Thank you for inviting me to address the University of Colorado School of Public Health’s Center for Global Health.

I plan to discuss today an approach to meeting food and health needs through the water programs developed and implemented by USAID and its partners.

This approach is reflective of USAID’s effort, known as USAID Forward, to make the Agency more effective by changing the way we partner with others, embracing a spirit of innovation and strengthening the results of our work.^[i]

More specifically, I would like to cover how we utilize a certain set of tools and approaches, catalysts if you will, which we believe will provoke speed and action towards the overarching goal of saving and improving lives.

These tools are derived from open source based development, partnerships and finance, science and technology, integrated programming and resilience and scale.  They all help catalyze the development and implementation of solutions. Unsdersocring these toos is the enagagment and empowerment of women throughout  our water programs.

This is not to imply that these are the only set of tools utilized by USAID in meeting health and food needs through its water programs. Rather, I have chosen to discuss them given their game changing potential to strengthen our ability, as well as that of our partners, to

• develop and apply new solutions which have significant scale, results and impact
• secure funding 
• increase our understanding of the present and future magnitude of water, health and food challenges
• create synergies between water, food and heath programs which meet multiple needs 

Let me turn to the needs we all seek to address.

The numbers of people on our planet in need of clean water, sanitation and a sustainable supply of water for food production are indeed staggering.

Staggering, for two reasons.

First, because the sheer numbers of people in need, the human toll, is almost beyond comprehension.

Second, staggering because we are all, one way or another, connected on this planet. The presence of such suffering and deprivation affects us all.

In terms of the human toll, consider this:

• Lack of safe water and sanitation is the world’s single largest cause of illness.^[ii]
• More than a billion people do not have access to safe water 
• Well over 2 billion people live without adequate sanitation ^[iii]
• More than four billion cases of diarrhea cause 2.2 million deaths—mostly of children under the age of five. As immune systems are progressively compromised with each bout of diarrhea, related illnesses indirectly kill millions more each year
• Almost 1 billion people across the globe will go to bed hungry tonight, 200 million of them children
• And, in the developing world, approximately 195 million children under 5 years old are stunted, due in great part to the impact of diarrheal disease on their nutrition ^[iv]

To meet water, sanitation and food needs, we face huge constraints.

Public and private funds for development are limited. Significant water resources are being depleted at a rapid pace. Arable land occupies a relatively small portion of our planet. Conflict and natural disasters cause immense suffering and impede the progress of development, turning back the clock .

Yet, in one area we do not face constraints.

That is in our capacity to empathize, to set a purpose for our lives that responds to the needs of others, and to realize that purpose by creating and implementing solutions whose scale and impact is potentially immense.

In creating and implementing such solutions, it is, I believe, in the linkages where lives will be saved and improved. Linking water, food and health. Linking the tools themselves: open source development, partnerships and finance, science and technology, integrated programming and resilience and scale.

Developing and implementing effective linkages will be key to USAID’s ability to meet global water and related food  and health needs.

Open Source Development

The magnitude of these challenges requires us to broadly open up the source and implementation of new ideas, to engage a wide range of people and institutions.

As USAID Administrator Dr. Rajiv Shah recently noted, “If we’re going to deliver on ambitious development goals within the next two decades, then we have to employ a much bigger definition of development to get us there. Development is too important and creativity too diffuse to be left entirely to the post WWII development institutions, including USAID. To support an open source development approach, our Agency must serve as a platform that connects the world’s biggest development challenges to development problem solvers – all around the world.  We recognize that talent is everywhere, but opportunity is not.”^[v]

To combine talent with opportunity, USAID is supporting three initiatives in particular:

