At a time when foreign-funded NGOs are under the government’s scanner,, Padma Bhushan awardee and co-founder of the Bill and Melinda Gates Foundation , says NGO activism is needed for society to thrive. She was speaking to TOI’sThe government needs to make continued investments in health if they want to make progress for women and children. They have this commitment to India’s Every New Born Action Plan, but continued investments are going to be really important. I was just in Bihar two days ago and I saw they have absolutely the right goals towards new born and child health but there are still gaps in supplies, HR needs, making sure the system works effectively. There’s still plenty of work to be done.When a woman can take the decision herself, when she is educated and has the choice about when and if and how to space her births, it transforms her life and her family’s life. In India, we know that 1 in 2 girls are married before the age of 18 and a girl, if she has a baby between 15 and 19, she’s twice as likely to die. So why is India part of the 10 countries with the highest maternal mortality rates? Because you’re losing so many of these young girls. A 15-year-old girl’s body is hardly ready to have a baby. When young woman can’t space the births of her children, her babies have a lower birth weight and she’s twice as likely to die.Yes, but the whole focus now on family planning is how do you put the woman at the centre and let it be voluntary, not having these targets, like there were in the 1970s in India. Today 77 per cent who are sterilized in India have never used another method, that’s completely different from the Western world. Wealthier women in Indian society go for other options, they go to the private sector and they do space their children. We need to make sure all women are educated and have those choices.The Indian government is now putting out postcards on IUDs and training people on how to insert those in young women. Over time I’d like to see the Indian government offer injectibles or even implants. Injection is a better option if you want to wait 6-9 months, but IUD is better if you want to wait for 5 years. The idea is to let women decide what works for them.There’s still much progress to be made. Indian society is having the right conversation, the fact that you’re getting more cases of rapes being reported is actually a sign of progress. But I was just in a tribal community in Jharkhand and there’s a lot of domestic violence in their own households and some of it is even women don’t even realise that its not acceptable. Women self help groups have become very empowering but you need to have a lot more of that kind of empowerment.By getting women into the facility and making sure the right things are done at the facility level. That is the key to bring down maternal mortality along with family planning. There’s a Better Birth check –list we have: things you ought to do right when the woman comes in. One of the very first things you need to do is take the woman’s blood pressure as a lot of women die because their blood pressure goes up too quickly. Hand washing, turning faucets with their elbows. Making sure there’s a warmer so the baby is delivered and can immediately go into a very simple warming plate: those things make a huge difference.I purposely didn’t dig into the Maoist-related issues. I was there to see women's self help groups and see where they actually make a difference. The organisation I was there with, Pradan, has 350,000 self- help groups. The women are so vociferous. They are no longer living in situations where they get a crop only six months in a year, but they get a crop round the year. They can plant vegetables and legumes. It changes the whole trajectory of their family because they are not scraping by for food for 4 months of the year. They can count on the supply of food and they can put a little bit on the local market and get an income. They said, I only had one sari to my name before, I used to wash my one sari in ashes. Now, I have a little bit of soap and I have two saris. My mother-in-law gave me the worst part of the house when I moved in, now my husband and I have built another room in the house. They have become so empowered in their own households. They see themselves differently. Their husbands see them differently and their mothers-in-law see them differently. It’s a huge change.And once they’ve got more economic means now they’re moving on to other social issues and they’re starting to act together against rape cases and drinking, standing up to men when they come home drunk, as a group. So they see the power of the group. I was sitting with a group of 20 women and they said we didn’t even know each other's names. We knew the men's names in the village but we weren’t called by our names –they didn’t have an identity. And now, we all know each others names. Even our husbands know our names and we use our names.Well, Kerala is actually a model. One of the amazing things that India has going for it is the competition among states. They look at each other, they not only look at health spending, they look at efficiencies. But the place that I’m seeing the most progress is Bihar. They really are bringing down their infant mortality rate, their maternal mortality rate, and the nutrition rate is starting to come up. They’re also taking a strong stand to eliminate Kala-azar, its great to see. I’m most impressed by the progress in Bihar, given where they’re coming from and their level of poverty.UP is incredibly hard because of the number of people there. It's huge. They have some inefficiencies in the health system that need to be addressed , they’re working on those. They need to get the ASHA system up and working better.We need to bring change through the ASHA workers—community health workers-- because they are the ones who are accepted by the village. As ASHA workers get better trained, they get more respect. Worldwide, we see a functioning health care system needs a community health care worker system, a cadre which India has. Many countries don’t have a system of community health workers. India’s actually invested in the cadre of health care workers. Need to keep investing more in training them.Things are getting better. Bill and I call ourselves “impatient optimists”. Childhood deaths used to be 12/100 in India in 1990s now that done to 5 children out of 100. That’s a huge rate of progress. 56 per cent die in the first month of life. So we’re impatient. We want to make faster progress.I went to a catholic school. My high school had a set of very liberal nuns and they really taught us about the catholic church’s vision on social justice. That the world ought to be equitable. We did a lot of local volunteerism in the community. Bill's very much from a background of community service. We agreed while we were engaged, that the vast majority of the resources from Microsoft would go back to society.The Tata family is an amazing example of philanthropy. Azeem Premji, Rohini and Nandan Nilekani too. We all talk about how philanthropy can be a catalytic wedge. It can take risks where govts can’t or won’t, and shine a light on public policy issues. Swati Piramal and her husband are doing incredible work in the healthcare sector. More are starting to follow their model.In a thriving society you need to have thriving NGOs and thriving government. I think the NGO sector should work hand in hand with the government. Sometimes they nudge governments that help move things along but whenever I see huge progress being made its when you have a healthy NGO sector and a healthy private sector and a healthy government sector. NGOs have an important role to play.