Hillary Clinton leaves the State Department after a whirlwind four years in office. Above, she gestures during a joint press conference at the U.S.-India Strategic Dialogue on June 13, 2012, with Somanahalli Mallaiah Krishna, who at the time served as India’s minister of external affairs. Photo by: U.S. State Department

Few U.S. secretaries of state have reached the iconic stature of Hillary Rodham Clinton. She leaves that office after four years with her rock-star status solidified and the informal title of the most famous woman in the world.

Given her high-power profile, Clinton surprised many by eschewing the usual path toward greatness for this country’s top diplomat. Departing from at least five decades of tradition, Clinton did not concentrate on solving intractable conflicts like those in Afghanistan and Israel, searching for a Nobel Peace Prize. Those wars were handed over to special advisors close to her: the late Richard Holbrooke in Afghanistan and George Mitchell in Israel. (Neither brokered a peace deal.)

Instead, she focused much of her attention and energy on international development, on issues considered small bore if well-meaning: saving children from dying of preventable diseases, connecting poor farmers to markets as part of a new food security program, and improving the lot of women whose lack of education and resources are at the core of some of the world’s thorniest challenges.

For Clinton, these weren’t “soft” issues but part of a “smart power” agenda crucial to U.S. economic and national security interests. And it was a focus that came naturally to the former first lady, who famously declared, at a 1995 U.N. conference in Beijing, that “women’s rights are human rights.”

Clinton leaves office this week having visited more countries than any of her predecessors. In the process, she helped to write the script for a new type of U.S. engagement abroad, one in which international development is a central pillar. No doubt development did not achieve equal footing with diplomacy and defense during Clinton’s tenure, as many within the aid community may have hoped, but more than a dozen experts interviewed for this article — on and off the record — say she has elevated its importance beyond any historical equivalent.

But has a higher profile for development led to better results? On this point, Clinton’s record is mixed. Reforms and new initiatives are incomplete, congressional support for foreign aid uncertain, and the alphabet soup of development programs spread across more than 20 agencies. Will the push this powerful woman gave to development be enough to carry her efforts forward even after she’s gone?

John Kerry, her designated successor, has largely been silent on aid, and in a rare joint appearance on the CBS “60 Minutes” television program last Sunday, only Clinton mentioned development, while President Barack Obama described his foreign policy successes in classic terms of winding down wars and pushing back al-Qaida.

Hope and change

In 2008, when Barack Obama was first elected president, he promised to double foreign aid within five years — a pledge he soon retreated from as the magnitude of the financial crisis became clearer. Many in the aid community had lobbied for a Cabinet-level aid agency that would operate independently of the State Department, but neither President Obama nor Secretary Clinton made a public commitment to that idea. And when a massive earthquake devastated Haiti, Clinton made clear that State was leading the U.S. response and Rajiv Shah, the newly minted U.S. Agency for International Development administrator, reported to her.

That press conference, in January 2010, captured Clinton’s attitude toward development cooperation. She took control of the resources available and tried to make sure the job got done, without regard to bolstering the independence of USAID. It ruffled some feathers, but many in the aid community decided it was a plus having someone in charge who was as committed to development and as politically influential as Clinton.

Nancy Birdsall, a founder and director of the Center for Global Development, is one of many aid veterans who have mixed emotions about Clinton’s tenure. She praised Clinton’s commitment to the issues and said she had expected the incoming secretary of state to be “terrific,” but would now rate her overall performance as “merely good.”

“I just wish as secretary, she had pushed for more autonomy and more of a policy role for USAID on decisions where the development voice is sorely needed alongside diplomacy and defense,” Birdsall said in an email. “The reality is that during her tenure, a lot of ‘development’ was run (and not particularly well) by the State Department.”

Birdsall captured what has become a hotly debated question: Was Clinton’s intention to build up USAID undermined by her conviction that the best way to protect the agency was to keep it under the firm control of the State Department?

Tensions came to a boil over the structure of U.S. global health efforts, which receive the lion’s share of aid funding through the State Department, USAID and, more recently, the Department of Health and Human Services. At the center of the debate was the Global Health Initiative, established with much fanfare in 2009 to streamline work across multiple government agencies. But last year, the Obama administration announced it was abandoning plans to allow USAID to lead GHI. Instead, an Office of Global Health Diplomacy was established at the State Department, a decision that led influential health experts like Laurie Garrett, senior fellow at the Council on Foreign Relations, to accuse Clinton and her staff of undercutting the agency whose job it was to oversee foreign aid.

