 Needless to say, this is a quality crowd. So I'd like to invite you all to move a little bit closer. Indulge me. Indulge us. Make us feel like we are closer to you. We will have a conversation this way. Come up and make us feel warm. Thank you. My name is Carl Hoffman, and I'm the president of Population Services International, PSI. And I am here with this distinguished panel to talk about doing well by doing good, which, after all, is an underlying theme of the entire presence here at SoCAP. I will introduce each of them briefly. And then we're going to have a bit of a conversation based on questions. But as I introduce them, I'm going to ask them also to just give us a few sentences about their own organization, where they work now, so they can speak in their own words about what they do. First to them, my immediate right is Jenny Yip, who is a program investment officer with the Bill and Melinda Gates Foundation. I'm sure you've all heard of it. Jenny came to the Gates Foundation after over a decade at Goldman Sachs and is working on program-related investments at the Gates Foundation. Jenny, do you want to say a word about the Gates Foundation and your role there? Sure. I'm sure most of you in the organization knows about the Gates Foundation. But essentially, we have three main programs, global health, which you can think of as upstream development, drug discovery, vaccine discovery, et cetera. Global development, which encompasses our agriculture and livestock programs, as well as downstream delivery for health products. And then the last program, which is US programs focused on domestic education. Thank you. And I should say full disclosure, Bill and Melinda Gates Foundation is a funder of ours, as is USAID. So let me turn second to Wendy Taylor, who is director of the Center for Accelerating Innovation and Impact at USAID's Global Health Bureau. USAID is probably one of the few institutions that expressly says its mission is to put itself out of business. Who among us would actually say that? Prior to that, she worked in the biotech space as a venture capitalist and also at the Office of Management and Budget. Wendy, say a word about where you work now. Great. The tent doesn't fall down on us today. I lead what is called the Center for Accelerating Innovation and Impact, which, as Carl said, and we're really a center of excellence that was just recently created to bring more business and marketplace thinking into how we not only develop innovations, but how we can accelerate their introduction and scale up in the developing world. So we are engaging not just in catalyzing new innovations, but also thinking about bringing in a lot of industry practices and thinking about how we invest, how we think about business frameworks for introduction and scaling. So we can talk about that. Thank you. Next to her is Pony Subaya. Pony is Global Program Leader at PATH. And comes to PATH, the PATH is a large international NGO program for accessible technologies and health, appropriate technologies and health, pardon me. Based in Seattle, but with offices all over the world. And a focus on innovation to bring innovative solutions to global health challenges. Pony came to that role from a long professional involvement with Pfizer, including managing Pfizer's Global Access Program, which is very much about bringing that large multinational into contact with the lowest parts of the health consumer pyramid, I would say. Pony, tell us about your work now at PATH. Great, so I'm the Global Program Leader at PATH for drug development. So PATH, as mentioned, is a large nonprofit. It's about 1,200 employees. And the focus is on global health and using disruptive technologies to meet unmet needs. Now there are actually five platforms at PATH. Drugs is one of them, but it also includes vaccines development and delivery, as well as technology solutions, for example, cold chain to deliver vaccines, diagnostics, in addition to community-based intervention. So really the whole gamut from research and discovery to really having impact at the field across the value chain. And finally, we have Laura Diakanu, who is vice president of the Health Services Fund at Global Partnerships, which has, for 15 years now, been doing work in the microenterprise and microfinance fields in Latin America, focused on Latin America, but I think also looking elsewhere in the world, if I understand it, bringing investors here into contact with partners in the developing world for sustainable outcomes. Talk about your work, Laura. So as mentioned, Global Partnerships is a nonprofit impact investor. We deliver debt, grant, and knowledge capital to social enterprises in Latin America and the Caribbean. Currently, those social enterprises are principally microfinance institutions and cooperatives, but we're expanding that concept of what a social enterprise is, as well, in the future. Those institutions, basically, they serve as existing last mile platforms through which financial services and nonfinancial services are being delivered to marginalized populations in the sectors of health, ag enterprise, microentrepreneurship, and green technology. And I happen to be focused on the health services part of that work. Thank you very much. So the context is global health and the changing landscape, the rapidly changing landscape in global health. And each of us, myself included, actually, but certainly each of the panelists, has an important and unique perspective on how that landscape is changing and the ways in which new partnerships are possible. Traditional government funders, which have been critical to taking global health interventions to scale, are creating new cross-sectoral partnerships these days to solve global health challenges in new ways. Corporations and foundations and impact investors, and we have those represented here on the panel, both in their present incarnations and in their past incarnations, invest in innovative and sustainable and replicable solutions that, when proven attractive and effective, can bring in public funding, which can then provide continuity and take some of these solutions to scale. So I want to talk with this panel about their roles in this new era, when the rules are sort of changing in terms of how we fund effective interventions in global health. First, let me start with Jenny and Wendy. So as I mentioned, two funders of my institution