Suhani Jalota was only 20 years old when she established a foundation to help impoverished women in the slums of her native city, Mumbai. She was 23 when Forbes named her one of Asia’s 30-Under-30 Social Entrepreneurs as her foundation was taking off.

Now, at the ripe old age of 24, she is embarking on her pursuit of a PhD in health policy on the econ track at Stanford Medicine’s Department of Health Research and Policy.

As a social entrepreneur, she is hoping to create self-sustaining health organizations managed entirely by the people in the low-income communities they serve.

Last year, Jalota, who is also in the first cohort of Knight-Hennessy Scholars, received the Queen’s Young Leader award from Queen Elizabeth II and attended the royal wedding of Prince Harry and American actress Meghan Markle, who is now Duchess of Sussex.

The Myna Mahila Foundation— which provides affordable sanitary products and promotes employment and empowerment among women in Mumbai’s slums — was the only non-UK charity chosen to receive donations in lieu of gifts for the royal couple.

Stanford Health Policy caught up with Jalota to ask her a few questions about what inspires her and how she became so passionate about sanitary health and empowering women in India.

Who inspired you to become social-entrepreneur at such a young age?

I come from a government family and, growing up, our conversations at home were always about the development of India and the status of women. My father is an Indian civil servant who has worked on water sanitation for the city; my mom works with underprivileged girl children, and my brother creates water filters for the same slum community. My grandparents were in the police. It’s just what we do. It’s our family calling. 

As for entrepreneurship, it was Duke University, the Baldwin Scholars Program and the Melissa and Doug Entrepreneurship Fellowship that actually made me believe that all the dreams I had to change the pitiful state of things on the ground in Mumbai could actually be achievable. There I learned to translate the problems I saw to actionable items that the institution was willing to back and support endlessly.

Then in 2011, I met Dr. Jockin Arputham, who spent 40 years working in the slums of Mumbai as the founder of Slum Dwellers International. He became my inspiration, my idol and my mentor. He singlehandedly improved the lives of millions of women.

Dr. Arputham passed away in October. I am here to complete this mission.

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What inspired you to establish the Myna Mahila Foundation? 

When I started spending more time with women in the slum communities they told me horrific stories about living on the railway tracks, children dying in front of them, and not being able to walk the public toilets without being sexually harassed. Some were taking pills to constipate themselves just so they did not have to go to the public toilet. Others would tell me how they had been married off at 12 and were still living with drunk husbands who beat them every day. 

Women were ignoring their own health and it really struck me as how this would lead to such wasted potential for the women, and for India.

The slum community leaders and I began brainstorming — we became very chatty. That’s where the name comes from. Myna from the chatty South Asian bird and Mahila, which means women in Hindi. And we found that their menstrual cycles were physically and mentally exhausting. We found that sanitation and hygiene were clear signals of dignity for women, so we jumped on that.

You see, 320 million women in India do not have access to sanitary pads. And menstruation in India is a taboo health topic; there is a stigma to shopping for sanitary pads. Most women use rags on their periods and these often become dirty, leading to urinary and vaginal infections.

When you are trapped under an aluminum roof where your horizon is the lining of the slum settlement, and you only see limitations ahead of you, it is difficult to see another way of life. After more than six years of working on sanitation and health research with these women, I realized the problems lay deeply entrenched in a woman’s lack of agency, or ability to make decisions. You are brought up to think that what the generations ahead of you have been doing is the only way of life. Hiding your periods, not cooking food or sleeping with the family during your periods, not going to the temple or playing sports — you believe this is the only way to live.

So we came up with a scheme to sell sanitary pads door-to-door to women who would normally not leave their homes or go to a pharmacy to buy them from male clerks. And we get to know these women; they are opening up and exploring things outside the confines of their husbands’ world. I learned that if women were confident to talk about their periods and menstrual hygiene, it could break the silence surrounding domestic violence or sanitation.

Tell us about the women who work for you and the women you serve. 

We employ women from the slum communities we serve, including the accountants, production and sales managers, and the education trainers. We work mostly with Muslim women as that is a representation of the demographics of the communities we are in.

We currently meet about 10,000 women at their doorsteps every month in the 12 slums across Mumbai. It’s not about giving out free pads — a woman gets her period 450 times in her lifetime, so what we’re trying to do is make sure that she understands that it’s a normal health cycle that should not stop her from getting her education and jobs. We have more than 500 girls in our sponsor a girl program, with 100 more girls joining every month. We hold individual counseling and mentorship for these girls along with menstrual hygiene workshops at health camps. We employ 20 women and have partnerships with self-help groups across the city who work with us part-time.

