Sue Desmond-Hellmann, chief executive officer of the Bill and Melinda Gates Foundation, has lauded India’s financial inclusion programmes, which she says have been key to empowering women across the country. On the eve of the release of the ‘Goalkeepers Report’, an annual progress check in promoting development, revealing new data and exploring the stories behind it, Desmond-Hellmann said health coverage for the poor in India should be improved to achieve the Sustainable Development Goals by 2030.
What does the ‘Goalkeepers Report’ focus on this year? What is your overall view of how global progress on Sustainable Development Goals (SDGs) is shaping up?
What I think is important about the report is that first and foremost the report gives us a chance to pause and celebrate spectacular progress. There is no doubt that the world is so much better off now than it was three decades ago and it is worth everyone looking at that and celebrating that. First and foremost, I want to make sure that I don’t miss that. Secondly, the report looks at everything from infant mortality to maternal mortality to HIV (human immunodeficiency virus).
The report also accomplishes in graphic form—really clearly outlines—what I would call jeopardy. And jeopardy is that we don’t focus so much on the past successes that we misunderstand that it is inevitable we continue to make progress in the future.
For example, modelling shows that if there is a 10% budget cut to treatment, an extra five million people will die between now and 2030. That is extraordinary. So there is clearly jeopardy if we do not continue to commit to these sustainable development goals. The other thing that comes through in the report is that these successes have come because of leadership. In every story, and each story is so compelling, somebody has stepped up to drive an outcome that is better than what was expected. And so when the successes are there others can look at those and say what can my country, my community do to achieve such successes.
And finally, the report allows us to look at SDGs on an annual basis and the goals and the targets and give it something to drive against. They give us a sense of accountability and pace. (The year) 2030 seems very far away but putting pen to paper we can ask the world to, yes, celebrate the successes but also hold each other accountable to continue progress.
What are the India-specific references in the report?
On India, the focus is on the financial services section. What the financial services section for the poor outlines is that when we think of being poor, it’s the absence of money but what we have learnt, what the world has learnt is that its not just the lack of money, it’s the absence of access to basic financial services so that the poor do not have access to savings, insurance, things like a bank account that many of us would take for granted.
And it is estimated that two billion people in this world live completely outside the formal financial system. So what’s in the report is a lovely example from India—about what happens in India for women and the results of incredible progress on the India financial system; Aadhaar and access to financial services is undergoing a revolution and I mean that in a positive way in India. And so there is an example of a control group and a treatment group about the impact on Indian women who receive wages directly into their own account.
And we know for sure that women’s earnings go up and purchases from their own income go up and so it is absolutely wonderful to see the progress that India is making and there is a beautiful picture in the report—a small business woman with her sewing machine—and I think it is so inspiring to see women take control of their fate. So this financial services report, their access to mobile money, financial services, India is a leader on this and other countries are looking at India to see what did they do in India that we can copy, that we can use India a role model for developing countries.
It has been two years since SDGs were announced. What do you think has been the progress on this?
I am in two minds and I think the report captures that very well. There are wonderful, beautiful stories of progress. So if you look at some place like Ethiopia, in the section on maternal mortality, there is a description of the kind of thing that we have seen in Ethiopia and (health) minister Kesete (Kesetebirhan Admasu, in office in 2012-2016) talked about the massive changes he has seen in the health system and healthcare delivery as a result of the health extension programme that allowed a woman to deliver her baby in a health facility. But I am also exceptionally aware of jeopardy the world is in.
In some ways, the HIV section in this report speaks clearly to me. And you see it in the curve. The HIV deaths, the global HIV deaths, peaked in the mid-2000s, in the first decade of this century and the Global Fund (to fight AIDS or acquired immunodeficiency syndrome, tuberculosis and malaria) was launched in 2002 and 2003 and you saw the deaths from HIV fall. We now know that between now and 2030 there are so many young people in sub-Saharan Africa who will be at risk from HIV and the modelling shows that if there is a 10% cut in the funding for treatment, five million people more could die of HIV between now and 2030.
And that is terrifying to think of what could happen if we don’t keep up the pressure on HIV, to prevent HIV deaths.
What about India’s progress on SDGs?
I am really positive about India’s commitment and we are collaborating with the government of India to improve health systems...If the world wants to accomplish SDGs, India must succeed. We won’t make SDGs unless India succeeds. First and foremost, we know and the world knows success on SDGs equals India’s success on SDGs. So I am particularly positive about efforts in states like Bihar and Uttar Pradesh to continue to (put) pressure on infant mortality, maternal mortality, the importance of malaria and TB and focussing on that...I am very positive about the efforts in tuberculosis, it is very important to us that the private sector succeeds. So I think that’s the extremely important thing. And you know the 2017 National Health Policy and 15-year vision plan—the government is committed, the government has made progress in the last 25 years. So if you look at the last 25 years in India, a child is almost three times less likely to die before the age of five. And a woman is half as likely to die in child birth as she was in India 25 years ago. So India has really made progress and India is great at technology. So using India’s technology to improve things like sanitation, child nutrition and financial inclusion—we are really positive about India’s ability to tap into its assets in technology to improve its nation’s health.
What is your view around global financing for public health, given the focus on universal health coverage?
We are big fans of universal health coverage and health systems improvement. In the end the government is accountable for the health systems of its populations and that has been true and will always be true. We are very positive about the role of philanthropy in collaborating and assisting government. We think that our investments in R & D (research and development)...in vaccines, diagnostics and therapeutics is an essential part of how the Gates Foundation can collaborate with government of India and with private industry. But the second thing is using creative financing mechanisms from the World Bank or other development banks to assist governments when they are working on health systems improvements and capacity building. I think it is a great way for the world to leverage the capital that the world has.
Which are the areas where you think India needs improvement?
I think the most important thing we want to see in India and you see it in the most poor areas is that the health system should work for everyone. And so everything from vaccine coverage to under-5 mortality, to neo-natal mortality and maternal mortality, having all the citizens of India benefit from the programmes and have access to the programmes and reaching those who are most underserved is essential for India to succeed. So it’s really a coverage issue, vaccinations and other interventions important for saving children’s lives.