Written by Mark Suzman
From the earliest days of the Bill and Melinda Gates Foundation, we have been proud to work closely with the Indian government at the national and state levels, aligning all our efforts with India’s ambitious targets under the United Nations Sustainable Development Goals (SDGs). In 2002, India became the first country outside of the United States where we set up a small team — a few years later, we opened a full-fledged office in Delhi and expanded our work to address priority issues. Some of the themes we focus on include maternal and new-born health, infectious diseases, agricultural development, and financial services, with a geographical priority focus in the states of Uttar Pradesh and Bihar.
Over the years, we have deepened our engagement with the country. As a foundation, we have had the opportunity to work closely with Indian partners who have led the way on health and development progress. We are proud to have worked with the Government of India on the Avahan programme for HIV prevention, India’s polio eradication programme, Mission Indradhanush, the Swachh Bharat Mission, and Poshan Abhiyaan. We have also invested in the country’s vaccine research, including supporting the development of Indian-made rotavirus, pneumonia, and measles vaccines. And, we are grateful to work with strong Indian partners in the governments of Bihar and UP across critical issues of importance in these states.
So, it was personally meaningful for me to return to India in June after my last visit more than two years ago to meet with many Indian partners — from government officials to health professionals, academic researchers, and digital innovators.
My trip could not have come at a more critical moment for global health and development. For the first two decades of the 21st century, the world made unprecedented progress toward equity. Child deaths were cut in half. The global poverty rate fell by three-quarters. But today, due to the damage wrought by Covid-19, impending famine, climate change and other threats, that progress is at risk.
But at an unequal moment in an unequal world, India is investing significantly in health and development, helping millions of people around the world live healthy, productive lives. Of course, I am not surprised. India has shown time and again that it can harness innovation to find novel solutions to new and existing challenges. The Covid pandemic took a toll on India’s health system, as in other countries. Nonetheless, the resilience of the health system enabled the resumption of essential health services, a testament to past investments in strengthening primary healthcare. Lessons from the pandemic have enabled India to design an ambitious five-year programme through additional investments to enhance primary healthcare in rural and urban areas, and significant improvements in pandemic preparedness. India approaches complex problems with resourcefulness, determination, and drive.
Consider the scale, speed, and efficiency of India’s Covid-19 vaccine drive, which administered over 2 billion doses within just 18 months of the launch of the vaccine in the country. It is no coincidence that this success story took place in India, the world’s largest producer of vaccines. But India is more than the world’s pharmacy: It is a crucial incubator for life-saving innovations and a hub for cutting-edge research and development. Take CoWin, the backbone of India’s Covid vaccination programme. The digital tools deployed in India to fight the pandemic can help combat other communicable diseases through strengthened surveillance, diagnostics and service delivery. While the devastating impact of this pandemic cannot be overstated — particularly for those who have lost loved ones — India’s pioneering digital tools have provided an impressive model for other countries around the world.
Key indicators around maternal and infant mortality also tell a powerful, positive story. India has ensured full immunisation coverage for over 76 per cent of children between the ages of 12-23 months, ensuring they can grow to realise their full potential. In the last five years, more women have delivered their babies in facilities rather than at home, thus improving health outcomes. We know those outcomes can improve even further when facilities have better trained health workers and modern health tools. I visited a district hospital in Lucknow, where the government of UP is pursuing innovative solutions and policy changes to meet the need for more specialists in the health system. Today, doctors are receiving mentorship through partnerships between medical colleges and first referral units. Nurses, too, are being mentored, and the quality of pre-service nursing education is improving. “Buddy-buddy” programmes match specialists with general doctors, empowering them with the skills and competencies they need to manage obstetric complications. I spoke to a doctor trained and mentored through this programme and could sense the professional pride and increased confidence these learning experiences have enabled for her.
I continue to be impressed by India’s innovative, cost-effective efforts to increase equitable access to healthcare. The Ayushman Bharat Digital Mission will strengthen the country’s digital health infrastructure, increase access to care through platform-agnostic direct-to-consumer applications, and enable consent-based data and information flow across the ecosystem.
India has done pioneering work on digital identity (Aadhaar) and its real-time interoperable payments system (UPI). In fact, UPI is touted to be the fastest growing digital payments system with almost 6 billion transactions per month. Newer use cases are now emerging in the country, based on the convergence of its existing digital public infrastructure stack, with incredible impact on the poorest and most vulnerable. One implication of this technology stack is that it has enabled India’s federal government to efficiently transfer welfare payments to over 750 million people directly in their bank accounts. This includes payments to 100 million smallholder farmers and pandemic relief payments during Covid to over 200 million women. This has enabled digital financial services for those who earlier lacked such access. These innovations are not just helping Indians, but they also have the potential to become global public goods, making digital financial services worldwide more inclusive.
As we work to recover from the devastating impacts of the pandemic, we cannot lose sight of our collective long-term goals. We must regain lost ground on key progress indicators and accelerate efforts towards achieving the Sustainable Development Goals. But if there was one lasting takeaway from my visit, it is this: We can still get back on track if we learn from past challenges and apply the very best Indian ideas and innovations — both in India, and around the world.
Mark Suzman is the CEO, Bill & Melinda Gates Foundation
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