as well as many others around the world, your organizations are both using new forms of partnership across different sectors to create greater impact in global health. What can you tell us from your perspective about what's changed in the global health funding landscape, and what are these new partnerships that are emerging as a result of those changes, and how are those partnerships proving themselves effective? Jenny, can you start? Yeah, sure. I think it's becoming a very, very large part of what we do and specifically where I sit on the program-related investments team. Just so everybody knows, program-related investments is we essentially make regular debt and equity investments in for-profit companies whose business missions closely align with the foundation's charitable goals. So the primary purpose of our investment is to forward the foundation's charitable goals, but we are expected to make a financial return. We, frankly, we like it when we make a financial return, obviously. But one way that we've been really structuring these types of partnerships with for-profit companies is in a term called global access. And I think, Tony, you're going to hear a lot of the same themes at Resonade, probably with you. But one way that we think about it is if the Gates Foundation invests in, for example, a biotech company that has a platform technology that can be applicable to multitudes of diseases, the Gates Foundation only cares about a very small subset of those diseases in a small subset of countries. But if we're one of the funders of this technology, what we do is then structure what we call global access. And it essentially means a quick dissemination of information, products, and services to the populations that we care about. So it's actually a contractual term that we use with all of our PRIs to say, we invest in this platform technology. When you apply it to diseases that we care about, you either have to have price ceilings, price maximums that are certain, depending on the country or whatever it may be. But if you were to apply that technology to cancer in the developed world, then you can kind of use that technology and sell it at whatever price you want and, frankly, make your millions and billions of dollars. So that kind of structure, it's essentially a cross-subsidization structure. That contractual structure has worked pretty well with our deals, and I think it's something that we're gonna get continuously sophisticated on and hopefully bring to our other deals as well. So you're leveraging really a global public good through the market potential of new interventions that- Exactly, exactly. Fascinating. When the USA, particularly under the current administrators leadership, has done a lot to develop partnerships between public and private sector, looking at new business strategies to bring into the development marketplace. Talk about how that is changing the role and the way USA looks at its work. Yeah, well, certainly partnerships has become a core part of what we are doing and we're looking to the private sector to help us look beyond our traditional operating models and find new solutions. And what's been interesting in the space is really to see industry's interests shift as well. I think shifting both in terms of seeing an opportunity to have impact where in global health, we still are seeing seven million children dying each year and 270,000 moms dying each year and companies are seeing the potential to be able to have unique ability to innovate and have a real and sustainable impact in those particular areas. But they're also seeing the real market opportunity and I think we've seen the market shift even just in the last decade. So looking to emerging markets as a new source of growth, you've got stagnating growth here in US and European markets and a lot of companies looking to the emerging markets as the new growth opportunities, the new frontier and in Africa is now very much part of that equation in ways that it really wasn't certainly in the health sector not too long ago. So the healthcare commodity market in Africa is poised to in the next several years which have become a $30 billion market and by 2020 a $45 billion market and you've got these changing economies where even the healthcare budgets are rapidly increasing in both low and middle income markets. So it creates the space for this kind of shared opportunity and a aligned interest between the public and private sector and so with the companies in terms of where they're engaging, I think they see the opportunity for both kind of short and long-term market growth and they're able to align or whether, modify, adjust, repackage existing products but also look to new innovations. So companies are actually licensing technologies that address more of the bottom of the pyramid. We're seeing companies actually look to new distribution models and recognizing that to actually enter into these markets they have to look at them differently and they have to think about new ways of using their sales force or new ways of distribution and we're also seeing companies actually look at not just delivering products which they're very good at but strengthening the health systems because that's critical for them to be able to move their products through these markets and so kind of shifting how they operate and in each of those areas there's opportunity for partnerships, there's opportunities for the companies to reduce their risk by partnering with the public sector through NGOs to reduce the cost to learn about operating in these markets in ways that they perhaps may not know otherwise and even to kind of piggyback off of delivery channels so it's been a real interesting, I think, shift in how companies are approaching. So that's an interesting point. It's not just USA working with corporations, public sector and private sector but in a way what you're talking about there is your role making markets, you're creating a space within which other partnerships form, corporations with NGOs, corporations with host country governments, I assume. Let me ask you though, since we're talking about the public sector, public money and public private partnerships, do you run into the risk or how do you manage the risk of picking favorites, of deciding which corporation might be worthy of which partnership when there may be multiple corporations that want to partner in a particular