Gayle Smith, 63, is the president and CEO of the One Campaign, a nonpartisan, nonprofit advocacy organization fighting extreme poverty and preventable diseases, particularly in Africa. She served as a top adviser on development issues in the Clinton and Obama administrations, most recently as administrator of the U.S. Agency for International Development.

You have worked in Africa in one capacity or another for decades. How did you first get involved there?

I confess, a little bit by accident. I traveled after college with my boyfriend. We went to Greece. And the short story is: We broke up, and I kept going. I went on to Egypt and then Sudan. And the more I saw, the more curious I became. So I became a stringer for the BBC, Associated Press, some papers in Europe. I lived in Sudan but covered wars in Eritrea and northern Ethiopia. And then ran into the biggest famine in modern history — the ’84-’85 famine in Ethiopia. See, I had been traveling with guerrillas behind the guerrilla-held side of the battle lines, the rural areas of both Eritrea and northern Ethiopia, and that’s where the famine hit the hardest. And that shifted me. I had seen things — horrible things. And I think I felt like writing about it was one thing. Doing something about it was better.

We talk a lot here about dignity. Dignity and opportunity kind of being what we’re fighting for. When you see a grandmother who’s probably raised six or eight kids and has barely eked out a living working the land, groveling on her hands and knees and eating dirt because that’s all there is, I don’t care who you are and where you came from. Nobody should have to face that kind of indignity.

So throughout my career, as a journalist, in NGOs, inside and outside government, I have been a big believer in investing in our common humanity. I think it's in our interest to do so. I think it's right to do so. And it actually works.

Going back to traveling behind the lines with guerrillas, how did that start, and were you scared?

You know, actually, I wasn’t. I was in Khartoum working as a reporter. And they approached me. They wanted reporters to come see what was going on. Because nobody believed there was a war. In fact, it was a pretty obscure, hidden war. So I went. The first part of the trip, we walked from eastern Sudan for probably 10, 12 days. Walked at night because there was bombing during the day. They were very, very disciplined. So I felt pretty confident that they weren’t going to behave in some reckless fashion. In times where it was active battles, you almost dissociate. You sort of step into another place where you’re keenly alert. You’re focused. You can tell the difference between incoming and outgoing. Hyper-alert, but not actively scared. I suspect that that’s a survival thing.

“War” and “famine” — you see the consequences of those words. And that’s life-changing. During that famine, the world provided assistance only to the government side. So hundreds of thousands of people who could have been assisted starved to death. Because of politics. I was angry but also very clear-eyed. And I think it drove a lot of what I did over time, how I thought about war, or things like development. I mean, famine is a colossal failure of development, of policies and everything that goes with it.

In your confirmation hearing for head of USAID, there was some pushback from people who said that you were soft on repressive regimes led by guerrilla leaders you had come to know.

There are a couple things that I learned in government when you’re engaging with other governments: What do you say publicly, and what do you say privately? And a lot of that is, how do you think you can influence someone? There are cases where I think the United States can influence by taking a strongly public posture. Others where that’s less effective, and it makes more sense to do something privately. Look, of course we want democratic partners. I look at some of the things we’re doing now with citizens, pressing their governments in Africa to do more on development, holding them accountable, giving them credit when they do. That, to me, is as much of a game-changer as whether or not we run a democracy program. Which isn’t to suggest the U.S. shouldn’t advocate for those things; I think we should. But ultimately, whether or not a government is democratic and accountable to its citizens is going to come from the inside.

This interview has been edited and condensed. Follow KK Ottesen on Twitter:  @kkOttesen .