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In the words of my mentor Dr. Arputham, it’s not our purpose to tell the women in the slums what to do; you must think about it from their perspective of what they need and help them create their own change. This has been my mission ever since.

We have millions of NGOs in India so you realize that if things are not really improving at a national level, then there’s something that we’re not doing right. We need the civic mindset to marry the efficiency of the business world. This makes people less dependent and more autonomous to be in control of their own situations. And that comes with a sense of pride.

Why focus on health and sanitation?

We are still struggling with the basics in India: basic health, which includes food, housing, potable water and improved sanitation. Numerous research studies have demonstrated that improvements in sanitation have led to dramatic improvements in health, such as life expectancy outcome measures. Unless we have basic health standards achieved, we will remain behind. To add to the problem, health-care is often deprioritized in India. While it accounts for nearly 18 percent of the GDP here in the United States, for example, it only accounts for 1 percent in India. Can you imagine that? With more than 1 billion people. The role of the public sector in India is to get people on the same level playing field with the basics: education, health care so you’re well enough to go to school or work, find food, shelter and water.

India is a true democracy — so if people start to recognize the importance of health and demand better health care, they can get it. 

What are your goals for the PhD?

To learn more research techniques to use for conducting experiments on the ground for a variety of topics, including women’s demand for health care, effects of positions of power in seeking health care, and the connection between environment and health. On the supply side, I am becoming increasingly interested in understanding pay-for-performance incentive structures in health institutions and for front-line health workers.

I will also be spending my December breaks and summers in India working at the foundation. After my second year, I hope to continue data collection for my dissertation topic: the effect of environmental changes on health outcomes, such as child stunting levels in the slums. As part of my undergrad thesis, I collected anthropometric data on 880 children to look at the effect of slum redevelopment (when the government forcibly relocates people from slums to government subsidized housing) on child stunting. I learned that when a child has one additional year in the buildings — instead of out in the slums with no toilets and clean water and proper ventilation — they were less likely to be stunted. The effect was even more pronounced (and significant) for children moving from slums without toilets than for children moving from slums with toilets.

Another area of research for me moving forward is how this plays out if a pregnant mother gives birth in the slums or the building. Is that affecting the child’s birth weight? Is water quality, sanitation, population density — have other health outcomes actually improved?

You could have gone anywhere for your PhD. Why Stanford?

The Knight Hennessy Scholars Program — that was a very compelling pull. Further, I think that being at Stanford gives you this additional advantage of having access to really positive technology like Virtual Reality — giving people exposure to a different world. We want people to demand better health care, so if they can experience what it feels like to walk into a hospital and a clean waiting room with a bench and a trash can, it can change their concept of what they deserve. I’m really excited to learn more about how new technologies can be applied in the slums to prompt people to stand up and demand better for themselves.

I took two women who work at Myna Mahila with me to the royal wedding. These are women who come from the slums — and what impressed them most was the cleanliness. They couldn’t believe how people could keep everything so clean. If more women see this through VR, they will start to think that this world should become theirs too. We have access to thousands of women and if we can teach menstrual hygiene education through this technology — well, as an entrepreneur, I get very excited about this. This is just one of the many technologies I want to learn more about and see if they can be applied in the slums.

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What did you make of Meghan Markle’s visit to the foundation in January 2017?

When she came to visit she told us she would support us in any way that she could. She kept her word. For us being chosen as one of seven charities for the royal wedding, I thought to myself, oh my God, she really thinks that we’re on to something that could actually change the world for many women. I feel like I have a huge responsibility to live up to their expectations. Now we have to keep our word to them and help women meet their true potential.

Note: This piece originally appeared at Lawfare.

Many analysts, practitioners, and scholars are skeptical of the efficacy of drone strikes for counterterrorism, suggesting that they provide short-term gains at best and are counterproductive at worst. However, despite how widespread these views are, reliable evidence on the consequences of drone strikes remains limited. My research on drone warfare and U.S. counterterrorism—some of which was recently published in International Security—addresses this issue by examining the U.S. drone war in Pakistan from 2004 to 2014. Contrary to the skeptics, I find that drone strikes in Pakistan were effective in degrading the targeted armed groups. And, troublingly, they succeeded in doing so even though they harmed civilians.