space? Well, it's something we have to walk that line very carefully and we have competitions where it goes through a procurement process and it's a competitive fair process but we also have mechanisms like our Global Development Alliance where companies can propose ideas to work with us and we have much more flexibility in how we can work with the private sector, can partner up in ways that don't necessarily have to go through a much more open, rigorous process. Tony, so PATH has had a very interesting trajectory over the years, it's, as you mentioned, done a lot of work in innovation and bringing new technologies to the consumer, to the health consumer in the global health context and recently you were a part of the exciting new partnership that PATH pursued in acquiring One World Health, a pharmaceutical company. So bringing that capacity inside its own walls. Talk to us about the sort of unconventional or non-traditional partnerships that you at PATH are pursuing now as you go about achieving your mission in the developing world. Who do you find yourself working with now that's new and different? Yeah, so I think it's kind of building what you had mentioned about partnerships because I'll give a couple of examples where I think very non-traditional partners were brought together, not just public and private but also, for example, academics. So our group, which is focused on drug development is in the process of developing and now we're in the market of a semi-synthetic artemisinin. Now this is actually a particular compound that is in the, what's malaria treatment called artemisinin-based combination treatment. This is the gold standard for treating malaria. However, this artemisinin used to come from a botanical source. And again, the prices and the supply would go up and down which meant patients with malaria didn't always get access to this important medicine. So the Gates Foundation recognizing the need actually funded previously One World Health Now PATH to work as the project coordinator and manager of this project. We first started out by working with the University of California Berkeley. And we looked and working with them that new technology was found using synthetic biology. And then from there, the baton was handed to a private sector, small biotuckle amorous. And from there, they took it and validated it. And then the next step was then turning the baton to a larger company who can take it and scale it and then distribute it to full-scale industrial capacity. And that was Sanofi eventus. So it really, as you can see, very different partners that have come together and it was a 10-year project. And over these 10 years, there was a lot of hurdles. And I would say not always smooth sailing because I think one of the important things we've learned from the different partners coming together is it's really important for different partners to understand each other's agendas, their goals, their pressures. And what is ultimately resonated is that we always have the goal in mind, the mission in mind. And I think that helped us get to currently now where we've actually achieved a full-scale production and we're hoping to be able to bring out the semi-synthetic artemis and base treatment into the market by the end of the year. But it goes to show that you can bring very nontraditional partners together and you can really make a end product that ultimately will have global health impact. It sounds esoteric. Anybody here ever suffered from malaria? If you were to suffer, if you had the misfortune to contract malaria these days, that's what you need. Artemis and combined therapy is the frontline treatment for malaria. So this is critically important. Thank you. Laura, impact investing. It's obviously a theme of SoCAP. It's a relatively new discipline. In your time practicing this craft, what have you learned at Global Partnerships about what works and what doesn't work in impact investing? What are the ingredients for success in impact investing? And do you think that it's really proven itself in the emerging market context? Yeah, I mean, as you mentioned, I think impact investing still means a lot of different things to different people. So the definition is still emerging. I think what we've learned over the last several years that we've started to see ourselves in this light is that, first of all, there's kind of no one-size-fits-all solution. When we started down this path working on health services business models that could really serve thousands and thousands of women with a fundamental essential package of health services sustainably and not rely on donor funding over time, we felt, along with our investors, that if we just kind of cracked the nut and came up with the secret business in a box, it could be replicated and scaled throughout the world. And I think one thing we've learned is that certainly not the case, that there are some perhaps basic principles to sustainable business models that can deliver essential services to millions of people, but each country context, each organizational context, makes our impact investment the reason the business case for investing very different. We have to measure our impact in different ways, depending on what that investment really is about, what we're trying to learn, what we're trying to achieve out of each individual investment. It's kind of more of a boutique approach now than what we thought we were embarking on several years ago. Another thing we've learned is that it really takes different types of capital to respond appropriately to different types of investment. Several years ago, Global Partnerships kind of came at every impact investment with one tool, and that was debt capital. And over the last couple of years, we've kind of expanded that range of capital, that range of tools that we're bringing to a problem, which is how to expand access to essential services that really make a difference to a certain population. And we've expanded it to include now grant capital as well as knowledge capital, because we're recognizing that investments in really early stage pilot models are not suitable for kind of a debt capital instrument, and that we really need to first go in with kind of knowledge capital, partner hand in hand with our partners to really design a business model that we have confidence in, present a business case for investment, and then bring some grant