We do a lot specifically in India, quite a bit more than in the country we do the second most in, which is Nigeria,” says Bill Gates, the co-chair of the Bill and Melinda Gates Foundation (BMGF) in a telephone interview. Outside the US, health, agriculture, sanitation, financial services are the four areas BMGF works in, and Gates says this uses up all their resources and that is the reason why the foundation is not looking at education initiatives in India. The biggest thrust for the foundation remains in healthcare and Gates says that there’s been a lot of great progress and continuity in work, even though there have different chief ministers. Edited excerpts from an interview.
BMGF has been working with state governments in India for a while. Have you seen the primary healthcare system in India maturing?
Certainly. When we first started working in Bihar, vaccine coverage was well under 30%. We were able to go into some of the districts and intervene pretty intensively, making sure that the supply chain worked and that people were hired and created dashboards. The vaccine coverage has gone up quite a bit. We got started later in Uttar Pradesh, but even there, in the parts of the state we work in, we’ve seen good results. And part of it is because of the common application software (CAS) platform that helps coordinate the different activities.
There’s a rising trend of breaking away from globalization across the world. Does that worry you in terms of the work that you’re doing?
I’m a huge fan of how global cooperation has worked well together. There are benefits of countries working together on peace, on science, on fighting terrorism, on fighting climate change. In general, I see that that’s going to continue. But you’re absolutely right that we have some people questioning the trade system, and I think that’s unfortunate. However, there’s nothing that’s going to slow down global scientific cooperation, because we have the Internet and we have new tools of science. So even though there are some near-term questions, mostly in the trade and immigration area, the global enterprise of using science to improve lives, nothing’s going to stop that.
Who, according to you, are the main stakeholders if we have to develop an adequate global response systems to deal with health-related emergencies ?
Well, there’s three big categories. There’s early detection, and that’s your health system seeing the outbreak at the very earliest stage, then there’s the tools that you have to have at the ready that—and there’s many sub categories of that, including diagnostics and drugs and vaccines. But then you also have to have a set of personnel who have done enough practices, simulations of it, like a big flu outbreak or a smallpox outbreak, that they’re really ready to understand how to communicate, how to quarantine, how to get the new tools manufactured and distributed, and how those get allocated. At this point, none of the categories are in a good shape on a global basis.
You are a big champion of partnering with governments for scale. What about working from within the government? Is that something philanthropists to look at?
If you want to improve primary health care and get vaccine coverage up, you have to partner with the government. If you want to make sure women are educated about contraception, it’s necessary to help the government work through their system. If you want to help improve the education system in India, you have to partner with the government.
The government makes all the decisions about what will be done, but they benefit from the R&D investments which philanthropists can go in and fund. I think either the private sector or philanthropists can help with things like instrumenting the measurement systems and the feedback loop.
BMGF is looking at sanitation from a different perspective with a low-cost community fecal sludge treatment plants in Bengaluru.
Well, there’s not much funding in innovative sewage treatment. We’re one of the only funding agency I know who works in that space. We’re also working at the toilet level itself, avoiding having to have a sewer solution, although that’s at an early stage. The fact that you can actually take that sludge and process it, instead of just having it sit out and dry or end up back in the river, that’s an exciting thing. The pilot is out there and running and people are looking at the economics and how desirable that is. We’re hoping that gets scaled up.
Do you think Indian philanthropists should look at the Gate Scholarship model in education to help fight inequality?
Well, everybody picks what they’re passionate about. The beauty of philanthropy is that it’s an individual choice that people are making. I’m sure there are tons of scholarship programs in India. I’m not an expert on that, because that’s an area we only work in the United States. But, yes, it’s a worthy area.
Engaging the workers who have worked on polio eradication to work with the issue of elephantiasis is interesting. But wouldn’t these workers need to be retrained?
For these neglected diseases, the basic thing is that you go out once or twice a year with a set of pills. These pills are donated by the pharmaceutical companies. So the main cost is making sure you get the delivery. The actual delivery of those pills in India, as we looked at it, the coverage levels were super low, like 30% coverage. And so in order to really get the numbers up, we took workers with National Polio Surveillance Project (NPSP)-type skill sets and got them involved in quality auditing and review to make sure the coverage would be there. If we use the triple-drug regimen, and get good coverage, we can actually, over a three-year period get local elimination. And if that was done well throughout India, we could take out lymphatic filariasis, which is the cause of the elephantiasis.
It’s been six months since the 2017 Goalkeepers report. At the six-month mark, is there any data that’s come in that’s making you positive today? Can you give us a sneak peek?
You don’t get that much accuracy in childhood death rates on a sub-yearly basis. The things that you see in the short term are quality of execution. You see the vaccine coverage levels, you see the uptake on reproductive health tools. There, we have more quarterly type data. We continue to see good trends for our work in India. However, field execution is not something that improves just in a period of six months. It’s slow.
Do you believe that philanthropists don’t necessarily have to work within government to make an impact?
Well, philanthropy is a very broad thing. If you want to just fund a new museum, you can do that without involving the government. If you want to give scholarships to kids, you can do that without involving the government. The main reason to work with the government is if you want to do something like dramatically reducing childhood death in India, where it’s got to be the problems in primary healthcare system. That’s the only way to save millions of lives. And there, you go to the state and the federal level and say, “Okay, what are your goals here? Can we help you achieve those goals?” You talk about various tactics where you bring your different strengths together. livemint