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Bill Gates - Accepting the Gandhi Prize

July 25, 2009
Prepared Remarks by Bill Gates, co-chair

Your Excellency, President Pratibha Patil
Your Excellency, Prime Minister Manmohan Singh
Honorable Mrs. Sonia Gandhi

Distinguished Guests:

On behalf of the Bill & Melinda Gates Foundation, it is my great honor to accept the Indira Gandhi Prize.

Alleviating poverty was always at the core of Indira Gandhi’s agenda for her country. She knew that GDP figures could never be the sole measure of human welfare in India, or anywhere else. She held firm to the conviction that investing in health and education for everyone was the fairest and the smartest way to invest in India’s future.

The distinguished men and women who have received the Indira Gandhi Prize share her devotion to improving people’s lives. Melinda and I are proud to be associated with all of these individuals—and with their vision for a more equitable world.

We started our foundation because we believe that all lives have equal value. The poorest child in the poorest country is just as precious as your children, or ours. We wanted to do our part to give every person the chance to live a healthy and productive life.

More than 10 years into our work, we’re more optimistic than ever. The phenomenal progress we’ve seen in India is one of the main reasons for our optimism. The National Rural Health Mission is already spurring innovation at the local level and generating impressive results. The proposed National Urban Health Mission could do the same.

So the best way Melinda and I can thank you for the honor of this prize is to promise to be the best partners we can be as India continues in this critical endeavor.

Let me be absolutely clear: India faces some of the toughest health problems in the world. It bears a massive burden of disease. But in the next five years, India can make more progress on health than it has made in any other five year period in its history.

You have the ability to save millions of lives and set a great example for the rest of the world. And the Gates Foundation will do what we can to help you take advantage of this historic opportunity.

India has two advantages that together can trigger major breakthroughs in health: First, you have the proven ability to innovate; second, you have a keen appreciation for the urgency of the situation.

I have always been a big believer in the power of innovation. As a businessman and as a philanthropist, I have found that progress happens fastest when a new discovery or a new idea generates a new way to approach an old problem.

Where solutions don’t exist, innovation can create them. Where solutions aren’t practical, innovation can make them cheaper, easier to use, and more effective.

India is one of the most entrepreneurial, technologically sophisticated, and innovative societies in the world. I learned that repeatedly over the years at Microsoft; India’s IT sector has always been incredibly inventive. And through my work at the foundation, I’ve seen countless examples that prove how far Indian innovation extends. 

Indian scientists are on the cutting edge of polio research, as India leads the world toward the goal of eradicating a disease for only the second time in history. An Indian pharmaceutical company has developed the first-ever bivalent vaccine that attacks the two remaining types of the polio virus simultaneously.

Another Indian company is experimenting with a new way to deliver the injectable version of the vaccine through the skin instead of the muscle. Because the device doesn’t have a needle, it will be safe, easier to use, and less painful for children. Even better, it requires only one-fifth the typical dose, which means polio vaccinations will be significantly less expensive.

But innovation is not just research and development. India is also a leading source of creative thinking about how to deliver healthcare to people who are hard to reach. In fact, that is one of the NRHM’s specific objectives. I was able to see how the model works two days ago at a community health center in Ghaziabad.

Some of the best examples of Indian innovation in the delivery of health care have to do with neonatal health. One of the most pressing health problems in India is the number of newborn babies who die, estimated at more than 1 million every year.  Part of the reason is that many women don’t give birth in health facilities where they can get skilled care, often because the infrastructure simply doesn’t exist.

In 2005 in Gujarat, for example, there were only eight obstetricians in the public health system—and that was to serve a rural population of 32 million! There were more private obstetricians, but most poor families could not afford to pay them.

To address this problem, Gujarat created Chiranjeevi, an innovative public-private partnership. The state contracted directly with private providers to deliver services to poor women in rural areas. The patients do not have to pay a fee for these services. In fact, they are reimbursed for travel expenses.

More than 800 private obstetricians have enrolled in the program, and in just three years the percentage of deliveries that take place in health care facilities went up by 50 percent. Chiranjeevi’s success has led Uttar Pradesh, Karnataka, and West Bengal to plan to institute similar schemes.

Other programs are having success with an innovative community-based approach. Two in particular, one in the Gadchiroli area of rural Maharashtra and one in the Shivgarh area of Uttar Pradesh, send legions of community health workers out to cover remote villages. They bring medicines and knowledge about safe ways to deliver and care for newborns into places where many families had no access to expert care.

These programs are saving lives: studies show that they have cut the newborn death rate by more than half.

Several state governments are replicating and adapting parts of both programs. Even some African countries have been inspired to adopt community-based approaches based on the Indian experience.

These delivery innovations are exemplary because they are focused on the health needs of the poorest people. Innovation isn’t worthwhile for its own sake. It’s worthwhile because it can help people. You don’t start with innovation. You start with human needs, and then you use innovation to meet them in new and better ways.

And that’s the second advantage that makes India prospects for health breakthroughs so great. In recent years, India has started to address the health problems of its poorest people with increasing urgency.