capital to bear that can prove that out. And once it's proven, then we can come behind that with loan capital to kind of expand it and scale it in that context. So those are two things that we've learned. I think that's very interesting actually. Jenny, would you agree that, so program related investments that you're helping to manage at the Gates Foundation, is it, it's a cousin of impact investing, it's related, you said in your remarks that your program related investment portfolio at Gates is expected to generate a positive financial return. Can you elaborate a little bit on that? I mean, at market rates, above market rates, below market rates, what is an acceptable financial return for the Gates, without giving away any secrets here, for Gates program related investments? I think we shoot for greater than zero. And I think the other way of framing that exact same question is also being able to assess risk and minimize risk. I think if we were to tell Bill in five years that we generated extra turns, he wouldn't necessarily be happy or be saying that you did a terrible job because I think how we are assessed is how well did you predict the risk today in something that's gonna happen in five years from now or 10 years from now? Because we are not a traditional impact investor, we're not a traditional VC. We're not necessarily looking for an exit opportunity because sometimes our projects do require 15, 20 years. If you're talking about seeding the adjuvant to a potential HIV vaccine, who's to say how much money that's gonna generate in the future? So I think for us, really it's the idea of calculating risk and calculating it well and balancing that with some of the charitable aspects and the social aspects that we expect. So several of us work in the non-profit environment and all of us have some experience with or in the non-profit environment. You know, we talk about the Gates Foundation. I mean, Microsoft would easily, I suppose, invest a million dollars or more to test and develop a potentially game-changing new product or intervention and has to accept the premise that many times it's gonna fail to do that and it will lose. It's part of its research and development activity. Pfizer obviously spends billions in this regard. But in the non-profit space where organizations are expected to deliver this health impact at scale, there's virtually no tolerance for that sort of risk taking. There's no pool of risk capital that's easily available. So I guess my question to the panel is, you know, is the conventional non-profit model broken in given today's realities? How do we deal with this problem of risk taking among in the not-for-profit space? Wendy, what would you say? Well, I mean, I think it's an interesting one. I mean, it's something we struggle with as well. One of the things that I did was spearheaded a grand challenge around saving lives at birth and it was really intended to be a global call for those really innovative groundbreaking transformational ideas. In other words, we would have to make some riskier investments to find those. But we have to be very careful in how we talk about how we invest in more riskier propositions because we're dealing with public funds. But at the same time, we expect only a small portion of those investments that we're making to be wildly successful. We hope everything will be successful. We will work to make sure everything gets set on the right foot. But we want to be able to create the space where we look for those big groundbreaking ideas and that does involve some element of risk taking. It involves failing. And there may be some failures. In fact, our administrator has talked about wanting to do failure summits and be able to- We'll be there. We'll be there. It's helpful to learn from your failures and you learn probably more from your failures than your successes. So I think we do have to create that space where it's okay to talk about failures. It's okay to present those learning so that we can avoid them in the future. So as a donor, I think there's, at least I can say there's some level of tolerance for that. That's good. Of course, they may not still be the capital pool available to do the experimentation. Pony, what would you say? Compare and contrast Pfizer and PATH in that one. I do think the whole industry, but also I think research itself is really evolving. And I think that some of the same questions are being, I guess, addressed both in the private sector and the non-profit sector in research as such. So I do think that when, I think like for example, when we're looking at new products and development, we're looking at ways of how can we kill projects early? Because I think one of the, including in the non-profit is projects are going on too long. So you may have four projects and you're taking years to kill it. Is there ways we could kill projects early? So there's a lot of research going on. Is can we have biomarkers? Can, and the other thing I think is not only the science, but I think we're also learning, we were talking earlier about how important it is for human-designed approach and market research. And I think we're learning, even when you're in early phases of development, go back in the field, is the profile of the product, is it appropriate for what the end user wants? And how do we continue to do that and not wait till a product is seven years down the road before checking with the end user? So I do think that rigor is important and I think it's because it is a small, a limited amount of money and how do we effectively use it? And this is where I think to your point, we have to learn from failures. And I think there needs to be more openness about sharing those because I think we help build other things for the future. I think that's a great point. Laura, do you feel like global partnerships, you trumpet your failures? I wouldn't say that we trumpet them yet. There has been a lot of conversations about expecting that not everything is going to succeed, although we hope that everything will succeed. But I do, I think that Pony makes a great point in that to the extent that we can be really, really clear about why we're making the investment to begin with and what success wouldn't look like for us, what do we hope to learn from the investment? It's kind of redefining instead of failure, it's learning, we're always learning because there will always be