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Weighing an Ambitious QDDR

Authors: Laurie Garrett, Senior Fellow for Global Health Yanzhong Huang, Senior Fellow for Global Health Isobel Coleman, Senior Fellow and Director of the Civil Society, Markets, and Democracy Initiative; Director of the Women and Foreign Policy Program Paul B. Stares, General John W. Vessey Senior Fellow for Conflict Prevention and Director of the Center for Preventive Action, Council on Foreign Relations
Interviewer(s): Deborah Jerome, Deputy Editor
December 16, 2010

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The Quadrennial Diplomacy and Development Review (QDDR), two years in the making, was presented by Secretary of State Hillary Clinton yesterday as a foreign-policy roadmap that sees "leading through civilian power" as a way to save lives and money. Among other elements, the review seeks to reorganize State Department bureaucracies, hand over the Obama administration's health and agriculture programs to U.S. Agency for International Development (USAID), and hire more staff.

Four CFR fellows weigh in on the effectiveness of the review's provisions. Laurie Garrett sees the QDDR as "spectacularly important" for public health and clinical medicine at a time when U.S. funding is crucial. Yanzhong Huang cautions that while QDDR could be a powerful contribution to U.S. projections of "soft power," the report hasn't outlined enough concrete measures to be convincing about real change. Isobel Coleman notes that while the report could presage real improvement in USAID, it's difficult to reform bureaucracies. Paul Stares applauds the effort to improve U.S. conflict prevention and response but points out that effectiveness will depend in part on careful attention to organizational structure.

Laurie Garrett, Senior Fellow for Global Health

The State Department's QDDR seeks to prepare all foreign assistance entities in the U.S. government for likely budget cuts, and move development and global health into what Secretary of State Hillary Clinton described as "civilian power in the twenty first century." Overall, it creates a complicated set of networks and bridges across the entire government, reflecting the need to minimize use of private contractors, and respond to a broader, transnational, set of challenges to U.S. foreign policy interests.

From the point of view of global health--HIV, malaria, health systems development, medical training, maternal survival, and infant and childcare--the most fundamental changes wrought by the Obama administration were announced eighteen months ago with the formation of the Global Health Initiative (GHI), which put planning and leadership in the hands of the Centers for Disease Control, USAID, and PEPFAR (the U.S. President's Emergency Plan for AIDS Relief). In theory, this triumvirate operates as equal bureaucratic partners, with each entity responsible for its own budgets and personnel.

"The pace of support has slowed, and the U.S. now dominates both public and private funding to the extent that policy changes in either the Obama administration or the Bill & Melinda Gates Foundation immediately alter the entire global health landscape."

But where does the buck stop? A key revelation of the QDDR is that the entire GHI will be under a yet-to-be-named†executive director who will answer to Secretary of State Hillary Clinton. This executive director will eventually transition leadership of the GHI to USAID, which will "remain independent," from the State Department though their directorates will function as "interwoven entities," according to the report.

If this sounds confusing, it is. The NGO community has, so far, praised the QDDR and applauded placing global health and Feed the Future (the Obama administration's global initiative to end hunger) inside USAID. But many health advocates are uneasy, particularly from the HIV/AIDS and malaria communities. They argue that PEPFAR and PMI (the President's Malaria Initiative) were deliberately set outside of USAID in 2002 because the development agency was incapable of executing such ambitious, multibillion-dollar health schemes. HIV advocates, in particular, bristle recalling former USAID Director Andrew Natsios's 2001 comment dismissing the viability of distributing anti-HIV medicines in Africa: "[Africans] don't know what Western time is . . . Many people in Africa have never seen a clock or a watch their entire lives. And if you say, one o'clock in the afternoon, they do not know what you are talking about."

Recently, CFR's Global Health Program hosted economists Christopher Murray and Alex Preker, presenting details on the impact of the world financial crisis on the funding of global health. Their key finding is that that the pace of support has slowed, and the United State now dominates both public and private funding to the extent that policy changes in either the Obama administration or the Bill & Melinda Gates Foundation immediately alter the entire global health landscape.

