It has been 16 years since Ashok Alexander quit his job at McKinsey, the management consulting behemoth, but he still uses corporate lingo to describe his work. Between nods at acquaintances and an order of filter coffe (“very hot please”) at the Taj Coromandel in Chennai, he frequently uses terms like “grassroots data” and “scalable solutions”.
Only this time, he’s not talking about the business world, but about his work as the founder of Antara Foundation, a four-year-old non-profit that promotes maternal and child health by providing solutions “at scale”.
He’s in the city for the weekend, juggling a few engagements. “My alma mater McKinsey did a very nice thing for me yesterday,” he says, about the previous day’s book reading organised in his honour. The book in question? A Stranger Truth: Lessons in Love, Leadership and Courage from India’s Sex Workers , Alexander’s recently-released account about his decade-long stint (between McKinsey and Antara), leading Avahan, the Bill and Melinda Gates Foundation’s India AIDS Prevention programme.
The big switch
It would be easy to assume that the eloquent and mild mannered 64-year-old — dressed in a long-sleeved black sweater and slacks — is a typical corporate honcho. To a certain extent, he is. He recently launched Alexander Associates, a training and knowledge-sharing network aimed at coaching young leaders in the business world (he self-effacingly promises a lot “fortune cookie gyaan ”).
But a chance encounter with the Gates Foundation in 2002 led to a dramatic career shift, propelled, he jokes, “by the misplaced conceit that I could save the world”. Even though he still worked for a powerful organisation (that pumped in over $300 million into Avahan), he also spent a lot of time in the field, interacting with sex workers, truckers, injecting drug users and men who have sex with men (MSMs). His objective was to understand the reasons for the spread of HIV among the population, ascertain why condom usage was low, and then provide a solution.
Measuring what matters
After a few mistakes, setbacks and a lot of skepticism from others (not to forget their denial of an impending AIDS epidemic), Alexander discovered a solution: grassroots data. So he and his team got to work, gathering mounds of it. “For two years, we were down in the trenches, getting data.” When anyone questioned the foundation’s policies, he would present the facts. “I would say, ‘with respect, that’s not how it works’. I had data, not opinion.”
Two years into Avahan, he realised that this model — of collecting field-level data and melding it with business-style problem solving — could extend to other social initiatives. Information gathering, which is second nature to business (“you won’t enter a market without asking questions”), is missing in public health delivery, he maintains.
That is when he started thinking about life after the foundation, zeroing in on maternal and child health as his cause du jour . “We Indians are a stunted, malnourished population. That’s the harsh reality,” he says. Then, as if he has just remembered where we are, he laughs and adds, “Not this well-nourished population, but out on the streets.”
The issues that Antara is battling, he says, are a ‘hidden tragedy’. “nobody knows, and nobody cares because it’s not our kids,” he says about India’s maternal and child-health. “Like HIV, it has very simple solutions that are almost impossible to scale.” And he is eager to find out whether this model could work in other fields — like education and adolescent health — and in other countries.
Counting on community
Working with a host of local actors — including nurses, midwives and even early-childhood educators — Antara Foundation identifies high-risk pregnancies in villages by bringing in community members. In the whole process, from mapping the locales (“which in itself is a big deal”), to using their colour-coded bindis to identify high-risk homes, it is the village residents who play a vital part in the data-gathering process.
But as much as he’s keen to bring corporate practices to the non-profit sector, he admits that the lessons flow in the opposite direction too. “Here’s something you would never do in business: say, ‘I don’t know how to get this data’. But that is something he became comfortable doing at Avahan, asking sex workers to propose solutions to their own problems.
The model’s success is good news, but he jokingly assures me that there is bad news too. “It’s not funny, why am I laughing?” he says, as he pours out his filter coffee. “The bad news is that I am not the Gates foundation.” Malnutrition, he says, isn’t a very appetising topic.
But he doesn’t seem too fazed. Or if he is, he isn’t showing it. “Even without a funder, I have a tendency to go way ahead,” he grins. “It’s like that Beatles song — you might be too young to know — I’ve got a driver, but not a car.”
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The race against HIV
A Stranger Truth written by Ashok Alexander
The Gates Foundation invested over $300 million in AIDS prevention in India, through Avahan. A 2013 report by Lancet Global Health estimated that the initiative may have prevented over six lakh HIV infections in the country, over a span of 10 years.
But for all its success, the initiative was not devoid of criticism. In 2009, Elizabeth Flock, writing for Forbes India, said that the foundation’s mistakes were expensive, and its practices unsustainable.
Alexander, whose book is part-memoir and part-ethnography, with extensive notes from the field (thanks to the copious notes he kept during his 10-year stint), is quick to concede that there were errors. Condom distribution programmes for sex workers and truckers, for instance, were not always successful when implemented. “We were moving extremely fast, and in the process, we made some mistakes,” he says. “Because we had a budget, we thought ‘we’ll fix it as we go’. Now that I am a small NGO, I have a better appreciation of how precious funding is.”
