I appreciate this opportunity to deliver remarks at this important conference concerned with water and health and the related intersection between science and policy.

Recently, USAID Administrator Dr. Rajiv Shah delivered an address at the TED annual conference where he noted that "… scientific and technological breakthroughs do more than address specific technical challenges; they inspire collective action by turning impossible challenges into solvable problems."

In my brief remarks today, I would like to share with you some of the elements of an approach, one of which targets scientific and technological breakthroughs, which we are taking to turn impossible challenges into solvable problems, particularly those that relate to the water sector.

Challenges

The challenges are enormous:

• Approximately 2.5 billion people are without adequate sanitation, 1 billion people are without access to safe drinking water; diarrheal diseases and WASH-related malnutrition kill approximately 2 million children under five each year.
• Children between the ages of one and two who suffer six bouts of severe diarrhea run high risks of physical and mental stunting, affecting their lifelong productivity.
• By 2025, the global population is projected to rise to 8 billion people, one third of which - 2.4 billion people, spread over 40 countries - will live in countries facing absolute water scarcity, contributing to political, social and economic instability in the developing world.
• In Africa, at least twice as much food must be produced by 2050 to avoid widespread starvation amongst an expected population of 1.8 billion. But, in Africa, food production per capita has been declining, and cereal yields have remained stagnant since the 1960s.
• By the middle of the 21st century, annual average river runoff and water availability are projected to increase as a result of climate change at high latitudes and in some wet tropical areas, and decrease over some dry regions at mid-latitudes and in the dry tropics. Many semi-arid and arid areas such as southern Africa are particularly exposed to the impacts of climate change and are projected to suffer a decrease of water resources due to climate change. Higher water temperatures and changes in extremes, including floods and droughts, are projected to affect water quality and exacerbate many forms of water pollution.
• The global search for energy and food supplies, as noted in the World Bank's 2011 World Development Report, is amplifying pressure on arable land in developing countries. This search for energy and food supplies impacts the availability and use of water.

Our Approach:

In addressing these challenges, we see three linked approaches as being central to transitioning from impossible to solvable problems - focusing on policies, programs, and partnerships. These approaches deal with:

• first, developing and implementing policies within the U.S. Government which will lead to significant global development impact;
• second, developing programs to support economic development which stress sustainability and program and policy integration; and
• third, creating partnerships to achieve breakthroughs in science and technology, as well as novel business or organizational models, operational or production processes. Regarding these approaches, let me first turn to the USG policies which drive our efforts:

Policies

The range of policies adopted by the Obama Administration which contribute to sustainability, impact and breakthroughs include:

• focus on contributing to globally significant, high-priority development objectives, i.e. increasing food security, mitigating the impacts of climate change and improving health, as well as the underlying importance of water and sanitation improvements to the success and sustainability of these efforts;
• integrative problem-solving and implementation across sectors and funding streams;
• a focus on innovation, science and technology, leading us to potential game-changing solutions;
• expansion of partnerships;
• increased rigor in monitoring and evaluation;
• a cross-cutting focus on gender considerations in all programming; and .
• support of enabling policies and governance.

The Water for Poor Act makes access to safe water and sanitation for developing countries a specific policy objective of the United States foreign assistance programs. The purposes of assistance authorized by this law are to,"… promote good health, economic development, poverty reduction, women's empowerment, conflict prevention, and environmental sustainability by providing assistance to expand access to safe water and sanitation, promoting integrated water resource management, and improving hygiene for people around the world."

In terms of focus and results, The Presidential Policy Directive on Global Development supports three major initiatives to implement core elements of President Obama's new development policy:

• Feed the Future (FTF) is the U.S. component of a global initiative launched by President Obama at the London Summit of the G20. FTF is aimed at promoting a comprehensive approach to food security by accelerating economic growth and increasing incomes through greater agricultural productivity, market access for the rural poor, and enhancing nutrition.
• Global Health Initiative (GHI) expands our global health effort and impact by improving disease treatment, integrating our interventions and expanding our investments to strengthen health systems, improve maternal child health, address neglected tropical diseases, and foster increased research and development.

Global Climate Change Initiative (GCCI) integrates climate change considerations into the U.S. foreign assistance strategy by fostering a low-carbon future and promoting sustainable and resilient societies for the coming decades.

Water, Sanitation and Hygiene (WASH) and the Presidential Initiatives

All three of these initiatives bear on WASH:

GHI includes a focus on inadequate access to water for household needs, both in quantity and quality, as well as improvements in sanitation and hygiene. Beyond control of diarrheal diseases and its connection to child mortality, as well as cholera and infectious disease risk mitigation, improved WASH also has enormous benefits for the care and support of people living with HIV/AIDS.