assumptions that are off that are built into models. So as long as we build into our investment, that monitoring, we really try to identify what are really the key indicators of success. How do we know that this model is on track? And we monitor that on a quarterly basis with our partners in one case monthly so that we can catch things early. So if things are really off course, we can know sooner rather than later, oh, this assumption that we made looks like it's totally off. What can we do about it to course correct to hopefully encourage it back on the path towards success, but I think also be clear about when do we say, okay, let's chalk this one up to learning and move on to the next one, yeah. Let me go back to your earlier comments which I just want you to amplify a little bit. So when you talk about the different varieties of capital that may be necessary for an impact investment environment, I think we often might think of, we think of patient capital in that regard, but we might all perhaps be thinking of financial resources. You're pointing out that there's knowledge capital, there's partnership capital, there are all sorts of different ways in which you might be investing without financial resources being a part of the picture. Yeah, but it's worth, I mean, we invest a lot of knowledge capital or partnership capital before we even get to the point of investing dollar one of grant in the case of the investments in the health services fund. I would say global partnerships invest almost a full year of staff time and travel, like really working with the partner to build their own capacity to really define, to make sure they're at the end of the day really owning the investment and they have the management team fully on board and aligned with, everybody's aligned with where we're trying to go and that's not cheap. And that's not something that actually a lot of donors are interested in putting their money behind or understand necessarily. So I think that's important to signal, but we do think that that's a really important part of kind of success or success rate at the end of the day is really investing that time and effort up front. So I would, can I echo that? And one of the things that we've noticed with our saving lives at Perth program, we have lots of innovators, we choose them, we choose those that we think have the most, greatest chance of scaling, yet we know that scale is one of the most difficult things, we might have lots of successful pilots, but many really fail to reach scale and so we're looking to invest that additional sort of technical assistance, knowledge capital and we've created an accelerator to be able to help a lot of our innovators think through pathways to scale, remind them that they should be designing with the end in mind, you don't want to be fixing technical problems at the point where you're in the market, you want to fix them in the lab and just a lot of helping them think through how it's going to be distributed at the earliest stages. But also we are looking at building a pipeline of innovations even in the private SMEs, we've developed an African Challenge Fund, it's the health enterprise fund and recognizing for a lot of those really really early stage companies, they need a lot of TA. And so in that model, and this is just we're investing with grants now, they're probably, it's too early for debt, certainly too early for the acumen's of the world to step in and they, we're putting in almost 50% of our investments going into TA just to make sure that they have that additional. The TA, you mean technical assistance, people sitting with them, working with them, teaching transferring skills. So I think it's critically important to set many of these enterprises up for success. Right. Yeah, actually I want to echo that too, because technical assistance, whatever you want to call it, technical assistance, portfolio management, consultants, time, resources, whatever it may be, we actually count that and that's a criteria in our investment criteria. So meaning if we don't have the time, energy, resources or expertise to do something, that actually might not be the right time for us to be investing in that company. Because if it fails, we don't have anybody to receive the learnings, we don't have the ability to then help out our potential portfolio company. So evaluating the portfolio management aspect of it, that could be three or five years in the future today before you make the investment. It's actually a huge criteria for us. So maybe even more important than the money is really the stewardship requirement. We've gone through about two thirds of our time. I think we should invite some questions and see if we can get a conversation going with all of you. In fact, each of you may have to ask a question. There are mics that are available from Cheyenne and from Bjorn if we need him, but certainly from Cheyenne. Does anybody have a question about any of the things that have been raised so far in this changing landscape in global health? Yes, sir. I'm Joseph Stuy. I work for the National Collegiate Inventors and Innovators Alliance. We fund, grant fund, and support mostly student innovation teams, but we are also working with Saving Lives at Birth and some other programs to help accelerate innovation. I guess my question is, if you're, they're incredibly smart, ambitious, young entrepreneurs, innovators who we work with, people who are doctors and decided that wasn't enough, I'll get an MBA, and I'll also do a startup all at the same time. And many of them are interested in global health. So what do you, when you talk to young innovators, what kinds of opportunities do you see that you wish young innovators were looking at and what kind of approaches do you recommend that they think about? Tony, can I ask you to take that first? Yeah, I think, and in fact, PAP has done that where, you know, they've reached out to like small startup companies and it's turned out to be an amazing product like we have this vial monitors that's being used and that started with a very small company of six employees. So I do think that you don't know where the ideas come from. So I think that's something philosophy at PAP is encouraging ideas to come through. And so we do have like open forum settings, sometimes like in Seattle, and we're going to start one in San Francisco to be able to bring in people who are interested