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Even as child deaths have declined by nearly 50 percent over the past two decades, deaths from pneumonia have remained stubbornly high.

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20 Years of Growth

India’s progress

In India I saw how aid and spending on health can make a difference.


India’s progress over the past 20 years has been quite phenomenal. It deserves recognition especially now, as rich countries consider whether to continue investing in global development assistance despite all the economic problems they face at home.

India still faces many challenges. More than 400 million Indians live in extreme poverty. The country is home to half of all the world’s malnourished and underweight children and one fourth of the world’s tuberculosis.

But over the past 20 years, India has really emerged as a dynamic, influential country. It’s been one of the world’s fastest growing major economies, and it’s playing an increasingly important role in world affairs, including as a member of the G20 and the BRICS group of newly industrialized nations.

The current situation in India is quite hopeful. The country has a lot of talented people. The universities are improving. Government spending is going up because of the nation’s economic strength. Some reforms are needed, and that’s progressing, gradually. India represents all the challenges you face when you have lots of people living in poverty. And so India can contribute to how we solve problems globally.

A lot of progress has come from the nation’s culture of innovation, which has produced some really original and creative solutions. Yet, aid also has played an important role. Our foundation has invested more than $1 billion USD in programs to fight disease and poverty in India. I’m pleased with the results, and we will invest more in the future.

During my recent visit, I had a chance to see the latest progress on things that matter a lot to us: on eradicating polio and curtailing the spread of infectious diseases like HIV/AIDS and tuberculosis, for example. And I saw how India is emerging as a model and increasingly a catalyst for improvement in other developing countries. For example, India has become a world leader in the development of high-quality, low-cost vaccines and other bio-pharmaceuticals, which are playing a huge role in improving health not only in south Asia but also in Africa and elsewhere.

Ending Polio

It’s now been more than a year since the last new case of polio was reported in India. In February, India was officially removed from the list of polio-endemic countries.

This is especially great when you look at it in context. Three years ago, India had more polio cases than anywhere else in the world. Its polio problem seemed like the toughest to tackle. Compared with the countries where polio persists, India is bigger by far, with the most kids, and still has regions where sanitation is poor. Within the country there’s lots of movement, which tends to spread infection.

Yet, India really stepped up to the challenge on polio. The government funded its own eradication program. They really educated mothers about why vaccination is good for kids. Twice a year, 2 million volunteers prepare 800,000 vaccination booths around the country—at schools, hospitals, and community centers. They immunize more than 172 million children one by one. Working with partners like Rotary InternationalWHO, and UNICEF, they have built an impressive infrastructure for delivering health services to some of the most underprivileged children in the world. And they have been very persistent in following up to find kids, even the kids of migrant workers, to get vaccination levels up above 90 percent. And so the disease stopped.

India is very proud of this achievement, and rightly so. It’s a direct result of political will, dedicated resources, and rigorous management and accountability. The commitment of government leaders has been critically important.

And that commitment is helping with other health problems. By extending vaccination into the poorest and most inaccessible places, the drive against polio has helped establish better public-health delivery systems that can improve the well-being of millions of children and families.

India’s experience carries lessons for developing and newly industrialized countries around the world. It proves that success can be achieved – against polio and other diseases, as well – even in the most challenging circumstances.

Curbing HIV/AIDS & Tuberculosis

Another great example of India’s progress is in its work to halt the spread of HIV/AIDS. Our foundation has been helping with this for a long time. With a number of Indian partners, we started the Avahan program. It’s fighting HIV/AIDS in communities and at the street level, helping local groups deploy peer-to-peer counselors, distribute condoms and provide HIV testing, treatment and care.

Important leadership has been provided by the national government, which has increased funding for HIV/AIDS and established a national strategic plan that includes community-led HIV prevention. The National AIDS Control Organization has done great work. NACO and Avahan have contributed to a 50-percent reduction in the incidence of HIV/AIDS over the past six years. That’s saved India something like $100 million USD in health costs averted because of fewer AIDS cases.

Now, NACO is facilitating a smooth transition of Avahan to management by the state governments. This transition is very important and encouraging because it indicates India’s resolve to sustain the fight against HIV/AIDS for the long haul, which is what it will take to really beat this thing. This is a great example of what collaboration between funders and governments can achieve.

Lessons learned from HIV/AIDS work have helped with other critical health efforts, like the Ananya partnership, which is really scaling up programs to improve maternal and child health. India is also a model for other countries on how to scale up HIV prevention efforts.

The country faces many other health challenges. For example, India has the largest tuberculosis epidemic in the world, with nearly one thousand deaths from TB each day. But there’s a solid basic TB control program and a real commitment to getting TB under control. The government has an ambitious strategic plan to provide universal access to good diagnosis and treatment to all TB patients. This plan can prevent the emergence of multidrug resistant TB thru prompt diagnosis and appropriate treatment.

India has begun to execute this strategy by making TB a nationally notifiable disease, which means cases must be reported to authorities. This will help ensure they get the care they need regardless of whether they are being treated by government or private doctors.

India is also using its leadership in information technology, which could be a big help to government and private health providers in monitoring the spread of the disease, improving the efficiency of the TB control program and in treating patients.

Leading on Low-cost Vaccines

Just a few decades ago in India, many basic vaccines were hard to get. They were almost all imported from overseas. But today, Indian manufacturers play a critical role in driving down prices for vaccines and making them available to not only Indians but also millions of poor people worldwide.

One of the leaders in this transformation is the Serum Institute, in Pune. I visited with Serum’s chairman Cyrus Poonawalla and other executives. Their work is absolutely vital to our foundation’s work around the world, because Serum is extremely good at making high-quality vaccines for many different diseases – and doing it at low cost so that poor countries can afford them.

Serum has gradually evolved from making relatively simple vaccines for things like tetanus to making more advanced ones. In response to a request from African leaders for a better weapon against meningitis epidemics, Serum developed a vaccine for meningitis A, the first vaccine created specifically for poor countries. Serum is developing important new vaccines against rotavirus, which causes diarrhea and vomiting that kills hundreds of thousands of children in poor countries every year.

Serum's the world's highest-volume provider of vaccines – does it at very high quality, very low price. It’s a great example of the potential for innovation in developing and newly industrializing countries – innovation that can benefit poor people everywhere.

Achieving Progress through Collaboration

Prime Minister Manmohan Singh recently committed to raising government investments in health to 2.5 percent of GDP by 2017, which will really help extend health services to more people and will pay big economic dividends in the long term.

During my recent India trip, I was very glad to see the evolution and strengthening of our partnerships with government.  I spoke with many government leaders including the dynamic chief ministers of two states, Bihar and Uttar Pradesh, which are among the poorest in the country. I was very impressed with the forward strides they’re making. The chief minister of Uttar Pradesh, Akhilesh Yadav, is under 40, the state’s youngest chief minister ever.

In Bihar, chief minister Nitish Kumar has helped drive remarkable improvements in farm productivity and is taking steps toward big improvements in health. Bihar’s maternal mortality rate is among the highest in India. But good things are happening. Last year our foundation launched a five-year, $80-million USD grant made in partnership with the state government and leading Indian and international non-government organizations. Bihar is becoming one of the nation’s biggest success stories.

As in Bihar, one important reason we invest in India is that we’ve found the government can be a very effective partner. Our government partners there are especially good at scaling up the very best ideas and sustaining them over the long term, as they’ve done with polio and now with HIV/AIDS.

This pattern has been repeated across the country over the past several decades. And as a result, aid has steadily become a smaller and smaller portion of the national economy. This is the good that can happen when aid donors and governments work hand in hand.