Three Key Findings

I have conducted research in Pakistan and the United States over the last few years, gathering new qualitative data on the politics of the war and its effects on the two main targets, al-Qaeda and the Pakistan Taliban. I have also evaluated detailed quantitative data on drone strikes and violence by al-Qaeda and the Pakistan Taliban. This research offers three important findings.

First, the U.S. drone war was damaging for the organizational trajectories of al-Qaeda and the Pakistan Taliban. I found that after the United States surged its surveillance and targeting capabilities in 2008, both groups suffered increasing setbacks; they lost bases, their operational capabilities were reduced, their ranks were checked by growing numbers of desertions, and the organizations fractured politically. These effects appear to have persisted until 2014. In a related paper, my University of Michigan colleague Dylan Moore and I show that during the drone program in the Waziristan region, violence by the two groups fell substantially.

Second, the U.S. drone war disrupted al-Qaeda and the Pakistan Taliban not just by killing their leaders and specialized rank-and-file members, but also by heightening the perceived risk of being targeted. Across a variety of empirical materials, including some collected through fieldwork, I found that both groups were direly constrained by the fear—a constant sense of anticipation—of drone strikes, which crippled routine movement and communication. In addition, leaders and rank-and-file jihadis regularly viewed each other with the suspicion of being spies for the drone program, which contributed to their organizational fragmentation.

Third, the notion of increased recruitment for al-Qaeda and the Pakistan Taliban due to civilian harm in drone strikes is questionable. In the local battlefield, I did not find evidence of any tangible increase in recruitment. Interviews with some surviving mid-level members of al-Qaeda and the Pakistan Taliban negated the impression that the groups benefited from a stream of angry recruits. Instead, a recurring theme was that they experienced desertions and manpower shortages because of the stress of operating under drones. To the extent that new recruits were available, both groups struggled to integrate them in their organizations because of the fear that they might be spies for the drone program.

Beyond Pakistan?

The U.S. drone war in Pakistan is a crucial case of U.S. counterterrorism policy, but it is one of many other campaigns. The U.S. government is waging such campaigns in Yemen and Somalia, and considering an expansion in the Sahara. In my work, I identify two factors which are important for the dynamics evident in Pakistan to hold generally.

First, the United States must have extensive knowledge of the civilian population where the armed group is based. The counterterrorism force needs such knowledge to generate intelligence leads on their targets, who are often hiding within the civilian population. This comes from detailed population data sharing by local partners, large-scale communication interception, and pattern-of-life analysis of target regions from sophisticated drones.

Second, the United States must be able to exploit available intelligence leads in a timely manner. As members of targeted armed groups consistently try to escape detection, most intelligence has a limited shelf life. The capability to act quickly depends on the bureaucratic capacity to process intelligence, decentralized decision-making for targeting, and rapid-strike capabilities like armed drones.

In Pakistan, the United States met these criteria with an abundance of technology and high-quality local partner cooperation. Starting in 2008, the United States mobilized a large fleet of drones and surveillance technologies to develop granular knowledge of the civilian population in the targeted regions. Despite deep political rifts on the conflict in Afghanistan, the Central Intelligence Agency obtained extensive covert support from Pakistani intelligence against al-Qaeda and the Pakistan Taliban, which enabled it to regularly locate targets. With ample targeting authority and armed drones operating from nearby bases, U.S. forces were able to exploit available leads.

In Yemen, however, the United States has struggled to develop knowledge of the civilian population and act on available intelligence. My interviews with U.S. officials and a leaked government document suggest that, until 2013, U.S. forces did not sustain aerial surveillance of targeted regions, the Yemeni state’s capacity in support of operations remained poor, and the targeting rules were stringent.

Implications for U.S. Counterterrorism Policy

The U.S. government’s preference for drone strikes is motivated by the desire to prevent attacks against the American homeland. My research suggests that the drone program has the potential to inflict enough damage on the targeted armed groups to upset their ability to plot and organize attacks in the United States.

The United States also deploys drone strikes to manage jihadi threats to allied regimes. In such cases, the political value of strikes depends, in part, on the capability of the local partner. An effective drone deployment can go a long way in providing a necessary condition for restoring order. But the local partner must ultimately step up to consolidate state control.

For example, President Obama’s drone policy degraded al-Qaeda and the Pakistan Taliban, securing the American homeland and substantially reducing the threat to the nuclear-armed Pakistani state. The Obama administration’s policy was sufficient because the Pakistani state was relatively capable and could build on the gains made by U.S. counterterrorism strikes. Indeed, Pakistan’s ground operations, although contentiously timed, consolidated those gains.