in some of the same therapeutic areas we're working in, but they may be looking at the problem very differently. So I do think getting involved and contacting organizations, whether it's PAP or PSI, depending on which part of the value chain there is interest in. I think that is very important. I also think it's very important to look at the whatever organizations website to see where they're focusing on and what are some of the challenges they're facing because there's so many areas in global health you can go to and you got to make sure you're aligned with the right organization. So coming to PAP for something that may be more important for PSI, it'll just help decrease the time. But I think it is needed because ideas can come from anywhere and I think a fresh perspective is always helpful. Any other? I would just add, I mean, I think what's exciting in USAID is we've now brought in this grand challenge model and it's actually opening up the door to those kinds of innovative ideas and giving them a conduit to actually get funding from a big organization like USAID. Gates Foundation has its grand challenge program. Canada has a grand challenge program and they tend to fund more of the Canadians for some of their, they have a STARS program to fund entrepreneurs. So there are different funding sources but it's still a hard pathway to find that funding and I think just in recent years we're starting to see better opportunities. It's also just, a lot of the universities seem to be aligning themselves around sparking innovation for global health or innovation for development and that's I think opening up the door for possibilities for some of the young students, entrepreneurs to find these new solutions to these seemingly intractable development challenges and through our grand challenge we have numerous examples where the ideas have actually come from students. They've been student projects that they did their senior year and now they're actually turning into something that you're getting scaled country wide and saving hundreds and thousands of lives even in their earliest age. So it's very exciting to see what young entrepreneurs are coming up with and finding their path into these larger development spaces. I'm gonna use the prerogative of the chair to also answer that question from my perspective if you don't mind, which is that energy that comes from young entrepreneurs and innovators and all the people who wanna move into global health is really exciting for all the practitioners but many of the challenges in global health are really not one susceptible to a new technological innovation. Some of the simplest, most effective, cost effective ways to save lives exist and what's really needed is something that winds up feeling and sounding unsexy but it is simply process improvement. It's simply figuring out how to deliver that last mile or that last 100 yards and that I think for anybody who's passionate about global health, you don't ever want to leave those who may not have a technological bent thinking that the only way to innovate in this space is through technology because a lot of it is just getting things into the hands of people who need them. Can I add to that? Yes. So I was gonna say, we're really not in the business of inventing new things or coming up with new technologies. Our challenge really is exactly that. Finding ways to deliver what's already tried and true and maybe has lost its sex appeal out there in the market but the fact is that millions of people still don't have access to those really basic essential services and products and a lot of that has to do with the information gap to even know what it is that they're experiencing or that they can manage a certain condition from their home or that they can't even prevent it. So I think what we're seeing is that there still is this kind of rural access frontier that remains to be solved so to the extent that there's innovation around how people receive basic information to educate them about how to handle a situation or when, because right now a lot of people in rural areas simply self-medicate or don't go to a doctor or receive any medicines at all because they just simply don't have access or don't know what it is that they have. Systems, I mean to the extent that there are IT solutions to help if there is a rural pharmacy to distribute products and services to bring down the costs and that and to just deliver really essential services that for whatever reason the public sector has simply not figured out. They don't have the capacity yet to be everywhere in their countries and so for that reason there are private sector providers delivering basic health services but they haven't yet figured out how to turn a profit off of the really rural remote communities. So there's this white space where there does need to be innovation to kind of push forward that near market solution frontier in terms of rural access. And the other big one that I think is on the frontier is chronic disease in the developing world that hasn't risen to the level of sexiness in terms of international community funding really flowing into this yet and yet we're seeing an epidemic in terms of folks, clients of microfinance institutions testing off the charts in terms of risk factors for to develop chronic disease in the future and this will become a huge burden, cost burden for governments in the future. So there's a lot of innovating to be done around that because I think chronic disease is still seen largely as a developed country issue. Great point. You had a question, somebody had a question. Hi, my question was there's often a lot of criticism in global health about the role of aid organizations or other organizations bringing in first world solutions and often allowing governments off the hook in terms of meeting halfway in solving these issues and I was wondering to what extent your organizations really focus on also capacity building and holding local governments accountable in putting their resources to meet you and help solve problems in a more sustainable manner. So the trade off between impact and system strengthening really. Jenny, would you like to give your perspective on that? Yeah, and I think the Gates Foundation is a little bit unique in that sense because we do have some clout in the international community to be able to do all those things. So the head of our global