Exemplar Effect

Gates Ventures’ Managing Director Niranjan Bose celebrates progress in global health outcomes, while investigating the criteria to amplify it.

Progress on Health Outcomes

Spin your globe and settle your finger on Peru. Take a closer look at the country and find the southern city of Cusco, surrounded by mountaintop villages and the ruins of Machu Pichu, one of the seven wonders of the world.

A girl born in those villages 35 or 40 years ago would likely be physically stunted and cognitively impaired. She likely would not have finished school and would have started having children when she was just a teenager. Her own children would have followed a similar, though not identical, trajectory.

But the data tells us that something remarkable happens when her grandchildren are born.

They grow.

From 2008 to 2017, Peru cut its childhood stunting rate by more than half.

Peru is not alone — we have witnessed extraordinary progress on health outcomes over the last two decades in countries from Senegal to Bangladesh.

You probably haven’t heard of any these triumphs. Here’s why.

Who Pays for Global Health Advice?

Businesses who want to know what sort of IT will best meet their needs can rely on advisors such as Gartner or Forrester that help bridge the “know-do” gap. And investors who want safe places to park their cash can rely on Moody’s ratings. But, in the global health sector, there has been no authoritative public resource that systematically identifies positive outliers across varied settings and geographies to determine what are the best practices that governments and funders can adapt and adopt to expedite progress.

As a result, many governments and funders have relied on anecdotal evidence to make decisions about how to strengthen health systems. When tens of millions of dollars — and even more lives — are at stake, this approach is woefully inadequate.

Why did this gap exist?

Unfortunately, the marketplace doesn’t pay for knowledge on global health. Businesses will pay for IT advice, but who pays for global health advice? When the countries that need this advice are often among the poorest on the planet, the answer must be philanthropists and funding agencies.

A doctor tends to a young patient in Peru, 2015.

Exemplars in Global Health: Stepping Up to the Plate

That’s why Gates Ventures, where I work, and the Bill & Melinda Gates Foundation are launching Exemplars in Global Health. This program has leading health researchers around the world working with in-country experts from the geographies which have made the most progress on key health topics to identify the policies, strategies, and programs that have helped drive their success.

Together, they expand on the strong foundational research from the World Health Organization, World Bank, and other institutions. The results of this collaboration have been surprising and groundbreaking.

Before the work on Exemplars in Global Health, for example, few would have identified Kyrgyzstan as a global leader in reducing childhood stunting. Perhaps even the leaders of Kyrgyzstan would not have held themselves up as a model to be emulated. They simply hadn’t been tracking stunting rates as the rates declined by half, from 36% to 13%. But our research partners noted the country’s progress and worked with local health leaders to better understand what Kyrgyzstan got right. As a result, we can offer lessons in reducing childhood stunting that may apply and appeal to other former Soviet bloc countries.

Our partners have identified dozens of positive outliers such as Kyrgyzstan around the globe.

The Role of Strategic Social Investors

This work demonstrates three important roles for strategic social investors. First, the market often misses opportunities to serve those at or near the bottom of the pyramid. Philanthropists can de-risk those investments to attract private sector interest or just step in to provide the service directly with the intention of demonstrating the business case.

Second, philanthropy can break down barriers and seed global cooperation on important research. It shouldn’t take a pandemic the likes of the novel COVID-19 to prompt global research cooperation. Social investors can build bridges to speed learning and progress every day
on a range of critical issues.

Third, there are few more important roles for philanthropy than filling in the blind spots for governments. Governments need good data to make good decisions. Often the existing data is unclear or
not accessible.

In the graph below, we see that although Ethiopia and Chad have similar per capita GDP, their health outcomes are dramatically different. Ethiopia’s under-five mortality rate is roughly half  that of Chad’s. What are the lessons we can discern from these positive outliers? And how might they be adapted and adopted by other health leaders?

Current Under-five Mortality Rate vs GDP Per Capita

We’ve known for many years that Ethiopia and Chad have starkly different health outcomes. What we didn’t fully understand is why.

Through robust research and data analysis over the last two years, our research partners have gained a better understanding of how Ethiopia achieved this success.

And, importantly, our research partners have distilled their findings into data-driven, actionable recommendations for leaders who want to bridge performance gaps.

Bill Gates joins world leaders at a press conference held to launch a plan aimed at saving 10 million mothers and newborns in the poorest countries by 2015. The 63rd annual General Assembly meeting, New York, September, 2008.

The Time is Now

This knowledge has never been more critical. At this moment, COVID-19 has made a profound business case for investments in strengthening health systems, and governments the world over are pouring unprecedented resources into filling exposed gaps in the shortcomings of their healthcare systems.

We need to ensure that these (and future) resources are invested wisely, and in a manner that not only responds to an acute crisis, but builds a more resilient health system for the future as well. Countries must strengthen their health systems in ways that will provide ongoing benefits both for daily challenges, such as reducing under-five mortality, and as we battle headline-grabbing once in a century threats such as the current pandemic.

We can rebuild and strengthen our health infrastructure to achieve these twin goals. The same monitoring systems that ensure every child receives the recommended package of childhood vaccines can also be used to track disease outbreaks and hotspots. And the same supply chain that delivers vaccines to every child can be used to deliver other pandemic-related treatments or prophylactics.

Our research focuses on the health topics of childhood stunting, under-five mortality, community health workers, and vaccine delivery and pandemic preparedness, which provides models and paths forward.

We believe there is no better time to invest in improving health outcomes. National leaders from Bangladesh to Brazil and Ethiopia to Zambia have made remarkable progress. Let’s make sure the ranks of these positive outliers swell and ensure that children in mountaintop villages the world over have a chance to grow tall and thrive.

Niranjan Bose

Niranjan Bose is the Managing Director (Health & Life Sciences Strategy) at Gates Ventures LLC, where he serves as the Science Advisor to Mr. Bill Gates. Prior to joining Gates Ventures, he was the Chief of Staff to the President of the Global Health Program at the Bill & Melinda Gates Foundation.Niranjan holds a PhD in Biochemistry from Dartmouth College and an MS in biological sciences and BS in Pharmaceutical Sciences from Birla Institute of Technology and Science, Pilani, India. He also received the Business Bridge Diploma from the Tuck School of Business at Dartmouth.