Despite being one of the fastest growing major economies in the world, India continues to battle several healthcare challenges. Of these, infectious diseases especially continue to afflict over 33% of the total ailing population in India ^[1] In the absence of containment and preventive measures, they can severely endanger public health in the country. Communicable diseases such as malaria, typhoid, tuberculosis, hepatitis, diarrhea and influenza are rampant in the country. They not only severely strain the public health systems, but also cause major socio-economic disruptions. Infectious diseases also bear a strong correlation with disability-adjusted life years (DALY), which are equivalent to years of healthy life lost due to prevalent diseases. Specifically, 35.7% of all DALY in India arise due to communicable, maternal, perinatal, and nutritional causes.^[2] In 2019, infectious diseases such as TB and diarrhea in India accounted for 3600 DALYs/100000 population.^[3]

Reform efforts to combat such disease burden in the country involve the government shouldering the maximum financial burden. The Union and State Governments are, on their part, trying to enhance their investments in healthcare, aiming to achieve 2.5% of GDP spending on healthcare by 2025.^[4] But a lot more needs to be done.

It is here that private funding in the nature of domestic, and particularly corporate social responsibility (CSR) donor giving can make a crucial contribution and bridge the gap.^[5] CSR is commonly understood as the duty of every company towards the society. It reminds the company that profit maximization for its own growth should not be its sole objective. Instead, generating social impact and incorporation of social goals in a company’s business decisions are equally relevant. In India, CSR is a mandatory requirement for any company meeting any of these three threshold criteria during any financial year: (i) Net worth of INR 500 crore or more; or (ii) Turnover of INR 1,000 crore or more; or (iii) Net profit of Rs. 5 crore. In any of these situations, the company is mandated to spend a minimum 2% of the average net profits (before taxes) made during the three immediately preceding financial years.^[6]

Interestingly, not only has CSR as a proportion of private giving witnessed an increase from 12% in 2015 to 23% in 2021; but is further projected to increase to 32% of total private giving by 2026.^[7] Of these, healthcare accompanied by the funds allocated to the Prime Minister’s National Relief Fund, has in recent years emerged as a primary avenue for CSR funding.^[8] Specifically, in 2020-2021, the CSR allocations for healthcare and the Prime Minister’s National Relief Fund increased by 30% and 112% respectively, whereas those for rural development and education contracted by 15% and 18% respectively.^[9] While the pandemic significantly influenced this with corporates generously contributing to covid-19 relief activities; interestingly the health pillar has been a preferred sector for CSR investments in previous years too. From 2014-2015 onwards, it has been second to only education in terms of attracting CSR donors.^[10]

For combatting infectious diseases too, CSR partnerships can play an invaluable role. This is in part because CSR is poised for a remarkable annual growth trajectory of 19%.^[11] The mandatory nature of the legislation and higher number of companies falling within the ambit of CSR governance, has spurred an INR 1 trillion CSR spend from 2014-2015 onwards.^[12] What these numbers highlight for infectious diseases is an opportunity that the world had not witnessed before.

When one talks about CSR and healthcare, support for vaccination drives and health camps is a natural preference for many corporates. Equally, others channel their funding on dissemination of important social and behavioural change messages on maintaining basic hygiene, undertaking precautions, inculcating handwashing habits etc. Fascinatingly, many companies opt to explore synergies between social and behavioural change communication efforts in health with the work they do in the education space. Yet others employ their funding on diagnosis, screening, medication and treatment of the infected patients. Often, companies also support with investments in training and continuous development of healthcare professionals. Yet some more prefer to extend support on capital expenditure of primary health centers and hospitals.

While these models of CSR spend in health are undoubtedly efficacious – a truly transformative impact can be achieved by supporting innovation and technology in healthcare, particularly through the start-up infrastructure. These aspects are currently lacking adequate allocation of CSR funding, which has traditionally seen miniscule allocation to technology incubators^[14] and has veered more towards supporting NGOs. While the Indian government did expand the orbit of CSR in 2019 to include contributions to government-funded incubators and towards research activities in science, technology, engineering and medicine at publicly funded academic institutions and bodies; this has not provided the necessary fillip to non-government players.

In addition, corporates are often keen to witness early impact of the initiatives they support. While a traditional healthcare intervention involving screening or vaccination drive may generate results quickly, start-ups in the field may struggle to demonstrate immediate outcomes.

Yet, technology and innovation can be able allies in solving problems confronting the health sector. As an example, the India Health Fund (IHF), an initiative of Tata Trusts, was set up in 2017 to reduce the risk of preventable deaths arising from communicable diseases. IHF is playing a catalytic role in the fight against communicable diseases, not least because restricted funds are deployed in this neglected sector. More impetus is laid on redressal of non-communicable diseases. On its part, IHF attempts to de-risk and enable promising technology which can aid in the diagnosis, treatment and prevention of communicable diseases. It considers collaboration with both the public and private sectors to facilitate the scale-up and adoption of these strategies in India and around the world.

Powering start-ups therefore hold the promise of a long-term and sustainable impact in addressing infectious diseases in the country; and rallying CSR partners towards this can aid the impelled growth of the start-up ecosystem in the country.

By Mrinalini Singh, Partnerships Manager, Tata Trusts

As a partnerships manager, Mrinalini Singh collaborates with Indian corporates and foreign foundations on supporting philanthropic initiatives of Tata Trusts. In her previous roles, she has worked with organisations such as the United Nations Association-UK, GIZ, and the Children’s Investment Fund Foundation on a range of public policy issues. Mrinalini has degrees in law from the Harvard Law School and the National Law School of India University.

Views expressed are personal.

[1] Ram B, Thakur R, Epidemiology and Economic Burden of Continuing Challenge of Infectious Diseases in India: Analysis of Socio-Demographic Differentials, Front Public Health, (2022), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9279679/

[2] Menon G et al, National Burden Estimates of Healthy Life Lost in India, 2017: An Analysis Using Direct Mortality Data and Indirect Disability Data, 7(12), The Lancet, (2019), https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30451-6/fulltext

[3] Global Health Estimates: Leading Cause of DALYs, World Health Organization, (n.d.),  https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/global-health-estimates-leading-causes-of-dalys

[4] Ministry of Health and Family Welfare, National Health Policy, 2017, National Health Portal, (2017), https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf

[5] Dasra, Bain & Co, India Philanthropy Report, 2022, Dasra, (2022), https://www.dasra.org/assets/uploads/resources/Dasra-Bain%20India%20Philanthropy%20Report%202022.pdf

[6] Section 135, Companies Act, 2013

[7] Supra note 5

[8] Id

[9] Id

[10] Srinivas I et al, Report of the High Level Committee on Corporate Social Responsibility, 2018, Ministry of Corporate Affairs, (2019), https://www.mca.gov.in/Ministry/pdf/CSRHLC_13092019.pdf . Note: The health pillar here includes WaSH and nutrition

[11] Supra note 5

[12] As c.f. Prasad GC, India Inc Spent Rs One Trillion on CSR Over Seven Years, Live Mint, (2022), https://www.livemint.com/news/india-inc-spent-rs-1-trillion-on-csr-over-seven-years-11646817710198.html

[13] Supra note 10

Publication Date: 27th Feb 2023