Case Study 9: India’s First Strategic Public Health Merger + $30 Million Fundraise from the Bill & Melinda Gates Foundation (BMGF)

Problem Statement

Prior to the merger, Piramal Foundation and CARE India were operating as two powerful but parallel entities in the Indian public health space. Each organization had deep expertise:

Piramal Foundation: Known for its leadership in system transformation, digitization (Digital Bharat Collaborative), tribal health (Anamaya), and large-scale collaboration through the Aspirational District Collaborative.
CARE India: A public health delivery expert, with decades of operational experience in maternal and child health, infectious diseases (Visceral Leishmaniasis, Lymphatic Filariasis), and frontline community engagement, especially in Bihar and Jharkhand.

Key Challenges:

Fragmented Impact: Independent operations created scale limitations that neither organization could overcome alone.
Operational Redundancies: Duplicate investments in administration, field management, and supply chains reduced frontline impact.
Funding Limitations: Both struggled to independently attract transformational, multi-year funding required for national-level disease elimination programs.

Strategic Approach

Project Sangam: Post-Merger Integration

The leadership envisioned Project Sangam as more than a merger—it was a strategic consolidation to create one of India’s largest non-governmental public health delivery platforms.

Core Components:

Unified Platform: Combined Piramal’s tech-led system transformation with CARE’s deep operational roots in community health, maternal and child health, and communicable disease control.
Integrated Operations: Consolidated governance, leadership, reporting lines, and operational structures across 784 blocks in Bihar and Jharkhand, covering over 134 million people.
Programmatic Synergy: Merged teams tackled a portfolio of complex health priorities including maternal mortality, immunization, malnutrition, Lymphatic Filariasis (LF), and Visceral Leishmaniasis (VL) elimination.
System Transformation: Leveraged digital innovations like the SAKHI App, AMRIT EHR platform, and state-level dashboards to build government digital capacity and streamline data governance.

Strategic Fundraising: $30 Million from BMGF

Following the merger, the combined entity pursued an ambitious $30 million funding ask from the Bill & Melinda Gates Foundation (BMGF), centered on disease elimination and systemic health improvements in Bihar and Jharkhand.

Key Elements of the Fundraising Strategy:

Unified Value Proposition: Positioned the merged entity as uniquely capable of delivering last-mile public health outcomes at scale, with deep government partnerships and proven digital platforms.
Strategic Alignment: The proposal aligned closely with BMGF’s goals of eliminating Lymphatic Filariasis and Visceral Leishmaniasis and strengthening public health systems.
Data-Driven Proposal: Provided detailed impact frameworks, baseline assessments, risk management plans, and systemic bottleneck analyses derived from both organizations’ operational histories.
Operational Blueprint: Presented a concrete execution plan including block-level staffing, government capacity building, frontline worker mobilization, and integrated review platforms to monitor program fidelity.
Demonstrated Track Record: Leveraged CARE’s previous success in Bihar’s health system transformation with BMGF and Piramal’s proven impact across the Aspirational Districts and tribal communities.

Impact of the Integration and Fundraise

Public Health Outcomes:

National-Scale Reach: Created one of India’s largest public health platforms with capacity to execute elimination programs for LF and VL across 784 blocks in Bihar and Jharkhand.
Enhanced Program Delivery: Improved drug consumption rates for Mass Drug Administration (MDA) programs, strengthened frontline worker capacity, and built community trust through unified outreach strategies.
Systemic Efficiency: Reduced duplication of efforts and administrative overheads, ensuring a higher proportion of funds directed to direct service delivery.
Sustainable Digital Systems: Advanced the digital public health agenda through integration of EHR systems, real-time disease dashboards, and improved line-listing for target populations.
Landmark Funding Achievement: Successfully raised $30 million from BMGF to power the unified health platform, securing both validation and long-term resourcing for the integrated vision.