What went wrong?

Sometimes, things don't go exactly as planned.

Together with partners, we aim to make extraordinary things happen so that children can survive and thrive, today and in the future. We support innovative ideas with ambitious goals to deliver urgent and lasting change. Crucially, we want to share knowledge about what does and does not work.

We all understand that sometimes things go wrong. Indeed, as a philanthropy supporting bold ideas to seemingly intractable challenges for children, we expect sometimes to fail. Below we will share and update some of our disappointments and what we’re learning from them.

Saving children's lives in Bihar

Oral Rehydration Salts & Zinc Treatments

In 2010, we began a five year grant in Bihar, one of India’s largest states, to reduce childhood deaths from diarrhoea. The project aimed to demonstrate that treatment with zinc and oral rehydration salts (ORS) could be scaled up by government institutions.

Our goals were:

to prevent at least 4,200 child deaths
to treat at least 3.2 million cases of paediatric diarrhoea
to have a successful government-led approach to treating diarrhoea that would be copied by other states in India.

What happened?

The programme fell far short of its goals.

We estimate that less than 1,000 children’s lives were saved. Every life saved matters and we thought we could do better than that.

Around 1.8 million cases of diarrhoea were treated, just over half of the number we targeted.

The public health systems failed to procure and distribute enough zinc and rehydration salts at scale to make a bigger impact.

While there was a big increase in the number of children treated, the numbers always lagged the targets as procurement of treatments and training of health workers by government in scale up districts took longer than expected.

Procurement issues

An independent evaluation in 2013 showed that only one third of health workers were providing zinc because they didn’t have the stocks at hand.

The situation worsened in 2014 when officials at Bihar’s state procurement agency were investigated for corruption, and all procurement was stalled.

Despite these disappointments, there was also good news: the CIFF grantee, Micronutrient Initiative, worked with officials to ensure that zinc and ORS were incorporated in India-wide health protocols, monitoring indicators, and training.

And tens of thousands of community-based health workers now have the skills to provide effective treatment for paediatric diarrhoea once supplies resume.

What we learned

The design of the programme focused on helping the Government to reach children in need with two specific treatments – zinc and ORS. We had not accounted for – or prepared sufficiently for – the system changes required for the effective public procurement and distribution of these commodities.

We also assumed that the anticipated improvements in quality of care in the public sector would draw customers away from the many private health providers across the state – which only happened to a very limited degree. While those children reached with treatment benefitted, the regular stock-outs failed many others.