Yet Clinton was in a serious political bind, according to Carol Lancaster, dean of the School of Foreign Service at Georgetown University and the former deputy administrator of USAID under President Bill Clinton. The major accomplishment of President Obama’s first term was health reform for Americans — nicknamed Obamacare — and the Department of Health and Human Services was critical to its implementation. To wrest control of global health programs, Clinton would have had to challenge HHS’s growing role in global health, a no-win proposition.

“Hillary thought that was too big a lift to try to change,” said Lancaster, who has watched Clinton’s interest in development grow since she accompanied the first lady on her first trip to India in the 1990s.

Ambassador Eric Goosby, the head of the new health diplomacy office, has since been hiring communications associates and technical experts — a move watched with some trepidation by their colleagues at USAID, which Clinton had vowed to turn into “the premier development agency in the world, bar none.”

Shah, the USAID administrator, acknowledges that that U.S. global health efforts remain scattered.

“We didn’t make structural changes in what we acknowledge is a fragmented health account,” he said in an interview. “But I would point out that we’re saving more lives and we have a bigger budget than before.”

Rebuilding U.S. aid

When Clinton assumed her post as top U.S. diplomat on Jan. 21, 2009, the country’s foreign aid architecture lay in shambles.

USAID had been gutted, turned into a contracting agency without the people or resources to carry out its own agenda. The Defense Department controlled billion-dollar development initiatives in Iraq and the Af-Pak region, and aid programs were scattered across various government departments. President George W. Bush’s two signature achievements in development cooperation — the creation of PEPFAR and the Millennium Challenge Corp. — had shifted the center of power further away from USAID.

Reform had become a major cause for aid veterans, think tanks and a host of others — including USAID’s implementing partners, who continue to struggle with complex procurement rules, funding delays and what they call inexperienced contract officers. Clinton antagonized some of them when she called for USAID to reduce its reliance on contractors and beef up local partnerships in countries receiving aid. This created fissures within the community of NGOs and consulting firms that depend on the agency’s business.

Clinton, though, was addressing the far larger problem she inherited from the Bush administration. Following the 2003 invasion of Iraq, President George W. Bush gave the Pentagon authority over massive aid programs; audits later revealed that contractors had squandered billions of dollars. During the recession that followed, government was looking for savings.

That focus has paid off, Shah said.

“For the first time in history, USAID has reduced the cost of food aid by going for efficiency, reducing cost by lessening restrictions on shipments and by buying local, cheaper,” he argued.

Despite their hard-fought campaign for the Democratic Party’s presidential nomination, there appeared to be little tension between Obama and Clinton on reforming the U.S. foreign aid architecture. Once Clinton joined the president’s “team of rivals,” tensions bubbled up a few levels below them, resulting in a minor turf battle between Obama supporters and Clintonites at the State Department and elsewhere. Gayle Smith, a widely respected aid veteran who joined the White House as a senior director responsible for global development, was a public champion for a more independent, perhaps even Cabinet-level aid agency and for granting the USAID chief a permanent seat at the National Security Council. It didn’t happen.

To outsiders, it seemed like Smith was being clobbered by Clinton. Those who were part of the deliberations, though, said it was never a battle over power but over how to best protect USAID.

The White House published the landmark presidential policy directive on global development on Sept. 22, 2010. Clinton followed shortly thereafter with the release of the first-ever quadrennial diplomacy and development review, a blueprint for putting Obama’s directive into practice. The QDDR, based in part on a similar review done by the Pentagon, reaffirmed Foggy Bottom’s central role in guiding foreign aid. It also highlighted several themes Clinton had been championing, from food security to women’s rights and the engagement of the private sector in global development.

A ‘transformational’ figure

At USAID, Shah is now implementing many of the priorities outlined in the PSD and QDDR. The 39-year-old administrator — trained as a physician and one of the early leaders at the Bill & Melinda Gates Foundation — has been praised for imbuing his agency with a renewed sense of optimism and innovation. Under Clinton, the agency added 800 new jobs and increased the budget to $20.3 billion before a hiring freeze put further expansions on hold. USAID opened a policy and planning office and began to improve the monitoring and evaluation of field projects.