Feed the Future (FTF) has multiple water links, particularly through water productivity. The major connection for WASH, however, is through improved nutrition and food utilization, one of the major objectives of FTF. The role of WASH in improved nutritional status is well documented, especially for young children, whose repeated bouts of diarrhea can cause stunted growth and brain development, as well as lowering resistance to other diseases. If a child does not die from acute diarrhea, she or he may well die from pneumonia as a consequence of chronic malnutrition.

Global climate change, associated with increased floods and droughts, threatens to negatively impact existing water and sanitation services and reduce future gains in access and service quality. Resilience to future variability depends upon improved drinking water and sanitation services for the highest risk regions

USAID Administrator Rajiv Shah approved the new evaluation policy in January 2011, which will set a new standard in our field. By aggressively measuring and learning from our results, we will extend the impact of our ideas and of knowledge we helped generate.

We will provide performance evaluations for every major project, conducted by independent third parties, not by the implementing party themselves. And we will release the results of all of our evaluations within three months of their completion.

When programs are successful, we will look to scale them up. But when we learn that a program has not produced results warranting taxpayer money, we will scale it back or shut it down, and learn from our experience. And in the spirit of extreme transparency, we will release in either case--success or failure--the results of our evaluations publicly, within three months of their completion so that you, your colleagues and the American public can see the results of their investments, whether they tell a story of success or failure. We will integrate this project evaluation data into our foreignassistance.gov dashboard.

Food Security Technology: Ridge Tillage and Water Capture in Mali: We believe that soil conservation and tillage technology plays a key role in meeting water, food, and health and climate adaptation requirements. An example of the application of ridge tillage and soil conservation technology is found in USAID's Soil Management Collaborative Research Program (SMCRSP) which refined ridge tillage technology in Mali and conducted agronomic research on its effects in Mali, Senegal and The Gambia. While there had been substantial anecdotal evidence across the Sahel that rain harvesting contributed to water table recharge, research under the SMCRSP was the first to quantify it using scientific methods. Notably, SMCRSP and Malian researchers discovered two side benefits from ridge tillage's positive effects on the water table: the recharged water table allowed women to start dry season gardens which contributed to the potential for additional revenues and more nutritious diets. And, it contributed to the productivity of high-value tree crops which provided food, oil, construction, and forage products. Given that the water table recharge is less susceptible to rainfall variability than annual crops, winter gardens and tree crops not only contribute to food security, but they build resiliency against climatic variability.

Engaging women and girls in improvements in sanitation and hygiene: In Afghanistan, our Sustainable Water Supply and Sanitation project (SWSS) engages women and girls in improvements in sanitation and hygiene in these ways. First, women's groups have emerged as leaders in decision-making around village sanitation improvements for all the same reasons found around the world: women's focus on dignity, privacy, and family health. Second, SWSS works with local NGOs in each village to create women-driven Family Health Action Groups where young mothers learn hygiene practices and the skills to communicate them to other women. Third, half of the SWSS hygiene education trainers and facilitators are women who travel to villages to train NGO staff and Community Health Workers in the basics of sanitation and hygiene. Fourth, we work extensively with girls' schools across the country to provide facilities and teach hygiene and hand washing practices - 30,000 school children were mobilized on Global Hand Washing Day in 2010, and we anticipate an even larger turnout this year. Fifth, the SWSS team has a women-led finance staff who have mastered USAID's accounting requirements, and accounted for every dime of funding provided, while the leaders pursue their MBAs in evening school in Kabul. This three-year investment has made enormous changes to the lives of individual rural and professional women and girls.

Remote sensing and information technologies: the Horn of Africa: In order to develop successful water, food climate health programs, it is essential to apply information systems to enhance our ability to both understand and respond to present and future situations. For example, early warning systems such as the USAID-supported Famine Early Warning System Network (FEWS NET) predicted drought in Africa and allowed donors to take quick action before the worst conditions set in. In those areas that were expected to be hit the hardest, USAID helped households with "commercial de-stocking"-selling off some livestock while the prices were still high, which helped families bring in enough income to feed themselves and their remaining livestock. USAID also pre-positioned significant amounts of food and non-food commodities and worked to rehabilitate wells before the worst drought conditions, preventing the need to launch expensive water trucking efforts in those regions.

