India's PM will be able to monitor every child's health: Nachiket Mor

Interview with National Director for Bill and Melinda Gates Foundation- India

Nachiket Mor, the India country director of the Bill & Melinda Gates Foundation recently launched its second India Country Office Letter. Mr Mor, a former banker, outlined his vision and the foundation’s agenda for India in the coming few months. Here is an excerpt from a roundtable interaction with Mr Mor and other officials of the Gates Foundation held at its office in Delhi on August 9, 2017. 

There seems to be a great deal of interest in the technology solutions the Gates Foundation is providing to the Indian government. Tell us more about it. 

One of the projects that we are involved in at the request of the Ministry of Women and Child Development is to monitor what is going on the ground regarding the Integrated Child Development Scheme (ICDS). Our intervention uses the ubiquitous mobile phone as a data entry tool. Right now every Anganwadi worker manually fills in data. The trouble is how to process this information and correlate it with the mother and child. If I am the district collector or the prime minister of the country, I need to know what is happening in every district of the country. Our project is called the Common Application Software (CAS) which was built over the last two years and has been rolled out now.

Over 50,000 Anganwadi workers are using it. Now we have live information about 4 million women and children. You just feed in the inputs and you can see the whole information. The analytics are not done every day since there is plenty of datasets. Now we have every aspect of a child’s health and identity. What was its weight last month; what is its weight this month.  Who is its mother. What is going on with them. Are they severely malnourished. Do they need the health system to intervene? It is a remarkable system and is now operational on the ground. The ministry is expanding it. Never before has India had a system like this.  

How do you ensure the accuracy of the information being typed in by the worker and how do you ensure this data leads to intervention when need be by the administration? 

These are ongoing challenges. Now you can compare different Anganwadi with the available data. You can tell when someone is reporting over-optimistic data relative to another one. The district collector or the supervisory authority of the Aanganwadi worker can go and ask the worker how she is reporting optimistic figure as compared to someone else. There is still some way to go before we see get high-qualityy auditable data. 

Tell us about your new initiative in the field of sanitation. 

PM Modi early in his tenure emphasised Swacch Bharat as a key priority. The key first step towards this are building toilets. But what happens after building these toilets is also equally important. A lot of our work focusses on fecal sludge management. The technology the Gates Foundation is using is pretty straight-forward.  Our underlying philosophy is that many large cities should move away from energy consuming sewage treatment plants. In India where municipalities have budget constraints, our solution is a viable one. Our Bengaluru project is the first one and by 2020 we expect that there would be 25 such plants supporting sanitation across India. The plant uses basic technology, uses gravity and no electricity. Its design is inexpensive to build and maintain which makes the cost benefit analysis clear to state governments in India.

Every city under the Indian government’s AMRUT programme needs to have a feacal sludge management plan to receive money under this scheme. These plants will be set up closer to the city so that truckers who carry this waste do not have to travel long distances. It completely eliminates the need to build expensive sewage lines and other infrastructure to transport waste.  There is no odour emanating from these plants. In fact our Bengaluru project looks like a garden. This goes a long way in addressing the concerns of residents living in the vicinity as well as local politicians who don’t have to bother that they are living near a sewage plant. The only way you know sewage treatment is going on there is by seeing the trucks coming there. We know urbanization is going to proceed at a rapid pace in India. And for urbanization to proceed in an orderly manner, India would need many pieces of infrastructure. And this is a key piece of infrastructure. 

The Gates Foundation has been known for its stellar work in the field of HIV prevention in India. What draws your attention to elephantiasis? 

PM Modi has specifically mentioned lymphatic filarisis as one of the disease he wants to eliminate in India. The disease is not as visible as it used to be. But the World Health Organisation (WHO) has estimated that 650 million people are at risk of contracting this disease also called elephantiasis. It is not fatal but is extremely disfiguring. The government has been following a double drug regimen for a while and it has had its impact in controlling its spread.

Our trials in a couple of other countries show that if you add a third drug to these two being administered by the government, the disease load falls quite rapidly. The drug in question is Albendazole. This triple drug combination is far superior in reducing microfilaria that causes this disease. Our belief is that If the government approves this programme, this could greatly reduce the chance of a resurgence of the disease. This triple drug therapy wouldn’t have to repeat again and again, unlike the double drug therapy that has to be repeated every six months. This would go a long way in eliminating the disease.