Indian Prime Minister Narendra Modi's first visit to the United States has ushered in a wave of newly found interest and enthusiasm in US-India engagement. There has been considerable interest by both private and public sectors alike regarding the outcomes and specific deliverables that will follow on the heels of the visit to fulfill what President Obama calls the "extraordinary promise of U.S.-India strategic partnership". Areas of bilateral engagement receiving the most airtime include the standard fanfare of defense, energy and infrastructure. An area that has received little attention, quite shortsightedly, is engagement on public health. There are a few key areas of low hanging fruit in which there are natural and obvious synergies for engagement in public health between the US and India.
What was perhaps most remarkable about India's most recent Mars Orbiter Mission (MOM) was not that it reached Mars, but that India was able to accomplish the task cheaper than Hollywood spent to produce the film "Gravity." India is the world leader in frugal innovation, inspired by the unique constraints of limited resources. In terms of public health, India has developed some of the world's most cost effective specialty health care services such as LifeSpring maternity hospitals which provide high quality care to expecting mothers at 1/6 the cost of comparable private clinics or Aravind Eye Hospital which performs 70% of the eye operations of Britain's NHS for just 1% of the cost and half the complication rate.
India also has a technologically sophisticated approach to distributing public health insurance (which is available to those in the bottom quartile of income distribution). The value of public health insurance, 30,000 Rs per household, is dispensed on fingerprint encoded biometric smart cards in a program called RSBY. As Kavita Patel from Brookings has noted, "The U.S. has struggled with any biometric-type approach to public health insurance and could learn a great deal from RSBY's deployment."
Global Health Security
Some have referred to virus pandemics as posing the single greatest threat to humanity. And given porous national borders and global interconnectivity, it is not a stretch to imagine the next pandemic affecting billions of people globally. President Obama has repeatedly pointed out the potentially profound global economic, political and security implications posed by viral outbreaks.
The Ebola epidemic in Western Africa should serve as a wake up call for the Centers for Disease Control (CDC) to help support and further bolster disease detection, isolation infrastructure and the training of in-country first responders in resource-poor settings around the world. When former US Health and Human Services Secretary Kathleen Sebelius visited India in January of 2012, she announced a collaborative launch between the CDC and India's National Center for Disease Control (NCDC) of a Global Disease Detection Center. The US should not only continue to support such efforts, but should further build and advance such collaborations.
Public Private Partnerships
Public health is a perfect area for USAID and the State Department to advance agendas on private sector engagement in development. As the majority of capital flows to the developing world have shifted in the past thirty years from Official Development Assistance to private flows such as Foreign Direct Investment, the private sector commands an indispensible role in the development process.
Sanitation is a particularly appropriate area for public-private cooperation. As recently as 2012 it would be political suicide for a leader to suggest that India needs more toilets than temples, as Rural Development Minister Jairam Ramesh had. Despite this legacy, Modi has tackled the issue head on by addressing sanitation in every major speech and also by vowing to end open defecation by providing a toilet in every household by 2019.
600 million people in India don't have access to a toilet, and open defecation promotes gastrointestinal disease, which is one reason half of all Indian children are malnourished. USAID should consider creating a Global Alliance for Sanitation to help coordinate public and private partners to help support India in the herculean task of providing sanitation to 600 million. A parallel example, which could serve as an operational framework, would be the Global Alliance for Clean Cookstoves to which the US has committed more than $50 million over 5 years.
There may also be an opportunity for USAID to support social entrepreneurs in sanitation through innovative financing. Here, John Sauer identifies the role of a social creditor or social investor willing to provide patient capital to facilitate a "sale-on-credit" of toilets to consumers. USAID's Development Credit Authority has experience using risk sharing to help mobilize private investment to fill financing gaps. Perhaps USAID could find ways to provide credit to fledgling social business in sanitation.
These are a just a few areas of low hanging fruit where bilateral engagement on public health would pay dividends well beyond investment and would have widespread support. According to a 2013 survey by the Kaiser Family Foundation, nearly seven in ten Americans believe that spending on health in developing countries helps protect the health of Americans by preventing the spread of diseases, and over half believe that such spending is helpful for improving the image of the United States globally.
Now is a defining moment of leadership between both countries. Any strategic partnership must include engagements on public health in order to fulfill the extraordinary promise of the world´s two largest democracies.