Shah is confident that U.S. aid has turned the corner.

“I can say absolutely with a straight face that under this administration, we have raised the profile of aid by engaging with all elements of American society,” he said.

Clinton’s role, he said, has been “transformational.”

That transformation is clearly meant to be global. In 2010, Clinton lobbied for the confirmation of former USAID Administrator Brian Atwood (who also heads Devex’s board of advisors) as chair of the Paris-based OECD Development Assistance Committee, a panel of bilateral aid ministers from the industrialized world that meets regularly to discuss development priorities and processes. A year later, Clinton gave a keynote address at the OECD’s Fourth High-Level Forum on Aid Effectiveness in Busan, South Korea, that distills her philosophy on aid.

“We need to continue shifting our approach and our thinking from aid to investment, investments targeted to produce tangible returns. And we have to be very honest about it, because wise investors choose their investments carefully,” she said on Nov. 30, 2011.

To anyone who has attended a Clinton Global Initiative gathering, this sounded familiar. The secretary of state’s husband, former U.S. President Bill Clinton, has struck a similar chord for years. The Obama administration’s focus on engaging the private sector to amplify development results is a sign of the times.

The first elected official to be named secretary of state since Edmund Muskie’s forgettable one-year stint in 1980, Clinton translated her political skills — mastered as first lady, senator from New York and presidential candidate — into a four-year campaign to deepen U.S. commitment to development. To the delight of USAID professionals, she adopted the lowly clean cook stove as her signature issue. Designed to remove debilitating smoke that threatens mothers and children with respiratory diseases, the cook stove came to symbolize how a simple idea can break through the complicated, frustrating business of development and transform lives.

Whenever abroad, Clinton made time to meet with people outside of officialdom. She has spent hours with university students, farmers and low-level officials looking for change. It’s a powerful reminder for the foreign policy workforce that international engagement is, first and foremost, about people and their wellbeing — perhaps Clinton’s most consequential achievement as secretary of state.

Out in the field, aid workers are noticing a difference. Greg Adams, who directs Oxfam America’s advocacy on aid effectiveness, recently toured seven countries. The biggest change he saw was how the U.S. government is now “partnering with local actors and listening to local priorities,” he said.

To facilitate this change, Clinton has made U.S. ambassadors the nominal CEOs of development cooperation within their host countries.

History in the making

The tug-of-war over Clinton’s legacy on U.S. development cooperation will continue long after she leaves her seventh-floor office in Foggy Bottom. Did she overreach or did she save USAID from extinction?

“Hillary Clinton has given USAID a boost in its prominence and size and maybe political support,” says Lancaster. “It is among the most competent aid agencies in the world, with original ideas, and that is important because USAID came close to losing all of that.”

And Raymond Offenheiser, president of Oxfam America, credits Clinton for “giving USAID its frontal lobe back. She made development a signature aspect of her time at State, arguing that fighting global poverty is an urgent American challenge.”

Andrew Natsios, who headed USAID under President George W. Bush, disagrees: “Clinton didn’t save USAID; she absorbed it by stealth into State,” he said, accusing her of taking credit for initiatives begun by Republicans.

Clinton’s tenure suggests that there’s an alternative path than that which values structural reform above all else. That path lies in programmatic reform and the changing of institutional culture. Without it, lasting change may be elusive.

As secretary of state, Clinton used her star power to open up lines of communication with the private sector, with Burmese leaders, with ordinary people living under extraordinary circumstances and reaching audiences who normally pay little attention to development.

Cheryl Mills, Clinton’s counselor and chief of staff, said in an interview that the outgoing secretary of state may be leaving office, but not the development scene.

“She was concerned about development long before she walked in this office,” Mills said, “and she will be long after she walks out.”

When she does, on Friday, Feb. 1, Clinton will leave behind a stronger, yet still overly complex and fragile U.S. aid architecture but also a new foreign policy mindset — “21st-century statecraft,” as she calls it — in which development plays a central role.

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About the author

  • Elizabeth Becker

    Elizabeth Becker, award-winning author and reporter, has been covering foreign affairs and development issues for 40 years, as a New York Times correspondent, the senior foreign editor of National Public Radio overseeing the network's global coverage, and beginning as a war correspondent in Cambodia for the Washington Post. She first interviewed Hillary Clinton in 1992 during the Democratic presidential primary. Becker serves on the board of Oxfam America.