proportion of their Parliament that are women than their cabinet that are women than in the United States.  So, I think that there's a lot that we could learn from many countries around the world in terms of how do we get better representation of women and keep policy positions.  We know that governments that have more women in leadership, in policy leadership positions, have less corruption, have more stability, have greater indicators you know on all range of societal factors.  So, it's something where I think we do need to look at how could we do a better job?  You know, the fact that we have never had a woman President and you know as we look around in developing worlds, you know this is something that now is kind of commonplace where we're still grappling over is it time yet to have a woman President?  So, you know I think there are a lot of ways in which the United States could take a page from many developing countries as well as many developed countries around greater inclusion of women in policy levels.  And you know, there's a lot of talk about this these days with everything from Cheryl Sandburg's book on Lean In, to-- and Marie Slaughter's "Can You Have It All" article.  But I think these issues here in this country-- I think there really is a revitalization of some of these issues around women and women leadership.  And I think you know there's a lot to be learned from the rest of the world.  
>> Andrew Ridgeway: How does CARE balance the tension between alleviating poverty now and threats to the environment and other sustainability challenges?
>> Helene Gayle: Yea, well we take-- you know this issue of sustainable development is something that's very, very important for us.  And we're really doing a lot of work with our sister organizations, environmental organizations to look at how do you development work in a way that also looks at sustaining the environment and looking at projects where because of the many of the communities in which we work in are the same communities that are most affected by a climate change, environmental degradation and so you know we really believe that you have to-- it has to be hand in hand.  It can't be development or poverty or the environment.  It has to be the two hand-in-hand and how do you come together with sustainable solutions for the environment, but also looking at long-term develop-- income development and economic development in making sure that what we do doesn't have a detrimental impact on the environment and the climate.
>> Andrew Ridgeway: How has CARE shifted towards or supported aid models that increase country ownership?  And if you could, please speak specifically to Liberia's Health Sector Pool Fund.
>> Helene Gayle: I don't know anything about Liberia's Health Sector Pool Fund.  What was the first part of it?
>> Andrew Ridgeway: How has CARE shifted towards or supported aid models that increase country ownership?
>> Helene Gayle: Yea, well the whole issue of country ownership is the way-- you know the way we feel we have to work.  So, you know our-- we look at our work as how do we work ourselves out of a job over the next you know 10, 20, however many years, but really looking.  How do you develop ownership by the country?  How do you make sure that we're building capacity?  So, most of our work today is not done by CARE.  It is done in partnership with local organizations whose capacity we work to build and working alongside of communities to make sure that whatever we do builds long lasting capacity in those communities versus CARE doing the work.  So, it's just the way that we work and you know building local capacity and country ownership is just part and parcel of you know our fabric and the way that we work.  You know give an example of, you know in Afghanistan about a year or so ago there were a lot of burnings of schools and particularly schools that educated girls.  CARE schools were the only schools that weren't burned down because they had been or one of the few organizations who didn't have any of their schools burned down because we had been working with those communities for so long that they felt that those were their schools.  They didn't feel like they were schools that were imposed on them by somebody outside.  They felt that those were, in fact, their schools, that they had ownership over them.  So, while a lot of other schools were actually burned down in the communities, ours were the ones that were able to be sustained.  
>> Andrew Ridgway: What if any kind of resistance to assistance has CARE seen in its work, i.e. local dominant business class, pushback from the local authorities, cultural ministries, etc.  
>> Helene Gayle: I'm not sure exactly maybe whoever asked that might.
>> Yea, I was really wanting to know about any kind of pushback you've received from trying to help [Inaudible comments] So like in Madagascar you mentioned that you had [Inaudible comments] Would you ever get a situation where that group of people were upset with the work you were doing and maybe try to [Inaudible comments]
>> Helene Gayle: Yes, that's a great question.  You know, because I do think you know when you look at what we're trying to do, which is change the status quo, it does mean that you are in some ways threatening some people's interest.  And you know I can't say that situation particularly because it's new, it's evolving.  But we have had situations where because you are, in fact, changing the status quo you know people's interest are threatened and sometimes we have been threatened.  You know again, it sounds somewhat simplistic and repetitive.  I think the way that we've tried to do that is making sure that we are looking at how do we help mitigate that by working with all the groups that are involved?  How do you make sure that everybody feels like they have a stake in poor people winning?  How do you make sure that others understand how they can shift what they're doing, they actually have benefit from it as well?  And looking at making-- if in fact, the middle person is cut out of the situation how will they also have gained from that because we can give them training to actually allow them to develop some other skills that they may not have had.  So, really looking at the whole system and how are you making sure that if you have change in one sector that you're looking at what the consequences might be so that you can, in fact, mitigate that.  So, we try to look at the whole system and look at what might be the consequences and how can you bring everybody into it so that there's solutions that can be found more broadly and not just you now looking at one piece of the puzzle.  
