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The Business of Humanitarian Aid and Philanthropy: A Case Study

December 16, 2014

Piyush Tewari. CREDIT: SaveLIFE Foundation

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JULIA TAYLOR KENNEDY: You're listening to Impact from the Carnegie Council. I'm Julia Taylor Kennedy.

On this episode, we're using a single organization as a case study to look at how non-profits adopt business language, metrics, and strategy, and what that says about our society's approach to humanitarian work.

PIYUSH TEWARI: My name is Piyush Tewari. I'm the founder and president of SaveLIFE Foundation from India.

JULIA TAYLOR KENNEDY: Like many activists, Piyush awoke to the issue of road safety when it hit his own family.

PIYUSH TEWARI: I lost a young cousin in a road accident in 2007. When I researched more about the circumstances surrounding his death, I discovered that his life could have been saved, had he received emergency medical care on time. He was lying on the road for about 45 minutes, waiting for help. He asked a number of people for help, but nobody came forward, because of a number of fears surrounding helping injured persons on the road in India. So there was no bystander assistance. There was no ambulance that came forward. That's one of the reasons why he passed away.

JULIA TAYLOR KENNEDY: At first, Piyush grieved simply as a cousin. But he wasn't getting over the tragedy. As he researched more about road safety, he learned what a huge public health issue it is—one that's largely ignored. Every year, 1.3 million people die from road accidents, and India has the most road accidents in the world.

Plus, half of all roadside deaths in India result from treatable injuries, like those suffered by Piyush's cousin.

PIYUSH TEWARI: This was a death that could have been very clearly averted. I was encouraged by a number of people to actually channel that anger in the right direction and do something about the problem.

JULIA TAYLOR KENNEDY: At the time, Piyush was 27 years old. He was running the India country office of a U.S.-based private equity fund, managing a 300-person operation.

To explore how he could combat India's road safety problems, Piyush called a mentor named Krishen Mehta, who had worked at PricewaterhouseCoopers for decades. [Editor's note: Mehta is a longtime friend and supporter of Carnegie Council.] Mehta has since retired, and now helps launch organizations in India and elsewhere that tackle overlooked global challenges.

PIYUSH TEWARI: When I lost my cousin, he was the first person I called and spoke to about the incident, and asked him how he runs his philanthropic organizations in India, and how he would advise me to go forward. In fact, not only did he give me advice, he put me in touch with PricewaterhouseCoopers in India. That actually helped us set up the organization from scratch.

JULIA TAYLOR KENNEDY: Krishen and Piyush called the organization SaveLIFE Foundation. Just like any new venture, SaveLIFE's model has shifted over the years.

Let's call stage one, "first responders pilot." Piyush began with a technological solution that would bring help to accident scenes more quickly.

PIYUSH TEWARI: We realized that there was no way that we could inform a community volunteer within a certain area that an accident is taking place, even right next to their home, so that they could go and respond to that specific incident.

JULIA TAYLOR KENNEDY: Piyush gathered a team to develop a network that would activate automated calls to volunteer responders near accidents.

PIYUSH TEWARI: We could mobilize them every time we received a call from the local police, or from a passerby about an accident taking place.

JULIA TAYLOR KENNEDY: But in order to respond to calls, Piyush needed volunteers. He started with a highway corridor that runs between Mumbai and New Delhi.

PIYUSH TEWARI: We trained about 150 tribal volunteers—people who had not received much education, but were part of a tribal group, but had cell phones, and had access to motorcycles, who we then trained in lifesaving techniques, and then connected them through this platform.

JULIA TAYLOR KENNEDY: Access to motorcycles was key because on their motorcycles, volunteers can get to accident sites much faster than ambulances caught in traffic. The volunteers also tended to be geographically closer to the scene of the accident.

PIYUSH TEWARI: While the average response time of the ambulance was about 40 minutes, the average response time of SaveLIFE volunteers was under 10 minutes. So in under 10 minutes, we could have a trained person on the scene, equipped with a basic trauma kit, to give either CPR, or control bleeding, immobilize the c-spine, and ensure that the person is stabilized for movement into an ambulance for their transfer to the hospital.

JULIA TAYLOR KENNEDY: Encouraged by the success of this pilot group of 150 volunteers and the technology that notified them, Piyush wanted to replicate this model more broadly throughout the 10 million-person city of New Delhi.

And now we enter stage two of SaveLIFE's existence: first responders at scale.

Piyush knew he would have no trouble growing the operations side of SaveLIFE, given his experience running a 300-person office. But the funds just weren't in place. Since he was looking to work on road safety exclusively in India, Piyush focused on raising money within his country. But it was a punishing process.