development, Dr. Chris Elias, who actually came from PATH is actually spending a lot of his time with ministries of health or whatever it may be, making sure that these governments or government organizations are getting held accountable. But that's a very tough thing to do because you're trying to tread the very, very fine line between telling somebody what to do and saying, oh, you need to do X, Y, and Z for polio or whatever it may be and frankly, offending them so that they close off the borders and then you don't get to do anything. So it's a lot of diplomacy. It's a lot of partnerships. It's a lot of working together as opposed to the Gates Foundation telling you, country, what to do. So. Any other thoughts, Pony? Sure, I would just add that country ownership is actually a big part of how we engage with countries and so it's also not about just coming in and sort of imposing the sort of west view of all the various things that need to be done and countries need to actually sort of set their own development agendas. And I think the reality in the development space is that because the economies of these countries are shifting so rapidly, overseas development assistance as a whole is becoming such a smaller and smaller part of our sphere of influence is diminishing rapidly and so our ability to even shape where countries are spending their money is changing and that's certainly true in India and as these economies boosted up, it will be true in many other parts of Africa. And so I think our relationships with countries are changing and so country ownership dominates how we interact but we also do look for things like crowding out and want to make sure when we're investing it's not getting sort of the country investments or not drawing up and moving elsewhere. You want to supplement and not plant. Right, right. Pony, were you gonna say something? Yeah, so I think just adding on that, I think early in the early in development I think you have to be able to bring in the government so it's not a top down approach. I think one example I could path is the meningitis vaccine. So it was very, it's very successful, about 100 million people have been vaccinated but I think the one of the reasons for the success was the idea was generated but involved lots of different partners from global organizations in WHO who gave the policy and the credibility to it but then partnering with the manufacturing, vaccine manufacturing in India, the Sermons Institute of India and then working with the governments in Africa to really roll out the program. So it really was a partnership from the beginning. It wasn't like a top down approach and your point is right because if that partnership doesn't come early sometimes it's very easy for some of the ministries of health is just a dependent on the global fund and they don't really take the baton and I think involving them right from the beginning and showing them the proof that it is having health outcomes and it's gonna impact their civilian population and have impact on their society I think has helped move them along and I think that's one example of where it's worked in the right direction. I would agree. I mean the best operating environment for an international NGO is when the host government takes ownership of the program, directs resources, be it its own or coming from outside and sets objectives and priorities but the reality is that's very rare. It's very rare, unfortunately. Other questions or comments? Yes. Hi, I'm Avik Bal from iCure. We've seen many small young entrepreneurs doing different things but the end goal is the same. For example, they're providing primary healthcare or they're providing AIDS eradication or they're providing, but in small pockets, some in Tanzania, some in Kenya, some in Bangladesh, India, somewhere. In your capacity as an umbrella organization, a much bigger organization, and maybe have incubated many of these, are being associated, how do you connect the dots and instead of them trying to kind of penetrate into distribution models and stuff, they all come together and make a much bigger impact than they could have otherwise. So global networks, global systems, how do we aim for global systemic change rather than just point to point? Anybody? Tony? So for me, coming relatively new to the nonprofit sector from the private sector, that was also kind of, for me, surprising because just like in the private sector, there was also some amount of competition and not necessarily the collaboration that was optimal between NGOs, but I think there are certain partners that it seems to be being more and more facilitated whether it's by USAID or Gates Foundation is, let's not fund two different groups to do the same thing. How can we capitalize on each other's strengths? I think it's a good one. I don't think we're there yet, but I feel the journey has started where because there's limited funding, we have to capitalize on strengths and then really look at the impact. And so, I mean, I think we're starting the journey, but I don't think we're there yet. I would say the marketplace is imposing that on us now, it really is. The era of limitless resources is perhaps behind us, at least for a while. Yeah, I would like to say that we don't fund two organizations doing the same thing, but we sometimes do, but we're quite cognizant of those things and I think there's internal processes we have in place, for example, so that we're not reinventing the wheel in every country. I think there's always an issue of pilotitis and I said this in an earlier panel. It's very easy to make something work with 10 villages or 10 small groups, but how do you actually scale that to 10 countries? That's the Holy Grail, right? Absolutely. Other questions or comments? Disagreements? That's fine. Hi, I'm Brad Michaels with Social Lab and I am mindful, of course, we are at SoCAP. So in addition to thinking within the global health market, do you also see opportunities for broadening and innovating and looking at new partnerships with some of the groups that are represented here that may be outside the global health sphere currently? So partnerships outside health, great question. Lara, what would you say? That's a good question. I mean, I think a big one that we've been thinking about, it's not necessarily a different sector, but I think speaking to an earlier comment, kind of the idea of how does the public