Spending has brought tremendous success. Consider malaria, with disease incidence plummeting by 50 percent in eleven hard-hit African countries and by a quarter to a half in thirty-two of the fifty-six malaria endemic countries in the world--all, in just five years time. Smart global health spending really does save lives; the reverse is also true--cessation of spending puts millions at risk for disease and death.

Such successes, and the indispensability of U.S. funding and engagement, render the QDDR pronouncements, and the rising influence of USAID, spectacularly important for public health and clinical medicine in places as far flung as Kinshasa, Katmandu, and Cartegena. A key message to the world from the Obama administration is that future programs will have to integrate expertise drawn from many U.S. agencies, getting bigger bang for the health and development buck.

Yanzhong Huang, Senior Fellow for Global Health

By calling for leading through "civilian power" (i.e., diplomats and development experts) in solving global problems, the QDDR represents an explicit, serious attempt to project and improve U.S. "soft power." If successfully implemented, it would significantly contribute to an integrated "smart power"--the combination of diplomatic, economic, cultural, and military power advanced by Secretary Hillary Clinton in her confirmation hearing as essential for advancing America's core interests in the twenty-first century.

The QDDR calls for expanding the workforce in both the State Department and USAID and reducing the reliance on outside contractors. Given the ongoing economic crisis and the recent power shift on Capitol Hill, whether such requests will be well-received by the 112th Congress is a big question. Moreover, working smarter entails changes not just in the workforce but also in the organizational culture within the diplomatic and development communities. James B. Steinberg, deputy secretary of State, said yesterday at the QDDR announcement that a good infighter will no longer be rewarded. That's a good sign.

"The QDDR calls for expanding the workforce in both the State Department and USAID and reducing the reliance on outside contractors. Given the ongoing economic crisis and the recent power shift on Capitol Hill, whether such requests will be well-received by the 112th Congress is a big question."

Nevertheless, the QDDR has not prescribed any concrete and convincing measures that lead us to believe that this time it won't be business as usual. In the wake of the 2004 tsunami, the U.S. Navy was the first face of U.S. power seen by people in Banda Aceh, Indonesia. Why? Our military is efficient in conducting humanitarian missions. Unless our diplomats and development experts change the way they do business, civilian power will continue to fall behind military power in responding to global challenges.

In preventing and responding to crisis, conflict, and instability, the QDDR favors a lead-agency approach, with State leading responses to political and security crises and USAID leading responses to humanitarian crises. That division of labor would allow a more synergistic and effective response to multiple crises in failed or failing states (such as Haiti).

Still, having USAID lead for operations in response to all international humanitarian crises including disease outbreaks could be a mistake, given the agency's traditional focus in achieving long-term development goals. It might be effective in coordinating interagency response to "attrition epidemics" such as HIV/AIDS, but it does not have the expertise, experience, or resources to deal with "outbreak events" such as the 2003 SARS or the 2009 H1N1 pandemic. Designating USAID tasks or responsibilities that it is traditionally not good at fulfilling will further expand the gap between the challenges and the policy instruments, and destroy the prospect of reestablishing the agency as the world's premier development agency.

Isobel Coleman, Senior Fellow and Director of the Civil Society, Markets, and Democracy Initiative; Director of the Women and Foreign Policy Program

The QDDR has been a long time coming. For more than two decades, USAID has been sliding toward mediocrity and worse. It suffers from a cumbersome procurement process, a lack of in-house expertise resulting from years of insufficient operating budgets, and an inability to coordinate--let alone set the agenda--across the myriad government agencies involved in development. More often than not, the Defense Department seems to be in the driver's seat on development.

USAID is ill-prepared to meet the complex development challenges of the twenty-first century, and many have called for a complete overhaul. Former secretary of State Condoleezza Rice started down the path of change with her "Transformational Diplomacy" initiative, which focused more attention and resources on critical frontline states like Afghanistan and Sudan, raised the bar on foreign language competencies, and began to introduce modern technologies into the organization. But those efforts never addressed the core issues facing USAID.

