Interview with the Gaters Sr. 'India can learn from experience'

[Guest guest]

The Hindu. Online edition of India's National Newspaper

Sunday, Oct 10, 2004, Published on Sundays

'India can learn from experience'

In an exclusive interview, H. Gates - Bill Gates Sr. - shares his

thoughts with Dr. JAYA SHREEDHAR on a range of issues surrounding the AIDS

epidemic.

BILL & MELINDA GATES FOUNDATION

At the Naz Foundation at Delhi _ " Indian leaders are speaking out about AIDS,

which is important, " says H. Gates.

A lawyer and a soldier who spent three years fighting in World War II,

WILLIAM H. GATES Sr. first answered his son's request to help use his

resources to improve reproductive and child health in the developing world

by taking on the responsibility of providing the guiding vision and

strategic direction to the H. Gates Foundation

Gates Sr. and his late wife, Maxwell Gates, raised three children:

Kristianne, Bill, and Libby. Now married to Mimi Gardner Gates, he continues

his lifelong commitment to many civic programmes, cultural organisations,

and business initiatives. The Foundation was established in 1994 and later

merged with the Gates Learning Foundation to create the Bill & Melinda Gates

Foundation in 2000. The Seattle-based foundation has an endowment of

approximately $27 billion gifted from personal funds from Bill and Melinda

Gates. None of the foundation's resources come directly from the Microsoft

Corporation. The Bill & Melinda Gates Foundation works to promote greater

equity in four areas: global health, education, public libraries, and

support for projects in the United States. They employ about 195 people.

Their total grant commitments since January 2000 totals $4,723,447,436. The

grants given in 2003 alone amount to $1,182,791,982. The foundation supports

work in more than 100 countries and about 60 per cent of the grants go

toward global efforts.

H. Gates Sr. is presently visiting India, travelling through Delhi,

Chennai and Mumbai. He is here, among other things, to learn more about the

HIV/AIDS epidemic in the country and to appraise himself of some of the

activities that Avahan has undertaken over time. During the course of his

visit, he has been interacting with policymakers, business leaders and

outreach workers and discussing HIV prevention efforts for sex workers and

other vulnerable groups. Mr. Gates shared his thoughts on a range of issues

surrounding the epidemic, even while underlining the need for greater

commitment from various indigenous stakeholders to stem the flow of the

epidemic. Excerpts from the interview.

ONE of the mandates of the Bill and Melinda Gates Foundation is to work

towards global health equity. What is your own vision of how it translates

on the ground, say, here in India?

I assume that your interest is really focused on our global health

programme. Our vision is pretty simple; it is to eliminate unnecessary

diseases where man has it within his power to create vaccines or whatever

tools to get rid of them. We are working on an array of problems - malaria,

AIDS and so forth, all of which are big killers and don't have to be. Our

vision is to use our resources in a way that brings about the eradication of

those problems.

The underlying causal factors of such problems have remained with us for so

long that many believe that they are intractable, largely because it is

difficult to find the necessary resources to fight epidemics, particularly

HIV.

Well, India, South Africa, Botswana, and Tanzania you name it - there isn't

enough money in the world to settle the problems in those places at some

early time. So I think the question is one more of time almost, than

resources when you get right down to it. India's the second biggest country

and a huge percentage of the people here are very, very poor. There are a

lot of uncontrolled illnesses and health problems. What's needed is huge,

prodigious, and incidentally there's no possibility that we are going to

provide that, because we're not big enough to do that. We have good ties and

we can create models; we can show the way, but we're not going to eradicate

malaria, for example, by ourselves. We might figure out a way for government

to spend enough money to do that or with AIDS.

How do you see Gates Foundation structuring its relationship with India? You

seem to have a marked preference for private players.

We wouldn't think of it in those terms. We have relationships with actors

within the country. Certainly, the AIDS epidemic problem is of such

consequence and of such size that it inevitably leads to our collaborating

with state and national governments. We will be doing that and we will be

encouraging state and the national government to allocate more funds to try

to deal with the potential of a huge problem. If AIDS is not suppressed, and

in some ways we can reasonably assume, it will be a disaster.

What are your impressions of India's response to the HIV epidemic, and in

the context of our national response, how do you evaluate your activities on

the ground?

Well I think it is developing. India can learn from the experience of

Thailand, Senegal, Uganda, and Brazil, which have successfully reduced their

HIV infection rates. Indian leaders are speaking out about AIDS, which has

been critical in every country that has lowered its HIV infection rate.

