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.