In the Path to Possibilities in Healthcare & Innovation
The Bill and Melinda Gates Foundation in India focuses on key areas that will affect the future of India’s most vulnerable communities: reproductive, maternal, newborn, and child health and nutrition; sanitation; agricultural development; and financial inclusion. Headed by Dr. Nachiket Mor in India, the foundation, in its decade long journey here, has been building momentum in developing scalable, measurable programmes across all priority areas. Dr. Nachiket, flitting between the financial and philanthropic worlds, has been closely associated with the core interest areas of the foundation, including healthcare alongside sanitation, agricultural development and financial services for the poor.
In conversation with Rajesh Mehta, Consulting Editor, Governance Today, Dr Nachiket Mor, India Country Office Director talks about the foundation’s values, services and plans in India…
The first edition of our annual India Letter marked a significant milestone for the Gates Foundation, the completion of 15 years of our work globally, with 13 years in India, and we felt that it provided a good opportunity for us, to reflect on our progress in reducing inequalities in health, and in access to safe sanitation and financial inclusion; and to better understand the good practices that should be scaled up as well as the challenges we continue to face as we work together to help achieve India’s development goals. The India Letter was centred on the primary question: “What if every Indian had the opportunity to lead a healthy, productive life?” This “What if” is a vital question that we often ask ourselves at the foundation; so that the search for answers can enable us to deploy our collective expertise and to develop solutions that can potentially help solve the world’s most intractable problems. In the letter we highlighted three sets of initiatives in which we have been involved, as examples of successful foundation interventions, jointly with the government and our partners, to leverage our combined capabilities to help India get better results from her investments in the social sector: in primary healthcare services for women and young children, tuberculosis diagnosis and treatment, and sanitation.
In primary healthcare services, we found that onsite nurse mentoring, and improved clinical skills and better observation of clinical practices, led to reduced occurrence and better identification and management of maternal and new-born complications. The trends indicated a 22% reduction in Still Birth Rate (SBR) from 1.8% to 1.4% over a period of 12 months in facilities where nurse mentoring was implemented in Bihar. This reduction was two times higher than the historic trend. In addition, improvements were witnessed in the identification and management of other new-born and maternal complications such as the death of babies because of their inability to breathe and of mothers from excessive bleeding. In tuberculosis diagnosis and treatment, technology led innovations combined with carefully structured private sector engagement helped develop a new model for tracking TB patients, resulting in early identification and resolution of TB and Multi-Drug Resistant TB. In sanitation, the incorporation of a Faecal Sludge and Septage Management (FSSM) framework in key urban sanitation projects such as AMRUT and Smart City initiatives was a significant positive step towards bringing safe sanitation systems to millions of Indians.
How is it working with the Government of India so far? You also work with multiple governments in the states and Centre. Are there any challenges in this regard?
Since the inception of our work in India, our core operating model has been based on partnerships with the government, which are guided by their priorities, rules and regulations. At each stage, our work is informed by the ideas of a broad group of experts, both inside and outside the foundation, including government officials, community leaders, technical experts, and civil society leaders and advocates, to ensure that it is both impartial and rigorous in its approach. Using this approach, over the years, we have been able to successfully work with a number of governments both at the Centre and the States.
Could you enlighten readers about affordable healthcare innovation in India? Tell us about the foundation’s preferential choice of venturing only in the public healthcare domain, but not in the critical care needs.
As its core strategy, the foundation focuses on making both government and nongovernment service providers work for the poor. We believe that one of the fundamental drivers of human inequality is the prevalence of disease and malnutrition in the poorest parts of the world and that we can ensure good progress in reducing the level of inequality, by improving the manner in which both the private sector and the government meet the healthcare needs of the poor and marginalized peoples globally.
In India, the healthcare work of the foundation has encompassed both preventive and curative care, particularly as it concerns women and children. For example, the work of our partners in government health facilities on the mentoring of nurses, and on the establishment of Sick New-born Care Units ensures that there is good quality curative care available for mothers and children at the primary and secondary levels in states such as Bihar and Uttar Pradesh, and the work of our partners on the elimination of vaccine preventable diseases such as Polio; support to the government on its plan to introduce new vaccines; nutrition; sanitation; and in helping women have a wider choice of options for contraception, are all preventive interventions geared towards ensuring that there is a general improvement in population health and well-being.
What are your priority areas in India, other than healthcare? What are the areas the foundation can improve in?
In addition to public health, our focus areas in India also include urban sanitation, digital financial inclusion, and agricultural development. Additionally, as women play an increasingly important role in both farming and livestock management, we have a significant focus on efforts that seek to address traditional constraints in their ability to access knowledge, services, and essential products.
“Financing options for municipalities for urban sanitation; better access to credit through digital channels; better access for smallholder farmers to electronic markets; and understanding what truly works at scale in the area women’s empowerment, are a few of the many areas in which we need to do more work
And, in each of these areas as well as the ones mentioned earlier in health care, there is a continuing need for the foundation to learn and to generate greater impact. Financing options for municipalities for urban sanitation; better access to credit through digital channels; better access for small-holder farmers to electronic markets; and understanding what truly works at scale in the area women’s empowerment, are a few of the many areas in which we need to do more work and learn more.
What are your views on philanthropy in India?
believe that our deep-seated and growing tradition of individual and corporate philanthropy is one of the biggest strengths we in India can bring to bear against our development challenges. We have been witness to seminal examples of philanthropy in India from, among others, the Nilekanis, the Premjis, the Tatas, and the Piramals, who have generously allocated their fortunes, shared their knowledge and ideas, and committed their time to become champions for those who need help the most. It is also good to see the model of philanthropy in India is gradually shifting from one of only charitable giving to one in which there is a desire to effect longer term change through strategic philanthropy. The need for such efforts is particularly key in challenging domains such as health care.
How do you see the impact of the private market on the foundation’s work?
The Indian private sector produces over 60% of the world’s vaccines, including the locally developed one against the Rotavirus, and over 20% of its generic medicines. Given the significant cost and quality advantages that the Indian private sector offers, the foundation works closely with companies such as the Serum Institute, and Bharat Biotech, and provides them with assurances of offtake as well as product development subsidies, so that the costs of vaccines and essential medicines continue to drop, and the availability of new vaccines continues to improve. In fields such as diagnosis and treatment of Tuberculosis and in the increase in the number of contraceptive choices available to women, the foundation has supported the work of governments with the private sector, both at the national and the state levels. In addition, our sanitation program focuses on developing innovative approaches and technologies, both across private and public sector that has the potential to lead to radical and sustainable improvements in sanitation in the developing world.