India can build upon effective programmes in Maharashtra, Tamil Nadu, and

other States that have resulted in high rates of condom use.

I think we have an extraordinarily competent and devoted organisation in the

Avahan people - Ashok and the people he has around him in his very

fine board - and I think they're going about it in a way that is very likely

to be successful. Uum... but we have a way to go and I think that so far as

the country itself - both its government and its people - um.. We have a way

to go to get them - and I refer to both of them - in a state of mind where

what Avahan is doing will be most effective. It's difficult to manage these

huge problems in a country where the government has identified the problem,

as a major problem as speaking out about it. And I think we haven't quite

gotten there yet and I'm not suggesting that really in a critical way; I'm

just describing part of what seems to me to be our mission here, which is

to, to have the leadership of the country and the leadership of the states

take an active, forceful, energetic role in speaking of this problem. It

helps, mostly it helps in generating an alteration in people's attitudes

about the disease which currently is unfortunate because they don't

understand it, they think of it as being um ... .. having all kinds of

characteristics which in fact it doesn't. They are concerned about touching

people who are HIV positive and a great many things like that have to be

overcome. And that only comes with the important people who the media gives

attention to speaking up about these things and what has to be done to curb

this potential growth.

What do you perceive as being the future of philanthropy - as an economic

facet of religions, cultures or traditions that are dying in the modern

market-place? Do you see them playing an increasing role globally?

Globally? Philanthropy?

Yes, with specific reference to the HIV epidemic, more so in the face of

pernicious gaps and shortfalls in resources to fight the epidemic ... .

Yes, I think there is growth, certainly in ... in the place I come from, I

believe there is very clearly an increasing appreciation of the need for the

United States to be a good neighbour; a more generous neighbour perhaps than

we have been in the past, in terms of helping to deal with the very obvious

health problems of the developing world. The nation itself is taking actions

which are new for us particularly and incidentally in respect to AIDS where

the President and the Congress are determined that they are going to be

players in the international struggle with this disease and they are

allocating funds in a serious way. So that's, you know that's a piece of

what seems to me a growing concern worldwide about health problems in the

poor countries, particularly in Africa and India and China.

The coalition ruling the country is supported by left formations who

articulate a pro-poor, public welfare agenda. The government too has, on

assuming office committed itself to providing access to health and education

to the deprived. In such a context what do you see as being the role of

public/private partnerships, more so at a time when the Indian left is

insistent on addressing issues like redistributive justice?

Well, if some country were to achieve distributive justice it would be

solely a result of action of the government. I don't think there's hardly

anything that private philanthropy can ... could manage to do in that regard

that would... Private philanthropy just does not have enough size and

distributive justice is a pretty complicated question. You know a lot of

things go with the issue of distributive justice ... and among other things

.... has to do with the justice system which is entirely the responsibility

of the government. It has to do with retirement plans, has to do with

minimum wage laws; it has to do with public attitude about the use of public

resources in this land and the fundamental hinge ... which is the question

of taxation, ... it's not simple. But I am not suggesting that it's not a

problem because I do think that distributive justice is something that

nobody has quite showed us the way to do it yet.

Would you like to share your thoughts on some of the long-term plans you

have in mind for India?

This is my first time in India and my fourth day here and I'm enjoying it

immensely. Very interesting place, fascinating society and I am delighted to

be here... . Well I don't think our relationship with India is going to have

much to do with the issue of distributive justice. Our aim is to work in

health and ... I think that that's hard to say - we'll be here for at least

something in the neighbourhood of a five-year time span working on the AIDS

problems. Whether this would go longer and require additional funds ...

remains to be seen. I guess the bottom line of that is that if there are

other things that fit within our sense of what we think our priorities

should be we'll fund them. We don't have favourite countries or we don't

have less favourite countries (laughs). We ... to a large extent what we do

is count heads and if we are talking about a problem that is for example

disabling and killing more people else in the world or has the potential to

do that like AIDS, that's going to get our attention like malaria, diarrhoea

things that are known killers, known disablers, known causes of infant

deaths those things are going to get our attention and if people in India

want to do something to remedy those problems, we'd probably be there.

There is widespread resentment amongst activists in this country that

private sector participation in public interest issues is conspicuous by its

absence.

There is general concern that we do not have enough home-grown

philanthropists, and those that are there aren't doing enough.