PIYUSH TEWARI: Every time we would get support, it would be fairly limited, in terms of both the quantity, as well as in terms of how we can spend it.

JULIA TAYLOR KENNEDY: So he started to consider other options.

Piyush applied for, and won, a prestigious Rolex Award for Enterprise in 2010. A promo on the Rolex website explains who the foundation looks to support: visionary young men and women at critical junctures in their careers.

ROLEX PROMO: "The Rolex Award supports men and women who have a special spirit of enterprise, to initiate extraordinary projects that make the world a better place."

JULIA TAYLOR KENNEDY: As a Rolex Young Laureate, Piyush got about $50,000 and a lot of credibility.

PIYUSH TEWARI: Because, though access to funding is relatively easier globally, I think one has to be very cognizant of the fact that the funding is impact-driven. You have to create a process by way of which you can measure that impact and report back.

JULIA TAYLOR KENNEDY: Piyush worked with Johns Hopkins University to develop a nine-point impact assessment mechanism for every single accident to which SaveLIFE responds. As a result, he's able to rattle off all kinds of statistics demonstrating the real impact his organization is having on road safety in India. And they're pretty impressive.

PIYUSH TEWARI: About 6,500 policemen trained by us have taken close to 120,000 people to hospital in the last three years, with a survival rate of about 98 percent. So what we've seen in Delhi, is that we've contributed to a reduction in road accident deaths in Delhi, from 2,325 deaths in 2010, to 1,810 deaths in 2013—about 500 lives being saved every year.

JULIA TAYLOR KENNEDY: Not only did the Rolex Award help Piyush scale his first responder program and have real impact on road safety in Delhi, it also put him on the radar of other funders.

PIYUSH TEWARI: Echoing Green happened because of the Rolex Award.

JULIA TAYLOR KENNEDY: From an enterprise award to an entrepreneurship fellowship, Echoing Green is a non-profit organization that gives social entrepreneurs $80,000 over two years to grow their organizations.

RICH LEIMSIDER: Piyush, we knew right when we first started to get to know him, that he was that social entrepreneur.

I'm Rich Leimsider, the vice president of fellowship programs at Echoing Green.

To be candid, "social entrepreneur" is one of those terms that's had some success and so that means that there's a lot of people who find it useful to define themselves as a social entrepreneur. For us, it's the most basic definition. It's an entrepreneur. An individual who is starting a new organization, whose focus is, absolutely first and foremost, meeting sort of deep, unmet human needs, and has that kind of socially minded perspective. We are agnostic about whether it's a non-profit or a for-profit.

JULIA TAYLOR KENNEDY: True to that entrepreneurial spirit, as Piyush scaled his organization and worked with Echoing Green's community and mentors, he tweaked his model.

RICH LEIMSIDER: We knew if he discovered that this model wasn't the fastest or best way to actually solve some of these challenges that he would easily or gladly adapt and change. He wasn't somebody who wanted to run the biggest first responder training program in India. He was someone who wanted to end the scourge of roadside deaths.

JULIA TAYLOR KENNEDY: Piyush realized that to scale his roadside assistance network beyond Delhi, he would need to involve the national government, which brings us to stage three of SaveLIFE's development—from enterprise to public policy.

As the funding rolled in, Piyush hired attorneys and others who could lobby for national support. They worked with India's government to write and pass a law that would both provide auto insurance and first responder networks to drivers on all national highways.

PIYUSH TEWARI: We're hoping over the next three to five years, every single national highway in India will have that program deployed, as part of the scheme that government will be expanding.

JULIA TAYLOR KENNEDY: At the same time, Piyush established a driving safety program for truckers to prevent accidents.

PIYUSH TEWARI: Because about 40 percent of all deaths in India happen on national highways. The majority of them involve trucks.

JULIA TAYLOR KENNEDY: Piyush became well-versed on the economic impact of road accidents, beyond the number of lives lost.

PIYUSH TEWARI: India suffers an astounding loss of 3 percent of its GDP every year, as a result of road crashes. An estimate that we did last year, told us that about a million families have been pushed into poverty because of road crashes in the last decade, either because of death of their breadwinner, or disability suffered by the breadwinner.

JULIA TAYLOR KENNEDY: SaveLIFE has also been instrumental in lobbying the Indian Supreme Court to intervene and protect passersby who might stop and help in the aftermath of an accident.

PIYUSH TEWARI: In India, almost three out of four people will not come forward to help injured persons, regardless of whether there were other people around or not.

JULIA TAYLOR KENNEDY: Why won't they help? Well, they could get caught up in the legal system for years.