• LAUNCH, a partnership with NASA, USAID, Department of State, and NIKE to identify, showcase and support innovative approaches to global challenges through a series of forums.^[vi]
• USAID’s Development Innovation Ventures (DIV), a grant program using staged financing to invest in game-changing ideas, rigorously test those using cutting-edge analytical methods, and scale solutions that prove they work.^[vii]  DIV is an open competition for ideas – any sector, any country, or any region. Through DIV, we have supported WASH for Life, a $17 million partnership between USAID DIV and the Bill & Melinda Gates Foundation to achieve cost-effective, sustained development in the Water, Sanitation, and Hygiene sectors.
• Grand Challenges for Development has two goals: entice a broad range of people to generate innovation and progress against critical problems through tools such as prizes and competitions; and intensify the role of science and technology in helping people in developing countries. We seek to push USAID’s global development community to identify barriers to its success and recruit a community of innovators to help overcome those barriers. Since kickoff, USAID has received hundreds of submissions from around the world on ways to solve its first two Grand Challenges, titled “Saving Lives at Birth,” and “All Children Reading.” “Saving Lives at Birth” has already awarded a round of cash prizes that are helping fund top ideas or scale up ongoing, innovative programs that address mother and child mortality. Recently USAID launched its third Grand Challenge “Powering Agriculture.” We hope next year to launch a Grand Challenge on water. ^[viii]
• USAID’s Higher Education Solutions Network aims to engage students and faculty and catalyze the enthusiasm on campuses for international development, making it easier to turn advocacy and ideas on campus into action and results in the field. We are seeking proposals that will accomplish the following objectives: utilizing knowledge and research to improve our understanding of development problems; identifying, designing and evaluating the range of potential solutions for development problems through the sciences, technology and engineering; and creating an opportunity for students and faculty to apply their knowledge to address development challenges in new and creative ways.^[ix]

Through LAUNCH, we have showcased:

• Water testing technology, developed by Dr. Mark Sobsey, which provides a simple, low-cost test for quantifying fecal contamination in water. Each of Dr. Sobsey’s three variations on this test involves a plastic bag into which is placed a water sample and a bacteriological medium that does not need to be boiled or autoclaved, and that can be incubated at temperatures 25–45 degrees Celsius—a range encompassing the environments of nearly all tropical and subtropical countries. ^[x] In 2012, USAID will be doing a validation study in Africa and providing some technical advice on commercializing the product.^[xi]
• Irrigation technology (dRHS™) developed by Design Technology & Irrigation Ltd. (DTI) and DuPont  which utilizes a network of subsurface pipes that can be filled with almost any type of unpurified water—brackish, salted, polluted, industrial wastewater, and agricultural run-off. The pipes are lined with a unique hydrophilic DuPont material that allows water vapor—which cannot carry salts—to diffuse through the pipe walls, while the contaminants are retained within the pipes.^[xii] DTI is now working with NASA on the same technology, in a different form, for use in water recovery, purification & re-purification for low gravity applications and potentially deep space missions as well as for irrigating plants/crops in low gravity.  ^[xiii]

Through WASH for Life, USAID has invested in:

• Sanergy, where in Kenya eight million people in urban areas do not have access to a simple, hygienic latrine, and instead are forced to use a pit latrine with hundreds of other people. With $100,000 from DIV, Sanergy, a startup social enterprise, is building and franchising a dense network of 60 low-cost latrines to slum residents, collecting the waste daily, and processing it as fertilizer and biogas. Designed by MIT engineers and architects, the low-cost, modular hygienic latrines can be assembled in one day. The sanitation centers are franchised to local entrepreneurs and local youth groups. Revenue from the organic fertilizer and biogas energy add to the model's profitability, which has earned awards from MIT, Echoing Green, MassChallenge, and others. Within five years, Sanergy plans to expand to 3,390 centers reaching 600,000 slum dwellers – creating jobs and profit, while aiming to reduce the incidence of diarrhea by 40%. Sanergy’s low-cost latrines are designed to each serve 77 people who will pay for the service.   Because the waste from each person generates 22k WH of electricity and 40kg of fertilizer annually, the 10 million people in Kenya’s slums create a potential $72 million market per year.^[xiv]
• WaterSHED, an NGO based in Cambodia, seeks to seed the commercial introduction of an innovative hand-washing solution in Vietnam – a country where 900,000 cases of malnutrition and 9,000 deaths per year that can be associated with improper hand-washing practices occur.  In rural Vietnam, only 6.1 percent of people wash hands with soap before eating.  The economic costs, due to these cases of poor sanitation, are estimated at $262 million per year. Effective hand-washing with soap in Vietnam could significantly reduce over 10 million cases of hygiene-related communicable diseases per year. With support from DIV, WaterSHED has commercially launched a marketable hand-washing device to encourage proper hand-washing at critical times.  With a retail price of $6 per unit, this “HappyTap” device, along with behavior-change messaging, could help create a new market for attractive, aspirational, but low-cost sanitary products that encourage better hygiene practices. The device will be evaluated based on its market performance and whether uptake leads to improved hand-washing practices, and in turn, improved health outcomes. ^[xv]

