Back in the heady 1990s, a lot of energy was put into some exciting attempts to make the world a fairer, more sustainable place by tackling poverty with ideas that were proven to work.
Much of that energy came out of Bangladesh, where BRAC and Grameen had begun to design practical, bottom up answers to health, education, economic and gender challenges. Some came from the late C.K. Pralahad’s work to make society aware of the potential of “Bottom of the Pyramid” consumers to help shape a different model of capitalism.
And some of it came from attempts to share ideas and information about what we now call ‘North-South’ development work more widely in the US through a program that came to be known as Lessons without Borders.
The idea emerged serendipitously in a discussion between Marion Wright Edelman, head of the Children’s Defense Fund, and USAID administrator Brian Atwood, during which they noted the similarities of some of the challenges overseas and domestically. While US inner cities had measles vaccination rates of about 40%, governments in Egypt, the Philippines, India, Sri Lanka and Indonesia had achieved childhood immunization rates in the high 70% range.
Mentioning the discussion in an interview on C-Span a few days later, Atwood said USAID hoped to become more involved in sharing ideas with American cities. Baltimore volunteered to be the first test case. Other cities followed.
“The agency’s shift in focus from Bangladesh to Baltimore was an accident waiting to happen,” said Thomas L. Friedman in 1994. “With no cold war, it was eager to justify its usefulness to taxpayers dubious of foreign aid, and it discovered American mayors so beleaguered by the problems of their inner cities that they were ready to take help from anywhere, even if it meant comparisons between their inner cities and the third world.”
In June 1994, Baltimore Mayor Kurt Schmoke sent about a dozen staff and local social entrepreneurs to other countries that had successful health care and economic programs set up or supported by USAID.
Nairobi, Kenya, had raised its childhood immunization rates to 80% for two year olds but Baltimore’s immunization rate for 2-year-olds was only 56%, and only 62% of Baltimore’s school age children had all required immunizations. In 1995, using lessons learned in Nairobi, Baltimore launched a massive immunization campaign, including immunizing or collecting complete records for some 39,000 school-age children: The rate of documented immunization in Baltimore rose to 96%.

World map showing country classifications per the IMF and the UN (last updated April 2023). The countries in light blue form the “Global North”, the rest are mostly categorized as belonging to the “Global South”, with few exceptions under some listings. Allice Hunter, Wikipedia.
But a lot more was happening in Baltimore, thanks to the Lessons without Borders approach.
A peer lending program set up by Amanda Crook Zinn, head of Women Entrepreneurs of Baltimore, was helping poor women set up their own businesses, modeled after one in Kenya which taught women how to manage and save their money so they can establish credit.
Joe Jones started a prenatal care program, modeled after one in Jamaica, that teaches men parental responsibilities. In his Healthy Start program, women went door to door in two housing projects, looking for expectant mothers in need of prenatal care. The program worked with the expectant fathers, so they do not turn to domestic or street violence, said Jones, men’s services coordinator for Healthy Start.
With funding from the Department of Housing and Urban Development, Healthy Start also established a program for the unemployed fathers to help repair Baltimore’s housing projects. “Then little children can see men working instead of on the street corners selling drugs,” Jones said.
As well as Baltimore, Boston and Seattle hosted Lessons without Borders programs, bringing home some innovative techniques in health, economic development and the environment that have been discovered through foreign assistance programs. Innovations like social marketing, Oral Rehydration Salts, community banking, community empowerment, and microcredit and microenterprise development.

Kansas summer wheat. James Watkins, Wikimedia.
Lessons without Borders also developed partnership awards. In 1998, it went to Pennsylvania’s White Dog cafe for its”Table for Six Billion Please!” project. The restaurant, working with several non-profit educational groups, sent customers and employees to its sister restaurants in developing countries such as Nicaragua, Lithuania and Indonesia so they would experience each nation’s culture and thus better understand the issues facing each country.
Lessons without Borders appeared as USAID was reinventing itself as an agency, facing cuts in both the US foreign aid budget and its own budget. Key administration officials in the Clinton administration praised its restructuring approach. VIce president Al Gore spoke at the first Baltimore workshop, as did first lady Hilary Rodham Clinton, who described Lessons without Borders as a “way of saying we have learned from what we have done.”
USAID didn’t just stick to sharing lessons learned. It also talked about how the US benefited in financial terms from foreign aid. For example, in 1993, USAID had purchased $86.4 million of wheat, sorghum, soybeans and edible oils from farmers in Kansas for use in its Food for Peace programs. In 1995, the Kansas farmers had fed people in 30 different countries through the foodstuffs USAID had purchased. Similar purchases had been made in New York.
But it was challenging for people to imagine that US inner city life could be anything like the life of people in countries then known as ‘underdeveloped’ but now known to us as the Global South, as USAID staff learned while trying to help an inner city Washington neighbourhood save its health clinic. “I always thought that in the Third World they had worse problems than we did,” said one woman. “But they are telling me that is not necessarily the case.”
Sources:
Now available: the best kept secrets in government. USAID Developments, Fall 1996.
U.S. agency uses foreign aid expertise to help reopen a D.C. health clinic. Washington Post, Feb. 11, 1996
Cold War Agency Looks At Problems Back Home. New York Times, Jun. 26, 1994
Baltimore Mayor Honored for Initiative in Domestic Aid Program. Capital News Service, Oct. 31, 1996
Cover image thanks to Andrea Piacquadio, Pexels