In Washington, change can be slow, difficult work or it can come swiftly when smart leadership and circumstances converge. The financial crisis has shown just how quickly as sweeping changes to the US economy--for better or worse--came through quick, far-reaching actions by the Treasury department.
This year Congress and the administration have signaled their intention to overhaul US foreign assistance. I've thus far been deeply skeptical--worried that the process would be long, slow, and fail to change the paradigm of US-funded development programs (which too often fail to serve their purposes of lifting people out of poverty and improving health and education).
But the Obama administration is reportedly on the brink of what could be a truly game-changing appointment. Friday the Boston Globe reported that Dr. Paul Farmer, the McArthur "Genius Award" winning physician and visionary global health pioneer, is being considered to direct foreign assistance within the administration. The rumors seem to be true and he seems to have a great deal of support within the administration--and that reality says a lot about the boldness of Obama White House and Clinton State Department. It could go a long way toward healing some of the deep frustration over the 2010 budget.
Dr. Farmer would be a truly inspired choice. He has dedicated his life to providing healthcare and a higher standard of living to some of the world's most impoverished populations. He is a visionary thinker, a bold advocate who has challenged policy-makers, and an expert in international development who has shown he knows how to transform the way we fight systemic poverty. I hope he can be convinced to come to Washington.
For those less familiar with him, Paul Farmer founded Partners in Health over twenty years ago and he and the organization quickly rose to prominence by going against most every convention when it comes to providing for the health of impoverished people. Instead of providing poor-people medicine, Dr. Farmer has worked to provide world-class care in places like Haiti, Rwanda, the former Soviet Union, and Peru--pioneering AIDS treatment in resource-poor settings when many said it could not be done, providing child-health programs that looked at the whole child, and providing mothers and women with health services in communities that had never seen it. Even more critical for his potential new job, though, has been Dr. Farmer's revolutionary understanding of just what's included in "health." Paul Farmer and his team have extended their commitment to life-changing services far beyond doctors and medicine to include food, water, shelter and education. Partners in Health has worked with the World Food Program to distribute food to thousands. They have worked to install clean water systems for communities, started schools and education centers, and build simple, decent homes for hundreds of rural families in places like rural Haiti. They have simultaneously helped respond to emergencies like hurricanes and build strong long-term systems.
In short, Paul Farmer has shown that with commitment and smart use of resources, international development programs can work--can change lives and make human rights into human realities.
The US Agency for International Development and other US development initiatives are very much in need of this kind of vision. Mired in bureaucracy and political calculations, these institutions are too often serving a myriad of interests but failing to truly address the needs of those the programs purport to help. The successes--initiatives like US-supported AIDS programs (which are in need of change themselves)--succeed when they are focused on clear, measurable outcomes judged in services provided and lives saved rather than dollars out the door. This is the kind of vision Farmer has helped build.
With Congress set to re-write the US Foreign Assistance Act, this year offers a once-in-a-generation kind of opportunity to actually re-vamp our development aid. Only bold, visionary leadership will enable this process to rise above narrow interests to focus on outcomes for impoverished people and fighting destabilizing global poverty.
With Dr. Farmer, President Obama and Secretary Clinton may just have found the person who could lead the kind of sweeping change to Washington that they have so often promised. If they can convince him to come to DC, they will have shown the kind of political courage and commitment to bold leadership on international development I worried I wouldn't see.
Millions around the world have been holding their breath to see the direction of his administration's foreign aid policy as their lives literally depend on it. If this Dr. Farmer's appointment comes to fruition it will be a bold signal that the administration is serious.