Just as there have been major advances in using cell phones to improve health care in remote areas, we support the application of mobile phones to improve water management to meet health, food and other needs.

• The USAID/Indonesia’s “WATER SMS” project is applying new data collection tools and sharing methodologies through Short Messaging Services (SMS) and web mapping to increase civic participation to improve water services. The WATER SMS System is being designed, created and tested by communities, local government, and other water stakeholders to become an effective tool to improve water services for the urban poor. Residents, using hand phones and email, can rapidly report chronic and acute conditions. This may include conditions such as poor water quality or quantity, well failures, failure of tanker water supplies, or costs for tanker water. The project aims to empower residents and improve the ability of water providers to learn about and then respond quickly to acute, short term problems their customers are facing. The project will work in Malang, East Java, and Makassar, and South Sulawesi.^[xvi]
• In Afghanistan, only 12 percent of Afghans living in rural areas have access to clean drinking water. USAID is building the capacity of the Afghan government and local communities to provide potable water and sanitation facilities and to improve hygiene behavior. The Sustainable Water Supply and Sanitation (SWSS) project supports national and local government agencies, provincial reconstruction teams, and other stakeholders to design, install, and operate sustainable potable water systems, sanitation facilities, and hygiene education programs.^[xvii] The project supports a cloud based data analysis and monitoring tool "monitoring tool that uses the Ushahidi platform" known as “water tracker” which helps ensure the sustainability of some 2000 new wells. When there is a problem, an individual can call a number and leave a message in any language regarding the problem.  This gets translated into a written message, and the centrally located management system can then identify the appropriate way to fix the problem. This is all also mapped and trends are captured over time.  ^[xviii]

Partnerships  and Finance

We seek partnerships to benefit from different perspectives and expertise, the enhanced impact of working with one or more partners, and the additional funding needed to augment USAID’s limited funds.

We seek to engage a wide range of partners in our efforts to meet multiple needs:

• Early this year, The United States Water Partnership (USWP), a U.S.-based public-private partnership (PPP) was established to unite American expertise, knowledge, and resources to address water challenges around the globe, especially in the developing world.^[xix] This includes a commitment by The Coca-Cola Company and Coca-Cola Africa to the USWP to advance sustainable water access in African countries facing the greatest clean water challenges. ^[xx]
• In Tanzania, the Water and Development Alliance (WADA), the innovative partnership between USAID and the Coca-Cola Foundation, takes an integrated approach across natural resources management, rural development, and Water, Supply, Sanitation and Hygiene (WSSH). This program employs a multiple-use services approach both to meet WSSH needs and sustainably manage watersheds. ^[xxi]
• In the Dominican Republic, Ghana, and the Philippines, the International H2O Collaboration, a new worldwide alliance of Rotary International/The Rotary Foundation and USAID, is initially developing water and sanitation projects. [xxii]
• In the Coral Triangle, we launched a $40 million, five-year Coral Triangle Initiative (CTI) to better manage the biologically rich marine and coastal area known as the "Amazon of the Seas", in the waters surrounding Indonesia, the Philippines, Malaysia, Papua New Guinea, Timor-Leste, and the Solomon Islands. The CTI seeks to regulate the management of fisheries, protect threatened species, and help residents adapt to climate change in one of the world's most populated regions. Other partners on the initiative include the World Wildlife Fund, Conservation International, The Nature Conservancy, the U.S. Department of State, the Australian Government, Walton Family Foundation, CTI Secretariat, Asian Development Bank, and the Global Environment Facility.^[xxiii]

