Philanthropic foundations and governance for nutrition in India: insights from governance practices

Abstract

BACKGROUND: Within shifting state-society relations and the rise of non-state actors in global health, philanthropic foundations have undergone a striking shift in the extent and speed of their integration into decision-making processes. Existing literature has largely focused on their involvement at the global level, with limited research into their national-level engagement in governance processes that shape health, particularly in low- and middle-income countries, and in the domain of nutrition. The aim of this study is therefore to generate empirical insights to understand the nature of philanthropic foundations’ engagement in governance for nutrition in India, and to examine the implications of this engagement for dynamics of power.

METHODS: This aim was pursued through qualitative case studies of two philanthropic foundations, Tata Trusts and the Bill & Melinda Gates Foundation (BMGF), that were identified as prominent philanthropies in the governance of policies and programmes for nutrition in India. Data collection consisted primarily of semi-structured interviews involving 67 participants. Interviews focused on generating data about the perceptions of a wide range of stakeholders (from government, civil society, inter-governmental organisations, non-governmental organisations, philanthropic foundations, and the private sector) regarding the engagement of the two philanthropic foundations, particularly in policy advocacy. An interpretive understanding of these perceptions was pursued through thematic analysis of interview transcripts, focusing on the framing of the BMGF’s and Tata Trusts’ engagement as shaped by the political and governance context, the practices and functions that constitute these philanthropies’ engagement, and their implications for power dynamics.

FINDINGS: The first results chapter explores how discursive framing of Tata Trusts’ and the BMGF’s activities as technical support served to de-politicise their engagement amid tensions related to a nationalist and exclusionary political environment and fragmented policy landscape. In the second and third results chapters, analysis of these philanthropies’ governance practices further illuminated the functions they performed, and implications for dynamics of power. This includes drawing a distinction between practices that are enacted through funding and practices involving operational staff roles, indicating a shift in the nature of these philanthropies’ engagement. The second results chapter focuses on the governance function of generating evidence, through which funding and staff practices demonstrate a relationship between material and ideational power. The third results chapter discusses staff and funding practices that constitute the function of mobilising evidence, including through convening a core policy advocacy network in this context. This illuminates how they navigate and create spaces of governance in ways that contribute to power dynamics through the inclusion and exclusion of actors, and through framing and programmatic approaches for nutrition governance in India.

DISCUSSION: Insights into discursive representations of Tata Trusts’ and the BMGF’s engagement in national-level nutrition governance processes in India, and the governance practices and functions they perform, illuminate the contextual constraints within which they operate and how they navigate these in pursuit of their policy goals. In turn, this reveals how their engagement is shaped by, but also reinforces, dynamics of power and of inclusion and exclusion within this governance context. A focus on governance practices and functions identifies how specific mechanisms of engagement enact the political work of technical support.

This thesis provides a national-level empirical contribution from research in a middle-income country to the largely global-level literature on philanthropic foundations’ roles in health governance and explores implications for governance and policymaking.