They are not be to criticised actually because there's no culture for it,

there's no background; nothing they learnt about as kids that shows them

that's what rich people do. There's no way to figure it out for themselves.

They have to look across the ocean and see how this works. It's not a

terribly effective teaching tool. I suppose when somebody comes to your

country and shows a little something about philanthropy I suppose it's

possible that it should stimulate some thinking in that direction. If that

were to happen that's what one of the byproducts of being active.

Windows of opportunities

INDIA alone accounts for over five million of the seven million people

living with Human Immunodeficiency Virus (HIV) in the Asia-Pacific region,

where 5,00,000 people die of Acquired Immune Deficiency Syndrome (AIDS) each

year. The second most populous country has absorbed a ten-fold increase in

HIV infections in the last 10 years. India's HIV epidemic is less dramatic

and visible than Africa's misery, what with its low country average of

around one per cent HIV infection rate in the adult population.

The low country average conceals hotspots where the impact of the virus is

just a few years away from being felt with devastating consequences. Adult

HIV prevalence in Andhra Pradesh was close to two per cent till recently,

more than double the national rate. An Asian Development Bank-UNAIDS study

has gone on to predict that as a consequence, one in eight hospital beds in

the State would be needed for people sick with HIV related illnesses -

nearly five times the national average. Come 2004 and in some of the States,

four per cent of the adult population is already infected with HIV.

The study estimates that AIDS robbed the Asia-Pacific region of $ 7.3

billion during 2001, a toll borne overwhelmingly by HIV affected households

in the form of income lost because of sickness and death among adults. AIDS

is making Asia's poor households poorer and pushing those not-so-poor into

poverty.

In 2003, the countries of the Asia-Pacific region were estimated to require

approximately $1.5 billion to finance a comprehensive response to the

epidemic, but in reality, only $200 million was the sum total scrapped up

from all available sources - both public and private. The chasm is further

widening, what with the ever bulging backlog of prevention, care and

treatment costs. By the year 2007, regional resource needs for comprehensive

prevention, care and treatment will rise to $ 5.1 billion plus (which works

out to about $2 or about Rs. 90 per capita).

The ADB-UNAIDS study reveals that investments must increase ten-fold by 2007

given current trends of donor support. The North has the resources, or, can

mobilise them one way or another to substantially increase public sector

investments to fight the epidemic. Their corporate and their private sector,

along with an impressive array of philanthropists are additional assets in

their arsenal against AIDS. Not surprisingly, they are also being looked at

to bridge the resource gap being experienced in the South and plug chronic

budgetary shortfalls. Situational realities such as these place in

perspective and contextualises the role the Bill and Melinda Gates

Foundation - the largest single private donor in the world is playing in

India's national response to the HIV epidemic..

Slowing down transmission

Is it time for India's corporate world to break its resounding silence?

There is no reason to suggest that nothing is being done, nor is there any

reason to be complacent in the belief that enough is being done.

The Bill & Melinda Gates Foundation have come forward to commit $200 million

towards HIV/AIDS prevention and care work in India. Named " Avahan " , a

Sanskrit term denoting " call to action " , the Foundation's AIDS related work

has unfolded over the last year in partnership with grassroots NGOs,

government, and the trucking, railway, and oil industries. Two rounds of

grants totaling $150 million have been awarded already. The money is

supporting HIV prevention programmes in Tamil Nadu, Karnataka, Andhra

Pradesh, Maharashtra, Manipur, and Nagaland. " `Avahan' works along national

highways and areas of high HIV prevalence to help curb HIV transmission

among sex workers, their clients and injecting drug users " says its Director

Ashok . " By slowing down transmission among those most vulnerable,

we would also be indirectly protecting the general population. " Apart from

working with the mass media to help promote behaviour change among the

groups perceived to be most vulnerable to HIV, Avahan has already initiated

efforts to mobilise Indian leadership across society to fight the stigma

surrounding AIDS and create a supportive environment for HIV prevention and

care. In a move towards ushering in professionalism unto philanthropy, " we

attempt to increase the absorptive capacity of the NGOs by not only trying

to help them access the financial resources essential for their activities

but also empower them with technical and managerial expertise. A critical

component of such an approach would be to build robust programme monitoring,

surveillance, and long-term evaluation of our work so that we can actually

determine the impact our efforts have on the epidemic in India, " concludes

Mr. , a former senior partner with McKinsey and Company.

Dr. Jaya Shreedhar is Advisor Health Programs, Internews Network.

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