In contrast, in today’s Afghanistan, the U.S. government cannot rely on instruments of counterterrorism alone. U.S. officials realize that just degrading the Afghan Taliban and the Islamic State is unlikely to stabilize the country. The Afghan government remains so weak that it will struggle to consolidate territorial control even after substantial degradation of its armed foes.

Finally, a key limitation of counterterrorism strikes is that they cannot alleviate the ideological appeal of jihadi actors like al-Qaeda and the Islamic State. Strikes cannot substitute for efforts at countering online jihadi propaganda and de-radicalization. Thus, they should not be seen as a silver bullet that can defeat armed groups operating from safe havens and weak states.

Civilian Protection and Drone Strikes

Civilian harm in U.S. counterterrorism remains a vital challenge. While moral objections to civilian casualties are a powerful reason to reconsider drone operations, my research suggests that strategic concerns, like a surge in local violence or increased recruitment of targeted organizations, are not. In Pakistan, for example, drone strikes harmed civilians while also undermining al-Qaeda and Pakistan Taliban. Similarly, the U.S.-led counter-ISIL campaign in Iraq and Syria was very difficult for the civilian population, and yet also inflicted losses on the Islamic State.

If civilian casualties do not affect the strategic outcomes of counterterrorism campaigns, then the U.S. government must be convinced to protect civilians for purely moral reasons. How responsive might the U.S. government be to such appeals? It is unclear. The Obama administration was not transparent about the use of drone strikes. Under President Trump, the lack of transparency has worsened. Concerned policymakers and human rights activists must continue to push the U.S. government to be more transparent and to protect civilians caught up in counterterrorism campaigns.

The Shorenstein Asia Pacific Research Center (APARC) is pleased to welcome three postdoctoral fellows for the 2018-19 academic year. The cohort includes two Shorenstein Postdoctoral Fellows and one Developing Asia Health Policy Fellow. All three will begin their year of academic study and research at Stanford this fall.

For more than a decade, Shorenstein APARC has sponsored numerous junior scholars to come to the university and work closely with Stanford faculty, develop their dissertations for publication, participate in workshops and seminars, and present their research to the broader community. APARC's Asia Health Policy Program sponsors young scholars who pursue original research on contemporary health or healthcare policy of high relevance to countries in the Asia-Pacific region, especially developing countries.

The 2018-19 fellows carry a broad range of interests including authoritarianism in Southeast Asia, the use of coercion in national security, and community health policy in developing countries. Continue reading to learn about their qualifications and research plans:

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Siddharth Varadarajan, founding editor of The Wire, has been named the 2017 recipient of the Shorenstein Journalism Award. The award, given annually by Stanford University’s Walter H. Shorenstein Asia-Pacific Research Center (APARC), is conferred upon a journalist who has produced outstanding reporting on Asia and has contributed significantly to Western understanding of the region. Varadarajan will headline a panel discusson on April 16, 2018, at Stanford.

"Siddharth Varadarajan’s insightful reporting and analysis of strategic policy issues have made him a leading journalist and commentator," said Nayan Chanda, jury member for the award, and founder and former editor-in-chief of YaleGlobal Online Magazine. "His original perspective and courageous accounts of India’s domestic and foreign policies have for years received high acclaim, informing readers in India, the United States, and around the world. His initiative in independent, web-based journalism as founding editor of The Wire, his distinguished body of well-researched reports, and his profound commentaries exemplify journalism excellence and innovation."

Fifteen journalists have previously received the Shorenstein award. Originally designed to honor distinguished American journalists, in 2011, the award's scope expanded to encompass Asian journalists who pave the way for press freedom, and have aided in the growth of mutual understanding between Asia and the United States.

Among the award’s most recent recipients are Ian Johnson, a veteran journalist with a focus on Chinese society, religion and history; Yoichi Funabashi, former editor-in-chief of the Asahi Shimbun; and Jacob Schlesinger, a senior foreign correspondent covering economics at the Wall Street Journal’s Tokyo bureau.

Prior to founding The Wire, Varadarajan was the editor of The Hindu, the second-largest circulated English daily in India.

Varadarajan has taught Economics at New York University and Journalism at the University of California, Berkeley, in addition to working at the Times of India and the Centre for Public Affairs and Critical Theory, Shiv Nadar University.

