One Unique Notion

One of the most inspiring stories of global health success—one that I share whenever I get a chance—is India’s triumph over polio. Just a few years ago, India was home to the largest greatest number of polio cases in the world. It was expected to be the most difficult place to eliminate the crippling disease because of densely crowded urban areas, poor sanitation, large migrant populations, and the fact that over 27 million Indian babies are born every year. Now it’s been over two years since India has had a single case of polio. This story is proof that major health problems can be overcome in the most challenging places in the world. It’s also a powerful reminder of why the Bill & Melinda Gates Foundation inv­ests in programmes to fight disease and poverty in India.

Our mission as an organisation is to help all people live a healthy, productive life—and a huge number of people who are sick and impoverished live on the subcontinent. While India is experiencing significant economic growth, there are still 400 million Indians living in extreme poverty, more than in all 48 countries in sub-Saharan Africa combined. Half of the malnourished and underweight children in the world live in India.

We invest in India because we have established strong and effective partnerships with the government. The government of India has led the fight against polio. Twice a year, two million volunteers prepare 8,00,000 vaccination booths around the country—at schools, hospitals and community centres—and immunise more than 172 million children one by one.

The government was also essential in the development and implementation of our first project in India, an HIV prevention programme, Avahan, that reached millions of most at risk people. Ten years after its launch, Avahan has already saved an estimated 6,00,000 lives and we value India’s commitment to sustain this effort over the long term. What’s most exciting about India’s successes fighting polio and HIV/AIDS is they demonstrate what’s possible when we set clear goals, use innovative approaches and measure progress. They also show what’s possible when we collaborate.

We’re now working with the government of India on challenges like protection from other preventable diseases, guidance on better nutrition for newborns etc in a comprehensive way.  We are supporting this holistic approach in the northern state of Bihar. Bihar has struggled with low literacy rates, high crime, poor infrastructure, and worse outcomes in nutrition than sub-Saharan Africa. But a few years ago, things began to change with the new government led by chief minister Nitish Kumar. Government health expenditures started growing and routine immunisation rates doubled within four years.

The investments by the government helped inspire other donors, including our foundation, to join the Bihar government in a partnership and in support of their objectives to help reduce maternal, newborn and child mortality. This collaborative effort led by the Bihar government is known as the Ananya project (www.ananya.org.in). ‘Ananya’ means unique in Hindi, reflecting the partnership’s belief in the importance and potential of each and every person in Bihar.

Ananya is focused on family planning; pre-natal, delivery and post-delivery care for mothers and their infants; immediate and exclusive breastfeeding; nutrition; and routine immunisation. Treatment of diarrhoea and pneumonia and other infectious diseases as well as improved access to safe sanitation is also a part of the plan.

The polio monitoring and surveillance apparatus is now being used to help frontline health workers deliver routine immunisations to families living in hard-to-reach areas. It also helps give feedback to the local government on where immunisation progress is being made and where imp­rovements are needed.

The challenges facing families in Bihar are complex and far-reaching so we are continually looking to invest in new innovations to improve healthcare training and delivery. For example, we are exploring ways to use mobile phones to help frontline health workers teach families about pre-natal care, breastfeeding, nutrition, sanitation and other good health practices. We’ve also been equipping more than 1,000 village-level healthcare providers with video conferencing systems so doctors and specialists in urban areas can treat patients in remote areas of the state. These innovative healthcare approaches are not just for Bihar, but for all of India and beyond.

I travel to India at least once a year to see the work our partners are doing here. Each time I visit I’m struck by how much progress is being made. Working together, we have the opportunity to do more to help India’s poorest families build healthier lives. That’s what will keep bringing me back to India in the years ahead.

(Co-founder of Microsoft Corporation, Gates is co-chair with his wife of the Bill & Melinda Gates Foundation)