PIYUSH TEWARI: So even if there is minimal harassment by the police to extract a bribe, or just to make life tough for you, just going through the court system itself for many, many years, merely for the act of helping someone, can act as a deterrent.

In many cases, good Samaritans have also been detained at hospitals until police arrive, because they are potential accused also. So the Good Samaritan Law seeks to disconnect the act of taking the victim to a hospital, or assisting the victim from the investigation so that the act of saving someone's life should not be brought under criminal procedures and court procedures.

JULIA TAYLOR KENNEDY: The details are complicated, but basically, the Indian Supreme Court put the Good Samaritan Law in place this fall. India's legislature is also considering an even more comprehensive road safety bill, which SaveLIFE helped draft. So what started as a roadside assistance organization has morphed into something far broader.

On the funding side, SaveLIFE also experienced a growth spurt. Its budget has grown to $500,000 a year. Piyush employs about 15 people, many of them lawyers who left lucrative careers to help SaveLIFE on the legislative front. And he's become a bit of a darling in the global roadside safety community.

GAYLE DIPIETRO: I'm Gayle DiPietro and I'm the global program manager for the Global Road Safety Partnership.

JULIA TAYLOR KENNEDY: I reached Gayle in Geneva, Switzerland, where our phone connection left a bit to be desired. She explained that the Global Road Safety Partnership gets a big portion of its funding from Bloomberg Philanthropies. The partnership supports road safety organizations around the globe with grants of at least $60,000 per year—a big injection of cash for developing-world organizations.

The Global Road Safety Partnership gives those large sums because it sees road safety as a hugely urgent public health concern that can hit developing economies hard.

GAYLE DIPIETRO: We see the link to poverty when a family breadwinner is lost as being a public health issue. Most of the victims are young males in the 18-45 age group and that is the earning years and they are usually the breadwinners in the family. So it has huge social implications, as many public health issues do.

JULIA TAYLOR KENNEDY: The relationship between Piyush and the Global Road Safety Partnership is pretty unusual.

GAYLE DIPIETRO:We initially put out a grant calling for grantees or NGOs to apply for a grant. Piyush's organization didn't apply, but a lot of other Indian organizations did and India has got a huge huge road safety problem.

JULIA TAYLOR KENNEDY: Put yourself in Gayle's shoes: She's desperate to support a road safety organization in India, but doesn't see a single promising grant recipient among those that apply.

GAYLE DIPIETRO: I'm sure there was a needle in that haystack somewhere so I put out feelers around all of our corporate members, into our government partners, into our educational institutions. SaveLIFE Foundation's name had good recognition in the media and really solid organization.

JULIA TAYLOR KENNEDY: So Gayle approaches Piyush to see if he might be open to receiving her funding. He, of course, says yes!

GAYLE DIPIETRO: It's rare to go looking and find someone, but it can happen. You have to win the lottery every now and then.

JULIA TAYLOR KENNEDY: Having won the lottery, Piyush developed a very close working relationship with Gayle and her organization.

GAYLE DIPIETRO: Piyush is remarkable. He's got uncompromising ethics. He doesn't, for want of a better word, sell his soul to the devil for short term financial gain.

So, for example, there's a lot of money out there by the alcohol industry and that's just one of the no-nos in our field is not to take money from one of the greatest causes of road crashes. Piyush has had tempting offers, but he knows what their organizations stand for.

JULIA TAYLOR KENNEDY: Still, Gayle has given Piyush some tough feedback on his funding model.

GAYLE DIPIETRO: I did some work with Piyush on how to sustain an organization beyond a grant—what sort of direction and what sort of relationship to start building so that you have got something beyond the grants, because these things end one day.

JULIA TAYLOR KENNEDY: Piyush is well aware of the limits of his current project-based budget.

PIYUSH TEWARI: If tomorrow, the grant funding stops, I'll have to ask almost 70 percent of my team to leave. So it's not a very good situation to be in. What we're looking for is a lot more funding that can help sustain the organization longer-term because we are absolutely committed to dealing with this issue until it gets absolutely resolved.

JULIA TAYLOR KENNEDY: And funding can be fickle, especially in road safety.

GAYLE DIPIETRO: Investment in road safety is not sexy. If you take Ebola, for example, it's horrible but I think the number of people that are killed is probably only about the same as two days in the world in road-crash death and injury.

JULIA TAYLOR KENNEDY: But because both Ebola and road safety are public health issues, they compete for funding.

Take Piyush's experience at the 2014 Clinton Global Initiative annual meeting. He was invited to attend and became a complimentary member of the organization because of his accomplishments in India.