Reforming a bureaucracy is never easy, but at least the QDDR now establishes a framework for improvement and removes some of the uncertainty of recent years which has built and deepened USAID's demoralization.

The QDDR seeks to address structural challenges and more with a "sweeping reform agenda" that, if fully implemented, would begin to chart a new course for how the United States carries out development. Some of the much-needed fixes include: implementing multi-year plans for foreign assistance to make investments more predictable and sustainable; reforming procurement systems; making assistance more transparent through a web-based "dashboard" that clearly shows what USAID is doing; building USAID's human capital by significantly increasing the number of foreign service officers, hiring more local staff, creating a technical career path that leads into the senior foreign service, and creating a development lab that will bring twenty to twenty-five leading development thinkers to work there. In addition, the QDDR promises to improve evaluation and link future funding decisions to performance.

Of course, the devil is in the details. USAID will still have to contend with a Congress that likes to think it is in charge of development (and does control budgets), and it remains embedded in a State Department that will always view the development agenda through its lens of diplomatic and strategic priorities. (Some foreign assistance reform proposals had suggested spinning USAID out into a separate agency, but no secretary of State, including the current one, is willing to give up that control.

While the QDDR makes USAID the "lead agency" for the two big presidential initiatives on food security and global health, what that means in practice remains to be seen. Reforming a bureaucracy is never easy, but at least the QDDR now establishes a framework for improvement and removes some of the uncertainty of recent years that has further weakened an already demoralized USAID. Capitalizing on the QDDR will now require strong leadership, and at times sharp elbows, to implement the proposed changes and move the agency toward high-impact development.

Paul B. Stares, General John W. Vessey Senior Fellow for Conflict Prevention and Director of the Center for Preventive Action, Council on Foreign Relations

There is much to commend in the†new QDDR. For those of us who have advocated for more attention and resources to be devoted to the prevention of crises and violent conflict, the QDDR recommendations are especially welcome. †Not only is†"conflict prevention and response" formally designated as†a core civilian mission, but new resources and organizational structures are to be devoted to this goal. With the United States militarily overstretched and facing huge fiscal challenges for the foreseeable future,†averting costly new stabilization and reconstruction missions makes obvious strategic sense.

As with other every other part of the QDDR,†however,†the challenge now will be to convert these new commitments into something that truly makes a difference. This is not the first time a U.S. administration has declared its intent to do more in the area of conflict prevention and response. The most recent was National Security Presidential Directive--forty-four in 2005, which established†the Office of the Coordinator for Reconstruction and Stabilization (S/CRS) with almost identical aspirations as the QDDR. From its inception, however, S/CRS suffered from the classic "responsibility without authority" problem and remained institutionally weak, under-funded, and marginalized even within the State Department.

"With the United States militarily overstretched and facing huge fiscal challenges for the foreseeable future, averting costly new stabilization and reconstruction missions makes obvious strategic sense."

At first blush, the QDDR appears to have learnt this lesson by creating a new Bureau for Conflict and Stabilization Operations as part of cluster of bureaus led by an Undersecretary for Civilian Security, Democracy and Human Rights. This is an encouraging start but getting the "org chart" right is just part of the challenge to effective conflict prevention and crisis response.

First, State and the USAID will need to think strategically about prevention, particularly where to focus resources. With fifty-plus countries designated as weak or fragile states, choices will have to be made. Second, much greater emphasis†needs to be to be placed on "upstream" policy interventions to reduce risk factors in the fragile states of most concern and anticipate periods when instability and violence is more likely. The QDDR is hazy on this while being clearer about what should be done in response to crises. For instance, there is an intent to develop International Operational Response Frameworks to manage crises more effectively across the government. Why not develop something similar to avoid crises altogether? This can build on the valuable work that S/CRS made in developing an Interagency Conflict Assessment Framework. Third, even with good early warning and better planning, flexible contingency funds can make a critical difference. As State and USAID develop various rapid civilian response capacities, they have to make sure they can use them when the need arises--as it surely will.

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