New Delhi: For the last nine years, the world’s richest and most generous couple—Melinda and Bill Gates—has been writing an annual open letter about their philanthropic endeavors. The letter for 2017 was released on Tuesday. For the first time, it is addressed to an individual—their old and cherished friend and stock market maven Warren Buffett. Over the years, the letter used to address groups—employees of the Bill and Melinda Gates Foundation, global citizens as a whole, or like last year’s letter, young people in their teens.

The 2017 letter outlines the ongoing projects of the foundation across the world with special emphasis on issues such as vaccines, newborn care through nurse mentoring programmes, nutrition, women’s empowerment through efforts like Indian self-help groups, immunization, and preventive interventions in HIV, among others.

This year’s letter is also a little more personal. It has anecdotes about the Gates’s journey with Buffett over the years and talks about how some of their personal conversations have had an impact on the foundation’s work.

ALSO READ | Edited excerpts from the Gates Foundation’s annual letter

In an exclusive phone interview before the release of the letter, the couple shared their views on the work of the past year, lessons from India and the significance of this annual exercise. Edited excerpts:

Why is the 2017 letter addressed to Warren Buffett?

Melinda Gates: Warren made his generous contribution to our foundation exactly 10 years ago and we felt this is a good time to take stock of what we have achieved and addressed with the help of those funds.

Bill Gates: Warren’s contribution to our foundation is possibly the largest gift that anyone has ever given to someone else.

The idea of the letter and dedicating it to a single individual partly came from Warren himself as he suggested that why don’t we try to showcase and explain what we are doing to someone like him who is not engaged with philanthropic work full-time. He said why not put the work in perspective for someone who is not directly involved with the issues and work as we are.

How do you think these letters help and who are they meant for?

Bill Gates: There are many audiences for this letter. For us the most important audience is those people who care about these issues as much as we do. We feel there is a large number of people who want to know how the world is doing. They want to know the indices regarding—how is it faring in terms of health, education, infant mortality, disease prevention, to name a few.

Our letters help these people make the connections. It influences key players to strive towards making a difference. It also inspires more people to come forward because they can see/visualize how the values they stand for are being realized.

The letter gives hope and clarifies confusions. Even Melinda and I have gone through our journey of addressing some concerns and confusions that arise out of the work.

Melinda Gates: Most of our work is in partnership with others—be it government agencies or not-for-profit organizations, who are all specialists in respective fields. And these letters help them see the larger picture as well as the impact of the work they each individually are involved in. The letters aim to bring out the larger message and connect the dots for the readers.

In a manner of speaking, the letter also helps us in advocacy work and influences the various entities involved in trying to change the larger problems. For instance, the letter is read by even governments, therefore when we go to them with suggestions or models to help address some key challenge in the country—they can see how that specific model or a similar model has worked in another region.

When we reach out and advocate that more investments need to be made in, say for example, healthcare or infant care, the letter showcases how and where this investment has helped. It inspires them to come forward and support the relevant programmes and invest in the sector.

In the last year, what is the one key initiative that you feel stands out ?

Melinda Gates: Improving the quality of health facilities for maternal care. Especially the nurse mentoring programme— where the foundation in partnership with state governments and grass-roots organizations has helped improve the quality and quantity of nursing care given to pregnant women. The trends from government’s Health Management Information System data suggested a 22% reduction in still birth rate from 18 to 14 per 1,000 live births over a period of 12 months in facilities where nurse mentoring was implemented in Bihar. This reduction is two times higher than the historic trend. In addition, improvements are being witnessed in identification and management of other newborn and maternal complications such as asphyxia and postpartum haemorrhage. We have seen it work wonders even in Rwanda.

What is the one programme/project in India that you feel can be replicated in other developing nations?

Bill Gates: The 99 dot pilot project on tuberculosis (TB). The programme is based on using mobile technology and worked very well in India because of the high mobile penetration in the country. It basically helps track and monitor TB patients to ensure early intervention. Call centres and mobile-based notification systems are getting quicker diagnoses to more people and helping more patients to adhere to and follow treatment regimens.

Though nations in Africa do not have the same level of mobile penetration we are seeing in India, it is increasing. And given the success of the programme we are looking to expand to African nations as well as within India.

Melinda Gates: Women self-help groups have been fantastic in terms of the scope and reach. These groups provide space for women to share views, experiences and learnings with the peers and give them power to tackle a number of issues. We find these groups empower women not just as a community but as individuals as well. Through our foundation’s work in Uttar Pradesh, Bihar, Jharkhand, the success of these groups is unsurpassable. We are looking to expand it to other states in India like Andhra Pradesh and are also going to take it to the African nations.

In the last one year, the foundation’s engagement with the private sector has increased in India. Do you feel the private sector has a role in addressing some of the key social challenges, globally?

Bill Gates: I would like to go back to the TB example as we have learnt that people suffering from this disease do not immediately go to the public (government-owned) sector specialists even though diagnosis and treatment of TB is effective and free in the public health system. Since a majority of Indians seek private care, the imperative is to fight TB with the help of providers that Indians actually seek out. Here, we learnt the importance of engaging with the private sector healthcare providers because they are the first point of contact for those suffering from TB.

Similarly, as philanthropists we embrace the private sector for creating and manufacturing vaccines—which are needed to be produced at scale and reasonable costs.

But one cannot generalize. Each sector—government, private, philanthropic—has a unique role to play. That is why I would say there are instances where engagement with the private sector is critical to address some issues, while there are other examples where no one can have better impact than government agencies.

Melinda Gates: Any time we are working on specific goals—for instance reducing maternal mortality—we are working at the global scale and that is why we must work in collaboration. We always draw from the best in every sector—that is the only way to ensure most impact.

A key aspect of the foundation has been around data analytics... You even announced an $80 million grant last year to address women empowerment via data. Why do you feel data is important to addressing social development?

Melinda Gates: Good quality data shows us where and when to invest.

While we are still working out the details of how that $80 million grant will be deployed, I can tell you about an important collaboration we did in 2014 with the Johns Hopkins institute. We were looking at family planning. It started with first following the trial of contraceptives. Collecting that data over a period of 18 months helped us learn the supply chain influences, missing links about women’s lives and the influences, and also the power of educating them.

Which one of you can be said to be the boss of the foundation?

Bill Gates: It is four of us and not one. There is Melinda, our CEO Susan (Desmond-Hellmann), Buffett and me. It is a collaborative effort.

Melinda Gates: It is important for the world to know that it’s both of us running it together. One day Bill may take a call on our polio projects while I may be looking into family planning projects. But at the end of the day it is a collaborative effort.

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