When Piyush and I first met in September, he was getting ready to speak about SaveLIFE Foundation on stage with former President Bill Clinton, in front of hundreds of potential corporate funders.

PIYUSH TEWARI: It's certainly a huge honor for us to be able to access such a global platform and get access to individuals and resources that can potentially change the course of what we do.

JULIA TAYLOR KENNEDY: Piyush's vision was to use money raised from partnerships forged at the annual meeting to build a larger, multi-sector coalition in India to combat road safety. But he didn't get his time on stage. He was to be featured in the public health session.

And then the Ebola crisis hit.

I caught up with Piyush to get an update via Skype once he had returned to India after the meeting.

PIYUSH TEWARI: The presentation didn't happen, because I think—I'm not sure, officially, what the reason was but I think they brought in Ebola as a point of discussion so they moved pretty much all the presentations that were lined up in my track to focus on that issue.

JULIA TAYLOR KENNEDY: Piyush met separately with President Clinton and started conversations with several large corporations about his vision for SaveLIFE, but he didn't get the jumpstart he was hoping for.

PIYUSH TEWARI: It's been fairly slow. I have to admit that. The funding hasn't been very outrightly forthcoming in terms of—there are organizations who raised money at the event itself, which we were not able to. We've had a couple of conversations, follow-up conversations, no commitments yet, so we're hoping that the conversations convert to commitment sooner than later.

JULIA TAYLOR KENNEDY: So let's step back and take stock of SaveLIFE's story.

With a background in business, Piyush has built a non-profit organization on solid entrepreneurial principles: start small, measure impact, scale your model, shift your model to broaden impact, attract resources with your compelling economic reasoning, accept funding from sources aligned with your outlook.

Piyush is making enormously rapid progress with the government and on the ground with measurable impact. And yet, if the grants dry up, or if he's not able to secure further funding, SaveLIFE could disappear.

PAT ROSENFIELD: The problem with philanthropy is that results might take a generation or two generations to be achieved and that's where these foundations, especially the older ones, Carnegie and Rockefeller, took a long view.

Pat Rosenfield. I'm a senior fellow at the Rockefeller Archive Center.

JULIA TAYLOR KENNEDY: When it comes to the evolution of philanthropy, Pat Rosenfield is a walking encyclopedia. She's worked at the Ford Foundation, headed the Carnegie Scholars Program for 10 years, and she just completed a more than 600-page tome chronicling the history of the Carnegie Corporation. She's got a firm grasp on what drove these private foundations.

PAT ROSENFIELD: These were very big ideas, important missions that were dealing with structural social issues. Now, some of it impinged on economic performance but that did not motivate them at all.

JULIA TAYLOR KENNEDY: When did business acumen and entrepreneurship start becoming a priority for funders? Rosenfield traces the origins back to an article in Harvard Business Review in the 1990s.

PAT ROSENFIELD: Christine Letts wrote an article for the Harvard Business Review, and I think she had some co-authors, but we invited Christine to come talk. We absolutely were not on the same page with her. And I don't think anybody in that room on the private foundation side thought that this was going to go anywhere, because it just seemed so clear.

The measurement—rates of return and using business metrics and economic loan metrics—really banking metrics for measuring the impact of grant-making, what the World Bank looks for in its loans, not in its grants but in its loans—this is not what foundations ever thought was going to be a reasonable thing to be talking about.

JULIA TAYLOR KENNEDY: And yet, Rosenfield watches business terms cropping up throughout humanitarian work. Talking about road safety in terms of breadwinners dying in traffic accidents, for example, seems inappropriate to her.

PAT ROSENFIELD: Men, women, and children, and animals are dying every day from road accidents. It's not just in India. It's a really global phenomenon but it is something that affects everybody and it shouldn't just be breadwinners.

My favorite sign in India is "lane driving is sane driving." And when you're driving down the wrong way on a lane and it's a one-lane road or a two-lane road, rather, you see this truck coming right at you thinking, "I don't want to be here right now." So I might have been the breadwinner for my family but I was thinking about, "I don't want to get in a terrible automobile accident."

JULIA TAYLOR KENNEDY: Basically, Rosenfield thinks you shouldn't measure the value of human life in economic terms.

PAT ROSENFIELD: Yes, it has an economic benefit but you should not make that kind of judgment.

It's really a moral and ethical judgment about saving this life and you don't want to distinguish between the breadwinner and the mother, because if the mother dies, we know what that does to children. They are much more likely to suffer. And especially infants will die—much more likely—if their mother dies. You don't want children to die. That's a future breadwinner or the future member citizen in that society.