In the Philippines, India and Cambodia, we have highly successful supported efforts to build capacity and attract finance for water and sanitation infrastructure:

• In India, the USAID-supported Indo-US Financial Institution Reform & Expansion (FIRE-D), a 16 year $24 million project has funded technical support to leverage $1.2 billion to build water distribution and sewerage collection systems, increase solid waste collection and improve slum settlements for 2.4 million people. This has included FIRE-D helping the Madhya Pradesh Urban Infrastructure Fund plan and prepare bankable water and sanitation projects to be financed through municipal bonds and other sources of private sector capital.  FIRE-D also partnered with the UK Department for International Development to design and construct improved water and sanitation infrastructure in 12 slums in Dewas, an ancient town in Madhya Pradesh. ^[xxiv]
• In the Philippines, limited water financing is one of the primary obstacles to improving access to clean water for millions of people throughout the world. To encourage private investors to enter the water sector, USAID utilized its Development Credit Authority (DCA), a mechanism that allows risk sharing through partial loan and bond guarantees. The model worked: The Philippines Water Revolving Fund, launched in 2008 with the support of USAID, Japan International Cooperation Agency, the Development Bank of the Philippines, and other contributing partners, successfully attracted private financing for water and sanitation projects. The new public-private financing model forever altered the dynamics of water financing in the Philippines. ^[xxv]
• In Cambodia, our regional partner, WaterSHED, and local partners Hydrologic and International Development Enterprises, have developed an innovative public-private model for the production and sale of the filters and other household sanitation products.^[xxvi]

Science and Technology

We have made significant advances in the application of remote sensing technology to improve our understanding of, and adapt to, environmental changes.

• A University of Colorado Boulder team is partnering with USAID to assess snow and glacier contributions to water resources originating in the high mountains of Asia that straddle 10 countries. This assessment will be crucial in helping to forecast the future availability and vulnerability of water resources in the region, beginning with accurate assessments of the distinct, separate contributions to river discharge from melting glacier ice and seasonal snow. Such data ultimately will provide a better understanding of the timing and volume of runoff in the face of climate change.^[xxvii]
• The USAID-supported Famine Early Warning System Network (FEWS NET) is an information system designed to identify problems in the food supply system that  potentially lead to famine or other food-insecure conditions in sub-Saharan Africa, Afghanistan, Central America, and Haiti. The USGS FEWS NET Data Portal provides access to geo-spatial data, satellite image products, and derived data products in support of FEWS NET monitoring needs throughout the world. This portal is provided by the USGS FEWS NET Project, part of the Early Warning and Environmental Monitoring Program at the USGS Earth Resources Observation and Science (EROS) Center.^[xxviii] FEWS NET predicted a recent 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. ^[xxix] 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.

To strengthen food security, we are applying innovative and often traditional science and technology to water management.

• The Haiti Watershed Initiative for National Natural Environmental Resources (WINNER) supports vertical drip irrigation system, an innovative farming method that will benefit farmers with very small land plots. By planting certain crops vertically using this irrigation system, farmers can produce better yields using less land and water, particularly helpful in this heavily deforested country. ^[xxx]
• Soil conservation and tillage technology plays a key role in meeting water, food, and health and climate adaptation requirements. USAID’s Soil Management Collaborative Research Program (SMCRSP) 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.^{[xxxi]  [xxxii]}

Integrated programming

USAID believes that effective integration of water programs can lead to greater development impact and encourages multiple uses of water resources.  USAID seeks to increase integrative, multiple use programming linking WASH, water resources management, and water productivity with food security, global health and climate change objectives. Additionally, USAID seeks to link emergency WASH programs with longer-term development programming.

