The Bill & Melinda Gates Foundation has been operating in India since 2003. It works in four sectors—health, sanitation, financial services, and agricultural development.
The Bill & Melinda Gates Foundation has been operating in India since 2003. It works in four sectors—health, sanitation, financial services, and agricultural development. India features very prominently in the foundation both because it is a big number place and because of innovation. Much of the global work that it does in R&D ends up having an India focus to it. Girindre Beehary, Director India Country Office, Bill & Melinda Gates Foundation spoke to Anup Jayaram on the work it does and its achievements over the years.
Is your work equally distributed across the four sectors? Which sector has seen the most activity?
It would be health because of more maturity. We started working in India on health in 2003 with Avahan, an HIV/AIDS prevention programme. The health portfolio grew and matured faster, but in recent years, financial inclusion, agriculture and the WASH (water, sanitation & hygiene) programmes have begun to mature. Our focus is on issues that affect the poorest. There is a disease called Kala-Azar which only affects Bihar, Uttar Pradesh, Jharkhand and West Bengal. It does not affect the middle class. That is where we are focusing on. There is a huge R&D piece in health.
We are a big foundation. When it comes to having an effect in India, a few dollars don’t go very far. In health you need to work with the government, private sector and communities. We bring in technical assistance to groups that say we can provide similar systems to have the ability to think through a problem, come with solutions and drive implementation. In communities we will be foolish to fund directly at the community level because there are too many villages and communities. That’s where the government has a very large programme of investment on development of Self Help Groups. The funding outmatches anything we could put in. The third leg is the private sector which is a dominant part of India’s health care system. Everything we are doing may not work out and the only way to keep ourselves honest is with data. Our use of data is evaluative. A six monthly, yearly data in working in UP, Bihar give us a sense of how fast we are going.
What kind of data do you source?
We look if women are breastfeeding early, are they feeding kids and what amount of food are they feeding. A battery of indicators at the community level and the facility level tell us if it is functioning at quality. The whole bunch of stuff that we do actually tracks it very closely.
What about the development on other sectors?
On financial inclusion the objective is to ensure the poorest have access to financial services. The delivery element is working with the Pradhan Mantri Jan Dhan Yojana (PMJDY). The banks did try their best but ultimately what you see is dormant bank accounts. We said to ourselves there is another platform whose economics works better for banking. Our work on payments bank is an example of saying you know there is actually a confluence right now of JAM. Mobile telephony and identification helps reach financial services not through the banking system but through mobile telephony system with the banking back-end. So that’s the approach we are taking into financial inclusion.
What about sanitation?
Sanitation is a combination of doing and innovating. The more interesting piece is in innovation. The existing sewer based solution for urban centres in India costs a lot of money. Urban growth is chaotic and very fast. So laying down sewer systems in an environment which is growing fast is difficult. This is where some of the innovative work we have done in India comes in. Two years ago we invited 60 innovators in Re-invent the Toilet. We issued six small innovation grants to Indian organizations and consortia to tell us how we could re-invent the toilet. It is about ensuring that the conversation on sanitation doesn’t stop at toilets.
Agriculture is another key area for the Foundation..
The basic notion is how do we improve smallholder productivity. If you look at a small farmer in Bihar, Uttar Pradesh and Orissa, its usually 5 people who hold half an acre, maybe a buffalo. We know that income generated is going down over time. People make up for it by doing outside work, migrating and so on. So how do you improve farm income? We then walk back and say what can we bring to the table and quite a bit of R&D goes to that. There is Stress Tolerant Rice for Africa and South Asia (STRASA). Rice farmers in Orissa and northern India often face droughts and flood. So if you just plant the rice it dies and replanting rice after the season is over leads to low productivity. We need varieties that are tolerant to flooding. When you go to the field after flooding it is amazing to see the difference. On one side the crop is devastated, but recovers on the other side. Those things are changing agriculture.
How much do you invest in India?
We don’t have a target. But in the last 10 years it would be in the order of $100 million a year in India. It might be a little bit more now, $120 million. The way we work, you got to ask the question every year saying we want to ensure sanitation solutions are taken to scale. So this is how we develop the India portfolio not saying let’s spend X amount of money in India.
Has Indian innovation been replicated in other markets?
Indian R&D affects the world. The work we do in vaccines in India is now global. India is the biggest provider of vaccines for the developing world. So the majority of vaccines procured is Indian and we often partner Indian companies to help them get to the point where they can be participating in this market. What’s happening with financial inclusion in India is an exemplar for the rest of the world. The idea of potentially moving DBT through the JAM platform can transform the name of the game and economics of last mile connectivity. It’s a model that could potentially benefit the rest of the world.
How difficult is it to work in India?
It is never boring. You have to be prepared, you have to know your stuff, you have to be ready. Doors may open, may not open or may open several years later. But our job is to stay prepared for opportunities that may open. Those opportunities are not in our control certainly like a change in government, change in bureaucracy. All these things make it difficult in terms of whether or not we are able to move a particular idea forward. That part remains a little bit complicated for me but I think we have made peace with that and only thing you said is it controls our ability to be prepared for those opportunities as they come up.
The biggest challenge is size. It is a big country and everyone wants to do things at scale. You could compare India to Africa. The difference is India has a central government. While in Africa you negotiate with governments, India allows dialogue between centre and state and it is easier to do. I mean every challenge is an opportunity. So you can do things, innovate in India because of the numbers, because of the market size, because you can do things very very cheap and have models that have very low margins and yet work well because they are sufficiently profitable going into in the entire market.
Are there any emerging economies that we can look for role models?
There are models that we see in Senegal and Indonesia, which can be of use to India. In health India has a lot to learn from most countries. Turkey and Thailand have had pretty successful transformation in the healthcare system over the past 10-20 years. They have done very specific things and both benefited from visionary leadership from health ministers.