To me, the best measure of this urgency is the fight against polio.  I visited India last year to really understand the details of the polio problem, and I came away convinced that your program is a model—not just for polio eradication, but for public health in general.

The polio-fighting infrastructure here is just staggering. Every National Immunization Day, you mobilize more than 2 million health workers.

Vaccinators visit more than 200 million homes, one by one. 200 million! To make sure they don’t miss anybody, they also go to train stations, bus stations, and ferry terminals to immunize children who are on the move. You should be very proud of that level of commitment.

Your polio campaign is exceptional, but the pattern of increasing investments in health holds across the board. In 2005, public spending on health amounted to 0.9 percent of the total national budget. You have pledged to increase that figure to 2-3 percent by 2012, and through the NRHM and other new programs you have made good progress toward that goal.

If you keep up the commitment you have shown for the last five years, the list of things you can accomplish by 2015 is simply astounding.

First, you can eradicate polio. I know progress has been frustratingly slow in recent years, but eradicating a disease is hard work, and you are making progress. In the last two years, you have cut the number of lines of polio transmission from 14 to just two. You are developing new products to attack those remaining lines more effectively, and your logistical sophistication is the envy of the world.

Second, you can almost double routine immunization rates. Right now, less than half of Indian children get fully vaccinated. It’s clear that it’s possible to increase that number, because several states are already vaccinating about 80 percent of their children.

Third, you can save hundreds of thousands of children every year by introducing new vaccines to the routine schedule. There are vaccines Indian children don’t get, even though we know they are effective.  The vaccine for pneumococcal disease. For rotavirus.
It will take a major investment of effort and money to add vaccines, but it is a sound investment. These vaccines are proven lifesavers.

And that’s just the progress you’re poised to make on vaccine-preventable diseases.

The fourth thing you can accomplish in the next five years is saving hundreds of thousands of newborns by scaling up community-based interventions like the ones that got such excellent results in Gadchiroli and Shivgarh. Indians have already developed the strategies to cut the neonatal mortality rate considerably.

Finally, you can make virtually every child’s future brighter by turning your attention to India’s nutrition crisis. Almost half the underweight children in the world live in India. This problem is massive, and it’s ripe for innovative solutions. If you can help India’s unprecedented number of frontline health workers prioritize nutrition for pregnant women and children under 2, you can unlock the potential of tens of millions of children.

If you achieve these goals in the next five years—and they are ambitious but achievable goals—then India will not only save millions of Indian lives, but it will also teach other countries to save millions of lives.

You will prove that dramatic improvements in health are possible, and you will demonstrate precisely which strategies are most effective.

To make this massive impact, you must continue to press your advantages. Indian pharmaceutical companies, scientists, and government officials must keep on developing new health products and devising new models for delivering healthcare. And the Indian government must accelerate its progress toward its health spending targets, so that innovations benefit the poor people who really need them.

It is also imperative that new money for health be spent wisely—and in transparent ways. That means keeping good data and analyzing it rigorously to determine the impact your investments are having. India has made an excellent start with the Health Management Information System under NRHM, which uses the Internet to collect health data so that officials can set policies based on clear evidence.

We must also hold people accountable for results. Accountability is always going to be a challenge in a system as large as India’s public health system. For example, India is one of many countries where the reported vaccine coverage rate is much higher than the actual coverage rate.

By passing the Right to Information Act, the government has created powerful new incentives for meaningful improvements in health care—and strong disincentives for misconduct. A great next step would be building up your capacity to independently monitor and evaluate health programs—and then to make information about how the programs are performing available to the public.

Accountability reforms are doubly important. They are necessary to ensure an efficient healthcare system. But they are also a key ingredient of maintaining political support for health spending.


The wonderful thing about so many health interventions is that we know for a fact that they work. The evidence is overwhelming. When voters know about the results, they want to do more. But if you can’t prove the value of the money you’re spending, then the appetite for that spending will disappear very quickly.

I believe you will achieve your health goals. You have the energy and the intellect to do it. And you have the commitment that is necessary. You also have the full cooperation and support of the Bill & Melinda Gates Foundation.

We are impressed by what is happening in this country, and we want to help.

We’ve been your partners for the past six years. Back when Melinda and I were first getting started in global health, we learned that India had a good chance to limit the spread of HIV and AIDS. So we joined the government to start an HIV prevention program called Avahan.

It’s a vast partnership involving hundreds of grassroots organizations and thousands of peer educators. Every month, Avahan reaches hundreds of thousands of the people most at risk of contracting HIV with condoms, counseling, and testing.

Through Avahan, we have learned how important it is to get local communities involved in delivering effective public health interventions at a large scale. The next challenge will be passing on all that we’ve learned and transitioning Avahan to the government and other partners. We look forward to continuing that collaboration.

So thank you again. Thank you for this prize. Thank you for your eagerness to face your country’s health problems.


Indira Gandhi devoted herself to creating a country that respected the potential of every Indian. In the next five years, you have the chance to honor her legacy by making massive health breakthroughs for the poorest among you.

I am excited to help you make it happen.

Thank you.

 

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