• In Ethiopia, we are integrating our water supply, sanitation and hygiene programs with HIV/AIDS treatment programs. Diarrheal disease can occur throughout the course of HIV and AIDS, affecting 90 percent of people living with HIV and AIDS and resulting in significant morbidity and mortality. To address this challenge, USAID's Hygiene Improvement Project worked with NGOs providing home-based care services in Ethiopia to design and carry out a trial of improved practices to help identify simple, easy to adopt WASH-related practices to integrate into HIV/AIDS programs to reduce diarrheal risk. ^[xxxiii]
• To address the impact of climate change and changing rainfall patters in the Senegal and Niger River basins, USAID plans to support the RIVERS project which investigates such linked questions as: what has been the impact of climate change on the vegetation of riverine systems to date;   and what are the benefits and costs of different methods of increasing food security though irrigated rice production noting the impact on livestock production. ^[xxxiv]
• In Tajikistan, USAID is supporting the Family Farming Program (FFP), a four-year effort to improve food security in Tajikistan by increasing the volume of agricultural production, boosting the income of food insecure households to make food more accessible, and raising the standard of household nutrition. This project has a significant irrigation component. At the community level, Village Extension Agents serve as activity monitors and liaisons to reach out and train across all FFP activities. Programming focuses on initiatives that have the most immediate yet sustainable impact and feature broad community inclusion, especially for woman-headed households and young women and men.^[xxxv]
• In Rwanda, USAID is supporting the Integrated Water Security Program which is designed to positively impact human health, food security, and resiliency to climate change for vulnerable populations in the African nation by improving the sustainable management of water quantity and quality. Two to four watersheds will be targeted to implement and integrate a wide range of low-cost and innovative technologies for water supply, sanitation and agriculture. The program will focus on multiple-use water services, sanitation marketing and product/supply chain development, as well as on-farm water-use efficiency schemes, and will implement initiatives related to community climate change adaptation and disaster risk reduction, together with climate-resilient water management. In the health sector, importance will be given to scaling up community hygiene behavior change. Lessons learned during these ground-level interventions, coupled with the results of national policy and institutional assessments, will be the basis for cooperation with national authorities to influence existing policy and create opportunities to replicate ground-level interventions in other parts of the country.^[xxxvi]
• In Somalia, USAID supports the School Environmental and Education Development for Somalia (SEEDS) program; it is designed to improve the overall educational environment in at least 120 school communities. SEEDS activities focus on five interrelated areas of intervention to achieve improved access to quality basic education and water services in Somalia, including infrastructure rehabilitation, upgrading the competencies of teachers, community education communities and ministries of education, distribution of teaching and learning material, improved maternal and child health care through rehabilitation of health facilities, and distribution of health kits and strengthening of community health communities.^[xxxvii]

Resilience and Scale

All of the previous tools, and others, ultimately contribute to achieving resilience and scale in rural and urban areas.

While we know we can't prevent drought, or any of the shocks that repeatedly drag communities into crisis, we can make real progress in ensuring that the next drought is less devastating. The 2011-12 drought was one of the worst in 60 years; yet, no famine struck rural Ethiopia last year.^[xxxviii]

• To help prevent famine, USAID supported the Government of Ethiopia’s Productive Safety Net Program: the program jointly funded with nine donors the predictable needs of 7.6 million chronically food insecure Ethiopians; provided cash and food transfers as wages for labor on such public works as check dams, gully reclamation, tree plantings, potable and multiple use of water stations, schools, health clinics, health posts, and water harvesting structures. The drought’s impact was lessened by a food-and-cash-for-public-works program USAID supports. From 2010 through 2016 the Agency’s Food for Peace office has budgeted $110 million per year.  ^[xxxix]
• For FY 2011-2013 USAID supported the Water, Sanitation, and Hygiene Transformations for Enhanced Resilience Project, wherein International Rescue Committee (IRC) and CARE Ethiopia operate in Afar, Oromia, and Somali regions of Ethiopia to improve access to clean and sustainable water sources for target communities. This effort provides 146,000 people with access to water all year round at a total estimated project cost of $7 million. The program improves hygiene awareness and access to sanitation among beneficiaries; improves pastoral rangeland land management practices; and uses approaches to reduce actual or potential conflicts over natural resources.^[xl]
• Although high-cost solutions like emergency provision of food, fertilizer, and extensive irrigation can help these families survive climatic shocks, USAID’s Office of US Foreign Disaster Assistance (USAID/OFDA) is considering affordable, long-term disaster response options to support farmers.  These interventions can be broadly categorized as regenerative disaster risk reduction (DRR), and include appropriate, small-scale technologies for water harvesting; rangeland management techniques, and other interventions that share the characteristics of reducing disaster risk while, at the same time, improving the natural resource base upon which rural livelihoods depend.  By adopting regenerative DRR as a development strategy, countries faced with increasing drought conditions can begin to reverse declines in productivity, and marginal areas can become more productive—contributing to the overall aggregate food supply, enhancing household livelihood security for rural communities, and reducing outmigration from rural to urban areas in search of work.^[xli]

