Photo: Ashish Chawla
Nachiket Mor, national director of the Bill and Melinda Gates Foundation in India and former board member of the country’s Reserve Bank, traveled to Athens recently on the invitation of Greece’s Foundation for Economic and Industrial Research (IOBE) to deliver a lecture on the subject of health systems in developing countries. During his visit, Mor, who is an expert on development policy and the impact of philanthropy, spoke to Kathimerini about India’s tough road to prosperity and other issues.
How has the Gates Foundation changed the way philanthropy is practiced and how is its impact measured?
The Gates Foundation funds new ideas and develops innovative partnerships to address the areas of greatest need so that we can achieve the greatest good for the most people around the globe. Our vision is a world where every person has the opportunity to lead a healthy and productive life. We believe philanthropists can play an important role, as they can pursue new ideas, take risks and adopt novel approaches to doing things in a way that can produce transformational results.
Our foundation focuses on innovation, on thinking outside the box with our partners and grantees to generate new solutions to old problems. Regular monitoring and evaluation are fundamental to the work that we do – it helps us identify gaps and bottlenecks, test solutions, understand what’s working and what’s not, and then make changes, where needed, to achieve the desired outcomes. We focus a lot on data and science not only for measurement and evaluation but also for solutions that are needed to address the needs of the poorest. Further, our work relies on close partnerships with the government, private sector, philanthropists and communities to ensure scale-up and sustainability. We believe that each organization brings their own strengths, so that together we can achieve more than any one of these organizations acting alone.
What are the implications of the civil society crackdown imposed by the Indian government? How much has it affected the Gates Foundation?
The Gates Foundation supports the health and development priorities of the governments in countries where we work. In India too, we are working in consultation with the central government and in partnership with various state governments, at their request, on various projects in health, nutrition, sanitation, financial inclusion and agriculture. We continue to see opportunities in India to partner with the government and other stakeholders to advance national priorities in health and allied areas.
What are the main challenges when a player as big as the BMGF enters the fray with its own policy priorities in a developing country? Is democratic legitimacy an issue? Have you experienced such tensions in India?
The foundation has no desire or ability to influence policymaking. While the foundation’s resources are significant, they represent only a small portion of worldwide funding, most of which comes from donor governments and developing countries themselves, and in India, in particular, our funding is a tiny fraction of the government’s funding.
The government of India is autonomous, self-governing and subject to its own laws, rules and regulations. Indians are running this great country of ours and we have the full capacity and capability to decide for ourselves what is in our best interests and to accept or reject advice no matter what its source.
From the onset of our work in India, we have proactively adopted a consultative approach to working with the government. We continue to work in consultation with the central government and in partnership with Indian state governments on mutually agreed projects aligned with their priorities.
How important is the role of digital payments in extending the reach of financial services to the world’s poor? What sort of initiatives in that direction have you implemented in India?
We believe that poverty and gender inequality are deeply intertwined, and that economic empowerment programs, including financial inclusion, have huge spillover effects. Our approach is to broaden the reach of low-cost digital financial services that work for the poor. We are not focused on establishing a particular product or distribution channel, but on finding ways to expand access to markets, and for the market to determine which products and channels can be most effective. We believe the right payment infrastructure with the right regulatory standards and customer activation strategies with a focus on women are critical elements of an inclusive financial economy. The Gates Foundation is a partner to India’s government in building platforms for financial inclusion. We believe that such innovations will help the poor lead healthier, more productive, more equitable lives.
We provide technical support to state and national governments to help establish public sector digital payment platforms. We have launched a range of financial inclusion data collection efforts, product design experiments, and pro-poor communications efforts to advance the use of digital financial services.
How far along the path toward universal healthcare (UHC) is India? What are the biggest challenges on the way to getting there?
UHC for any country is a very long journey. India faces additional challenges in terms of its low tax-to-GDP ratio (only 16 percent) and high rate of informal labor (about 90 percent), which limits its ability to finance healthcare at close to 1 percent of GDP from tax resources, with the consequence that over 60 percent of health expenditure is on an out-of-pocket-at-point-of-service basis and provision by a highly fragmented private sector dominates. Given its limitations, India has correctly prioritized the provision of essential infectious disease control and maternal and child health services to its entire population and is making very good progress on it. This is the first and an essential step in its UHC journey. For achieving broader UHC goals, it is pursuing a number of carefully structured ideas. These include: building its commercial insurance industry in an orderly manner to improve pooling and purchasing; developing new state and national level health agencies to act as purchasers and pooling entities; and improving its existing Employee State Insurance Scheme to ensure better pooling and purchasing for the formal sector. India is also encouraging the development of multiple models of primary care in both the private and public sectors. I am confident that, while this may take several years, these efforts will gradually allow India to progress toward UHC. As a foundation we are partnering with the government on most of these programs, making available, where necessary, both internal and external expertise in each of these areas.