>> Andrew Ridgeway: Are there corporate relationships that have not faired as well at the outset and what have you learned from these experiences?
>> Helene Gayle: Well, I think that the corporate partnerships that haven't worked well are when there hasn't been an open, honest dialog from the very beginning where the goals weren't clear, where the objectives weren't clear and where you really didn't have shared value.  And I think it's-- and shared objectives.  I think it's really important in any partnership that from the very beginning you're really clear and transparent about what each side wants from it and the objectives are clear and the game plan is clear.  So, we've had situations where, for instance, we might have a corporation or an organization that provides money for one purpose and we may think okay, well they asked for-- what they said they want to give us money for is to do project X, but what we really want to do is project Y.  Let's see if we can't morph it into what we really want to do.  Well that never works, because it's not transparent.  You didn't have the same goals and unless you're really starting from something where you really you know what you both want to get out of it, in the end it's going to be disastrous.  We've also had problems with corporations particularly and some corporations they extractive industry is a good example.  The oil and gas sector and the mineral sector where often times there's real challenges because the very nature of their work destroys the environment, often time is not as transparent in how the funds are being used.  There's huge possibilities for corruption and so, you know there are sectors that are much more challenging to work with, where we have had a real struggle in making sure that we're maintaining our values and making sure that the needs of the community that we're working with are being upheld.  And we have had to in some cases actually dissolve partnerships.  But I think it's really by being as clear as possible from the very beginning, what are you priorities?  What are your goals?  Making sure that we're being as transparent as possible and as partnership knowing when what you want out of it doesn't align and agreeing to disagree and move on.
>> Andrew Ridgeway: So, can you tell us about CARE's role in combating the spread of tuberculosis worldwide?  Are current measures sufficient to address the spread of drug resistant TB?
>> Helene Gayle: Yea, TB is not a big focus of CARE.  So, it's something from my previous lives that I've worked a lot with, but it's not a big focus of the work of CARE.  You know I don't think that currently we have enough to treat drug resistant tuberculosis, but it just frankly isn't something that I'm as involved in right now.
>> Andrew Ridgeway: In terms of the microfinance/community savings approach I have noticed especially with KIVA and [Inaudible] women are more likely to be trusted with loans.  Does this observation apply in other aid situations?  Are women more likely to receive aid than men and make better use of limited resources?
>> Helene Gayle: Yea, all the, you know, data on lending programs have shown that women have been incredibly good at repaying loans.  And you know most of the data suggests that women with loans will repay 96 plus percent successfully.  That said, you know there's starting to be more evidence.  It also suggests that often, that more often than was previously realized is that sometimes women are taking out those loans for men and men are then coercing women to repay those loans and often times coercing in sometimes violent ways.  So, I think there's a lot more evidence behind some of those statistics, but I think overall studies have shown that women have very, very high repayment rates.  But I think we're starting to look underneath that and looking at you know repayment rates are not the only measure.  I mean what's happening to the loans?  How are those loans being used?  Are they being used in ways that actually help to empower women or not.  Is there coercion as part of that?  Are women actually being able to use the loans in ways that benefit her and her children versus being used as a loan because so many of the loan programs are more available for women than men and men are actually using them?  So, there's a lot more to that that I think is becoming-- you know coming to light, but overall yes you know there's been a lot of studies that show that women are very, very successful in loan repayment.
>> Andrew Ridgeway: What are some of the challenges with changing traditional cultural values and having long-term change in communities that CARE has encountered and how have they been managed?
>> Helene Gayle: Sorry.
>> Andrew Ridgeway: The challenges with challenging traditional cultural values and getting them to change over the long-term in communities that CARE has worked with?
>> Helene Gayle: Yea, and I'm not sure who-- somebody who is there and who asked that if they want to elaborate on that a little bit more what exactly they were trying to get it or any specific--
>> So how do determine cultural change for long-term economic change for communities and the fact that some communities have a cultural perception, which would go-- like you just mentioned empowering women, but then having cultures maybe men coerce women or men use women?
>> Helene Gayle: Yea, so I think what we've tried to do in our work is to make sure again that in working with communities that we're not just doing programs, but we're also looking at how do you shift the norms, community standards, the way that people think about change?  You know again a good example is girls' education.  In many places around the world girls are not-- it's not seen as a good investment to send your girl, your daughter to school as opposed to your son as girls are expected to marry early, have children and education not seen as a benefit.  We've been most successful in increasing enrollment for girls in school when the communities themselves have been educated, where fathers really buy into the notion that if their daughter has an education she'll be more productive, she'll be able to have fewer children, her life will be better.  And so I think it really is by working with communities to understand the benefit that you can have that kind of cultural change. I was just in-- I mentioned I was in Benin, West Africa not long ago, a couple weeks ago and we were working with a program that looked at land tenure for women.  And a law had been passed not-- very recently that allowed women to own land.  In many places around the world as you know, women don't have the right to own land.  They had recently passed a law but the law was not really being enforced because there wasn't really strong community buy-in.  In that program we had paralegals, people who weren't lawyers but kind of legal extenders who actually worked with communities to start sensitizing them around the value of women having land ownership, giving tangible examples of women in their community who own land and were able to increase their agricultural productivity, because it's a very agricultural country.  And showing the value of that was able to start shifting about land ownership and land tenure and inheritance rights and some of the things that were new.  But it was by working with those communities that, in fact, that started shifting the cultural norms.  And so you know it's always this mix between how do you help an individual but then how do you help the society around that individual so that, in fact, that change takes place and you don't have an individual who's changed, but not a society that has changed along with them.  