Integrating HIV/AIDS and WASH: An excellent example of integrating our water supply, sanitation and hygiene programs with HIV/AIDS treatment programs is in Ethiopia. Diarrheal disease can occur throughout the course of HIV and AIDS, affecting 90 percent of people living with HIV and AIDS (PLWHA) and resulting in significant morbidity and mortality. A small but growing number of studies have demonstrated the importance of good water, sanitation, and hygiene (WASH) practices for preventing diarrhea and improving the health and quality of life for PLWHA household members, especially children, who are also at risk of contracting diarrhea from PLWHA suffering from the condition. Despite this evidence, WASH and HIV/AIDS are not routinely integrated into policies and programs, and home-based and palliative care programs seldom have a hygiene component. To address this challenge, USAID's Hygiene Improvement Project (HIP) worked with NGOs providing home-based care services in Ethiopia to design and carry out a trial of improved practices (TIPs) to help identify simple, easy to adopt WASH-related practices to integrate into HIV/AIDS programs to reduce diarrheal risk. These practices, known as "small doable actions", were designed to be negotiated by home-based caregivers with PLWHA and their families.

Stopping the practice of open defecation: In Ethiopia, nearly 3.6 million people in the Amhara region have stopped the practice of open defecation and now use a basic pit latrine as a result of hygiene promotion activities conducted through the existing regional health extension network and health bureau with technical support from USAID (through the Hygiene Improvement Project) in partnership with the Water and Sanitation Program of the World Bank. The practice of open defecation in the region dropped from 64 to 40 percent from 2007 to 2010. USAID and its partners provided training and tools to a cadre of frontline workers including health extension workers, farmers, and others who used modified Community-Led Total Sanitation (CLTS) approaches to motivate communities and increase demand for improved sanitation facilities to end the practice of open defecation.

Developing a sanitation marketing approach: In Madagascar, the USAID Hygiene Improvement Project (HIP) developed a sanitation marketing approach, including consumer surveys to identify which products were most feasible, desirable and affordable. This helped provide support for local entrepreneurs to make it easier for consumers to find and buy the necessary sanitation hardware. This hardware component complemented demand creation activities that began with a national WASH campaign, followed by regional and community behavior change promotion activities, including CLTS. The USAID grantee, Water and Sanitation for the Urban Poor, is also implementing a sanitation marketing strategy in the capital among peri-urban communities.

Supporting sanitation marketing, behavior change and demand creation: In Uganda, USAID worked with the National Sanitation Working Group to create broader support for sanitation marketing approaches. Through the Hygiene Improvement Project, USAID developed guidance and tools to support district level sanitation marketing programs and trained masons in latrine construction to complement behavior change and demand creation activities underway through USAID-funded partners.

Innovative finance tools to meet water needs: In Indonesia, USAID is supporting the use of Micro credit to increase access to clean water to achieve the Millennium Development Goals on access to clean water. One constraint to increased access to clean water for low income households in Indonesia is the upfront connection fee charged by municipal water companies. The GOI has committed to support the addition of 10 million new water supply connections in the coming five years. USAID provided technical assistance to support linkages between water utilities and local banks in enabling micro-credit for water connection to the low-income households. As a result of this effort, there were 22 master agreements signed between water utilities and local banks, benefiting 12,111 new households with access to clean water.

Achieving sustainability through governance and supply chains: To achieve sustainability on a country by country basis, USAID's largest per capita investments in WASH basic access improvement are currently ongoing in Liberia. USAID's flagship program in that country is the Improved Water Supply and Sanitation (IWASH) program. IWASH is aiming to achieve measurable county-level improvements in water supply, sanitation, hygiene in the three largest counties in Liberia and selected communities of greater Monrovia. In addition to a central focus on sustaining service improvements through building government sector capacity at the county and national level, IWASH aims to develop critical WASH product supply chains among the private sector to facilitate continued expansion of service into the future.

WASH for Life: In this regard, building on the USAID Forward emphasis on innovation, USAID has launched WASH for Life with co-funding from the Bill and Melinda Gates Foundation. Over the next four years, this $17 million partnership will use USAID's Development Innovation Ventures (DIV) program to identify, test, and transition to scale evidence-based approaches for achieving cost-effective and sustained WASH services in developing countries. Although projects addressing problems in any WASH area or any country may apply, WASH for Life is particularly interested in: interventions that operate in Bangladesh, Ethiopia, Ghana, Haiti, India, Kenya, and Nigeria; address issues in the sanitation and hygiene sectors in particular; and target beneficiaries earning under $2 a day.

Conclusion:

The successful implementation of USG development assistance policies, the emphasis on sustainability and program integration and the development of partnerships which effectively deliver assistance and those which lead to scientific and technological breakthroughs will play a critical role in meeting water supply, hygiene and sanitation needs. In so doing, these approaches will also contribute to increasing food productivity, adapting to climate change, and improving human health in a number of areas, directly or indirectly related to water borne disease. This will in turn significantly help the world in its efforts to move from impossible problems to solvable solutions.

Thank you.