So you don't want to make that choice and basically it's a public good where you don't have to differentiate between man, woman, and child.
        
JULIA TAYLOR KENNEDY: Rosenfield thinks even the developing world organizations applying for grants should move away from these kinds of metrics.

PAT ROSENFIELD: I absolutely wouldn't cave into that, because I have to think: Is that money worth it?  

JULIA TAYLOR KENNEDY: Instead of making an economic capital argument, she'd make a social capital argument.

PAT ROSENFIELD: It's a human good, a public good. So I would make the social capital argument, and social capital is just as viable as economic capital. That person may be the one who rallies everybody when there's a crisis and gets the whole community together—is a really good community organizer. Or that person is a mother who runs after-care programs for the children or just helps children learn how to cook or something that has probably no economic value to it but a huge amount of social capital to it.

And I would make it in very clear terms, not on assumptions—you have to collect data. So it has to be evidence-based. I'm not saying this is on opinions or wishful thinking, but if you frame it properly I'd say most foundations, of course, would be very much taken by the social capital argument.

JULIA TAYLOR KENNEDY: That said, Rosenfield is very impressed with the progress Piyush has made with road safety in India.

PAT ROSENFIELD: They're working on the whole range from the technology to the behavior. And it's really important. We know here in this country, Mothers Against Drunk Driving, Ralph Nader—the fight he headed in the '70s with seatbelts and now every car has a seatbelt. You wouldn't be in car without a seatbelt.

JULIA TAYLOR KENNEDY: There's a social norm to say, "You idiot, put on your seatbelt."

PAT ROSENFIELD: That's right. They changed a social norm and this was an individual through an organization—a public charity, rather—trying to work for social change. It was achieved and I think SaveLIFE is well on its way to doing that. And that should be the measure of success.

If they change the social norm and Indian drivers drive in their lane and everybody's wearing a seatbelt—if they can get that kind of behavioral change, to me, that would be a phenomenal success and this group should be winning prizes right and left.

JULIA TAYLOR KENNEDY: So given the important work that SaveLIFE is doing, should the organization focus on the social capital argument across the board as Pat Rosenfield suggests, or take a more pragmatic route by using economic arguments to attract resources? If it helps bring in funds, do the ends justify the means?

RICH LEIMSIDER: In some ways, a social entrepreneur can be ruthlessly practical about that and simply say, "How am I going to make this work happen in the world?"

JULIA TAYLOR KENNEDY: When he's asked this question, Rich Leimsider of Echoing Green comes firmly down on the side of pragmatism.

RICH LEIMSIDER: I will say one thing that I see our fellows struggle with time and time again: the reality that the whole reason they are doing what they're doing is that at some fundamental level, there is a system that is broken.

You talk about climate change, for example. We launched a climate fellowship last year and there are absolutely fellows in that community of social entrepreneurs who believe that they only want to succeed if sort of the whole world comes to recognize it's really important to work on these things.

Then there are others in that same community who believe you've got to do whatever it takes and if you have to make an economic argument to get people to join you in switching to alternative fuels and things like that, that's perfectly fine. They don't need everybody to totally toe the line on the sort of moral significance of it.

At Echoing Green, we're comfortable having both those kinds of social entrepreneurs in our portfolio.

JULIA TAYLOR KENNEDY: For Piyush, his driving mission is in the title of his organization: It's to save lives. And he says that the first responder volunteers in his motorcycle network aren't getting paid in dollars, but they enjoy the reputation they gain in their communities as lifesavers.

Piyush took a pay cut to start this organization, and the work isn't making him rich. But he's always aware of why he got into the road safety business in the first place.

PIYUSH TEWARI: Every time I meet a family who's faced the issue, or I hear about a major incident, I go back to what happened with our family because I think I understand what pain feels like, when you lose somebody close in your family. I think, because the issue remains a major issue, that reminder is there, pretty much consistently.

JULIA TAYLOR KENNEDY: Has Piyush's business background and entrepreneurial drive helped him get SaveLIFE off the ground? Probably. Hopefully his commitment and passion to his mission give him the staying power to keep his organization alive despite a fickle funding climate.

Thanks for listening to Impact from the Carnegie Council.

A special thanks to our production team Mel Sebastiani, Terence Hurley, Deborah Carroll, and Amber Kiwan. I'm Julia Taylor Kennedy. You can find out more about this podcast at carnegiecouncil.org. You can also find us on iTunes and policyinnovations.org.

We welcome your feedback—do let us know what you like or what we can improve. And please suggest future topics so we can continue making podcasts that interest you.

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