>> Andrew Ridgeway: Some argue that technology is the way to solve many or perhaps most development challenges.  Do you agree?  Can you give examples where technology has helped and also where it may have gotten in the way of what you're trying to do?
>> Helene Gayle: Yea, I think technology is a huge enabler and you know has huge benefit for some of the development challenges we face.  So, the mobile phone, mobile phone technology has had a huge impact.  We do a lot of work with mobile banking now so people who live in remote rural areas who never would have had access to banking, who used to only have the ability to have small transactions, who now are able to actually have you know interaction with financial institutions.  Our health work has been hugely impacted by the ability for people who are again in remote rural areas to be able to use SMS to either get information or to send symptoms so that health-- people who are in rural areas and village health workers are able to communicate with higher levels of health services and really save lives in a lot of ways.  So, there's-- there are a lot of ways, the advent of new clean cook stoves that have really been developed, that help to cut down on both the environmental degradation that goes along with chopping down trees for fuel, but also that helps decrease the environmental pollution that leads to pneumonias in children, fire accidents, etc.  So, I think those are just a few examples access to clean safe drinking water.  There are a lot of new technologies both for sanitizing and making drinkable water people can put.  We have a project with proctor and gamble.  They have a substance, a pure packet that you can put into water and you know change dirty water to clean you know right in front of your eyes or new filtration techniques and machines that are being used.  So there's lots of ways in which I think technology has been hugely useful.  But there are always limits and we had a really good discussion of that earlier today around some of the limits of technology and where the people who create some of these solutions are not close enough to the problems to be creating solutions that are actually useful for the people who try to have an impact on their lives.  Again, with clean cook stoves some of the very early versions of those were done by people who weren't talking to the women who needed to use them and they created cook stoves that once they were tried to be-- once they brought into villages and women tried to use them, they didn't even meet the needs of the very women that they were trying to serve. So, I think if we're not linking technology and technological solutions with the people who actually need to use them than we often can create in a vacuum things that don't have the real usefulness that they should.  So you now I think technology has huge impact and has had a huge potential but it also needs to be done in a way that looks at the actual needs of the people and making sure that the people are part of helping to design some of those solutions.  
>> Andrew Ridgeway: So, we have one last question.  You have a very interesting background.  Can you share a bit about how you got to CARE's presidency from your initial career path in pediatrics?
>> Helene Gayle: Yea, well, you know I started out as a clinical doctor in pediatrics.  But I went into medicine because I wanted medicine as a way of contributing to positive social change.  So, I always had in my mind that I wanted a career that would allow me to have as great an impact on the largest number of people that I could in the most meaningful way.  So, that's a big goal.  So, but I started with pediatrics and then migrated to public health, because it was a way of not looking at individual patients as your-- you know as individuals as your patient but looking at populations and communities as your patients.  And you know worked in public health for you know 20 some years, first at the centers for disease control and then went to the Bill and Melinda Gates Foundation.  But if you look at public health and if you look at the challenges within public health a lot of what leads to poor health are not just health factors.  And in my years of working in HIV and AIDS which I worked in for many years when I was at CDC, you know the factors that lead to the spread of HIV you know yes, it's a virus, but it's also poverty.  It's inequity.  It's discrimination and so many of those sort of things that are not just directly impacted by health and health interventions, but are the very sort of things that we work on at CARE.  It's the underlying causes. It's poverty.  It's inequity.  It's discrimination, stigma, etc.  So, for me it was kind of really working, coming full circle working on health issues, but looking constantly at what are the underlying causes of poor health and unequal distribution of disease and death around the world.  And that kind of led me to my work at CARE.  So--
>> Andrew Ridgeway: Well, thank you very much.  
>> Helene Gayle: Thank you.
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>> Susan Collins: So, I'd first like to thank all of you for some really excellent questions.  We would love to continue the conversation in our Great Hall, just outside of the auditorium.  We have a reception and I hope you will join us and stay for that.  I'd also like to thank my colleague Sharon Maccini and Marina Whitman for hosting the conversation and then a very special thank you on behalf of the Ford School.  Please join me in thanking Dr. Gayle.
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