Among the most effective ways to enhance the resilience of large numbers of people at scale in urban and rural areas is through the WASH programs. In that regard:

• The USAID Indonesia Urban Water, Sanitation and Hygiene (USAID IUWASH) project is supporting the Government of Indonesia efforts to achieve Indonesia’s Millennium Development Goal targets for safe water and sanitation. The project has been active in 34 urban areas, and in the coming year will expand to 20 additional cities to achieve the project targeted outcomes of increased access to safe water for 2 million people and an improved sanitation for 200,000 people, with 20 percent reduction of per unit water costs paid by the poor in targeted communities. The USAID IUWASH project will work with Indonesian government agencies (central, provincial, and local), local government owned water utilities, the Association of Indonesia Water Utilities, non-governmental organizations, communities, universities, and the private sector. The project will also address the challenges water utilities face to ensure water quality and availability in a context of climate change and increasing demand for water.”^[xlii]
• In Ethiopia,  The World Bank Water and Sanitation Program (WSP) invited the  USAID supported  Hygiene Improvement program in late 2005 to bring at-scale approaches to the Ministry of Health’s implementation of the newly endorsed National Hygiene and Sanitation Strategy. Together they agreed to focus on the Amhara region, selected because it was a USAID and WSP priority geographic area with great WASH needs, fewer donor investments than other regions, and a committed regional leadership. More than 5.8 million people in the region have been reached by hygiene and sanitation promotion activities, and an estimated 2.8 million people have stopped the practice of open defecation and now use a basic pit latrine. Amhara’s high-involvement districts saw significant drops in open defecation and large increases in the number of households using unimproved latrines. The practice of open defecation dropped from 64 percent to 40 percent and access to unimproved sanitation increased from 17 percent to 46 percent. ^[xliii]
• In Madagascar, the “HIP at-scale strategy”  focused on four USAID priority geographic regions—Analamanga, Amoron’i Mania, Haute Matsiatra, and Atsinanana—with an estimated population of 6.4 million. HIP focused on priority communes in each region based on an assessment of diarrheal disease prevalence, access to water, sanitation coverage, presence of development partners, and general vulnerability. From 2007 to 2010 the practice of open defecation dropped from 38 percent to 23 percent while access to unimproved latrines rose from 59 percent to 73 percent.  ^[xliv]

Conclusion:

If I were asked to sum up this presentation in one sentence, even one word, it would be this: it is in the linkages where lives will be saved and improved.

As I discussed at the outset, developing and implementing effective linkages will be key to USAID’s ability to meet global water and related food and health needs.

I realize that, intuitively, recognizing and making the linkages seems obvious. However technically, programmatically, bureaucratically, it is not.

Interdisciplinary approaches are not new to the university community. It seems to me that the approach outlined in my presentation is in line with the attention which universities give to achieving cutting edge impact through fostering new synergies

The University community has and can further the development of this art and science of water, food and health linkages/interdisciplinary approaches.

In so doing, universities make a huge difference in educating the present and future generation of leaders who will find it critical to use these approaches and tools to save and improve lives.

Thank you