My travels with The Antara Foundation have taken me to far-flung villages in the heart of India where the grandeur of natural beauty often masks the tragic condition of India’s poorest mothers and children. This is a crisis on a monumental scale, that has persisted for far too long. This is the challenge that I want to address through The Antara Foundation (TAF).
I have been fortunate to learn from varied experiences in the for-profit, philanthropy, and nonprofit sectors over my career. I left McKinsey & Company in 2003 after a 17-year stint to lead the Bill & Melinda Gates Foundation’s India program. We established an HIV/AIDS prevention program called ‘Avahan’ to stop the spread of HIV in India. In less than three years, Avahan had become the world’s largest ever HIV prevention program, working in six states and over 600 towns, in a pan-India partnership with almost 10,000 sex workers. The Lancet estimated that Avahan averted over 600,000 HIV infections. At the core of Avahan was a business model—integrating supply and demand sides that was both data-driven and community-owned, to tackle a massive problem, using proven preventive interventions, and taking them to scale. In 2014, I founded TAF to see if these methods could be applied to tackle the maternal and child mortality challenge.
Consider this – India’s maternal mortality rate is more than six times, and infant mortality rate more than five times that of the US. Almost a million children under the age of five die each year from largely preventable causes and a third of those who survive are malnourished. Malnutrition not only increases the risk of a child acquiring fatal infections, but also impairs a child’s cognitive development and physical growth. It all begins with the health of the mother during pregnancy. More than half of India’s pregnant women are anemic, increasing the likelihood of low birth-weight babies. India also fares poorly in its quality of public health facilities, skills of attendants, and adherence to simple but vital practices such as exclusive breastfeeding, timely immunization, and proper growth monitoring of children.
The government is taking valiant measures, and has called for support from many quarters, including nonprofit agencies. It is a massive challenge that TAF has taken up—impact at state and eventually at the national scale. TAF’s mission is to help transform India’s record in maternal and child health – to save each such child and secure her future.
There are two core beliefs at the heart of our work. The first is that solutions to major public health challenges are best determined by those closest to the problem. In our case, that is communities such as frontline health workers, pregnant women and other village groups. The second is the need for a scale mindset in the design and implementation of all programs. This is crucial to ensure substantial impact given India’s sheer size.
We began TAF’s work in the state of Rajasthan in 2015, where we developed our flagship innovation, the AAA platform, bringing the three village frontline health workers (ASHA worker, Anganwadi worker and Auxiliary Nurse-Midwife) on a common data-sharing platform, enabling the increased identification and treatment of high-risk beneficiaries. We enhanced labor rooms, and significantly improved the knowledge and skills of birth attendants in public health facilities. We collaborated with frontline workers to create more comprehensive, less error-prone and easy-to-fill service delivery record books to improve data quality and decision making.
Through all of this, we worked with district level functionaries to build capacity at all supervisory levels. Two of our key innovations—the AAA platform and rationalized record keeping—have been introduced by the Rajasthan government in all its 46,000 villages, directly impacting the lives of 60 million people—that is more than the population of California and Florida combined!
We are now launching programs in the state of Madhya Pradesh, starting with seven districts out of 55 in Madhya Pradesh, encompassing ~11,000 villages with ~11 million people, as proving grounds for the AAA Platform and ancillary methods, prior to state-wide introduction.
There is no more moving sight than that of a mother helplessly cradling her dying infant. And no greater joy than to see that baby healthy in a matter of week. This is the motivation that drives us all at the Antara Foundation.
Ashok Alexander is the founder of The Antara Foundation (TAF), which he set up in 2014. Prior to that, he was the country director of the Bill & Melinda Gates Foundation in India and a senior partner at McKinsey & Company. Reach Ashok at email@example.com