sector become more of an active partner with the private sector partners that we support on the ground, I think would be a really great development to see actually the public sector emerge as more of kind of the systems designer and coordinator and regulator, but embracing the fact that in order to have a country-wide health system that works, you really need actors from all the sectors to make that happen, that the public sector simply isn't enough and maybe shouldn't be enough to do that. I do think, you know, one thing we come up with against a lot of times is kind of that combination of the socially-minded organization with the business skills, so kind of changing the mindset. I don't know if this is what you're speaking to, but a lot of our knowledge capital really has to do with kind of changing the mindset of how these programs are being conceived and managed, that they're more than a social project, it's actually a business, so to the extent that those kinds of skills can be brought from other sectors into the health sector as social enterprises emerge and grow and scale, I think that would be really helpful, particularly the marketing as a skill. We've seen it time and time again being kind of a real hang-up that we run up against in terms of how do you reach thousands of women living in remote areas with the same standard message and the same standard services, the same information, that really takes a marketing expertise that your average NGO founded for global health or a health project doesn't think maybe is the most important skill to hire on, so that's another issue. Wendy? I would add, and I think it's sort of the big obvious one with this crowd is how do we leverage the billions that are poised to be directed into impact investing? How do we leverage that for health and are there ways that we can come up with creative, innovative finance structures to be able to bring impact investing in to further our development goals? Certainly we can play a role in building a pipeline of innovations to come up with investable opportunities. We can play a role in de-risking those investments, which is something that we do, but finding a way to tap into that additional capital is, I think, would be a very exciting place to be in something we spend a good amount of time thinking about, but also for the entrepreneurs in the room thinking about where there are cross-sectoral spaces. So when we think about health, where energy and health may intersect. Education. Or education. On the energy side, thinking about the cold chain as being an important piece of health care delivery and where new innovations on the energy sector can play a role. So I think there's lots of interesting cross-sectoral spaces for innovation and need some creative minds to... And our funding doesn't always support those intersecting spaces. I think the Gates Foundation is probably better at doing that. We get funded in the asylos, and so it's a bit harder to fund outside of health. But I think there's a lot of room for innovation there as well. We're all victims of silos. We're all victims of silos. One more question? Yes. Hello. I'm Athalia, and I am actually a recent college grad and worked a lot with an organization called GlobeMed, which is a national university-based organization where chapters work with different grassroots organizations to address global health inequities. A lot of what we do kind of focuses on developing this leadership pipeline for students and people who hopefully will go into work in global health and development. And I was wondering what sort of advice or even expectations you had for these future leaders who will need to be able to innovate and to be able to create and build partnerships. A great question to close the panel on. Forward thinking. Laura, advice to future leaders. What should they be looking at? What should they be preparing for? Wow, so while it was mentioned as a key challenge, the silo effect that we have currently. So I think to the extent that your vision is really multidisciplinary and yet client-focused. So always keeping in mind kind of what is the end goal, but not limiting yourself to any one discipline or kind of skill set I think is going to be more and more important. And those fundamental relationship skills are not necessarily learnable in school, but I think sometimes make the difference between success and failure in artwork because you do have to bridge cultures, you do have to employ diplomacy. There's a lot of persuasion yet passing the ownership and so those types of political savvy skills are really key. Tony, what would you say? Advice to future leaders. I think, first I think having the diversity of thinking is going to be very important. I think especially as the world gets smaller. And I do think people who have experiences on the ground is going to be very critical. I think traditionally it has been leaders coming from the more developed countries. And I do think now many organizations are really looking to increase leadership presence in the ground with local up and coming leaders not just from the developed world. And I think that's going to be very critical. I do think leaders are going to come women, different experiences, different backgrounds are all going to be very critical. And I do think listening is going to be very, very critical. There's been a lot of learnings in the aid world of not listening enough so we bring products that end up becoming failures. And I think that's going to be a critical, critical skill. Great. Wendy? I would just say to believe and enter to know that your ideas can have a tremendous impact and we are seeing young entrepreneurs really be able to play a significant role in development and we need those new ideas and new ways of thinking and the belief that small ideas can actually have tremendous impact. So I applaud you and wish you luck. You're absolutely needed so keep it up. The last thing I'd say is just perseverance. I think it's a very, very complicated problem we're trying to solve not enough just to have one great idea. You're going to need that one great idea and hanging on to why you believe in that great idea for months, years, if not even longer. So perseverance is definitely the key. Great. Well, we've got 16 seconds left to go. No, we're over by 16 seconds. I thank the panel. I thank you all. Thanks for your questions. Thank you very much.