Varadarajan is the editor of a book on the 2002 anti-Muslim violence and co-author of Nonalignment 2.0: A Foreign and Strategic Policy for India in the 21st Century (Penguin, 2014). He can be followed on twitter at @svaradarajan.

Additional details about the panel discussion and the award are listed below.

About the Panel Discussion and Award Ceremony

Shorenstein Journalism Award winner Siddharth Varadarajan will join a panel discussion including Nayan Chanda, jury member for the award, and founder and former editor-in-chief of YaleGlobal Online Magazine; Thomas Fingar, Shorenstein APARC Fellow; and Shalendra Sharma, professor in the Department of Politics at the University of San Francisco. The panel will be chaired by Daniel C. Sneider, Visiting Scholar at Shorenstein APARC.

April 16, 2017, from 12:00 – 1:30 p.m. (PDT)

Paul Brest Hall East, 555 Salvatierra Walk, Stanford, CA 94305

The panel discussion is open to the public. The award ceremony will take place in the evening for a private audience.

RSVPs for the panel discussion are requested.

Media related questions may be directed to Noa Ronkin, noa.ronkin@stanford.edu or (650) 724-5667.

The Shorenstein Asia-Pacific Research Center (APARC) at Stanford is now accepting applications for the Shorenstein Postdoctoral Fellowship in Contemporary Asia, an opportunity made available to two junior scholars for research and writing on Asia.

Fellows conduct research on contemporary political, economic or social change in the Asia-Pacific region, and contribute to Shorenstein APARC’s publications, conferences and related activities. To read about this year’s fellows, please click here.

The fellowship is a 10-mo. appointment during the 2018-19 academic year, and carries a salary rate of $52,000 plus $2,000 for research expenses.

For further information and to apply, please click here. The application deadline is Dec. 20, 2017.

Sophia Hu, a Stanford student and prospective anthropology major, writes a summary of an annual forum that examines China’s health policy in comparative perspective

The Asia Health Policy Program held its Third Annual Forum on China’s Community Health Services and Primary Health Care Reform on June 22 in Beijing. The forum featured a diverse panel of speakers who addressed how to improve China’s primary care and community health care services. From discussing insurance plans to evaluating national policies and encouraging students to consider working as rural doctors, the speakers presented a wide array of research and experience. A brief summary of each presentation is detailed below.

Weichang Wang, director of the Ningxia Health Care Reform, discussed his experiences implementing a reformed health insurance payment system, originally developed by a team of researchers at Harvard and executed in Ningxia, China. Through this plan, his team created a medical insurance fund for the town that prioritized reimbursement for lower-level institutions, i.e. primary care centers. The plan resulted in increased accessibility, frequency of visits and patient satisfaction at primary care centers. It also saved money; however, some issues did arise such as how to develop accurate projections for the medical fund.

Quilin Chen of the Chinese Academy of Social Sciences, informed by his experience in Inner Mongolia, examined the disparity of hospitalization rates among different regions. He analyzed several factors, including financial incentives for patients and hospitals, regional differences in culture, and technological changes among primary care centers.

Jiaying Zhao of Australia National University and Shanghai University proposed using artificial intelligence (AI) to support primary care centers. She highlighted the benefits of AI, including how it can help inform physician decisions and bolster patient trust in primary care centers. Zhao, whose presentation motivated a spirited debate, shared important insights on the growing role of technology/CS in the health care field.

Jeroen Struijs of the Netherlands National Institute of Public Health and the Environment gave an overview of the primary care system in the Netherlands. With one of the most highly regarded systems in the world, the Netherlands prioritizes primary care-centric health care. He described how Dutch citizens seek care with their primary care physicians first – or face a penalty – before going on to specialists or hospitals. He also explained their bundled payment system. This system pays health services providers for a “bundle” of treatment for certain diseases, helping to align provider incentives with efficient convenient care, rather than fee-for-service which financially rewards quantity of services.

Hyuncheol Kim, an assistant professor at Cornell University, examined trends in long-term care insurance and public cancer screening programs in South Korea with a regression discontinuity design. His analyses helped to explain the relative success and failure of those programs. For example, his analysis was consistent with a theory that an intervention has a higher likelihood of failing if those receiving the intervention have other channels to receive benefits, i.e. patients are able to seek private as opposed to public insurance. His presentation also inspired discussion about primary care in Korea and the challenges Korea faces – similar to those in China – in trying to move away from a hospital-centric delivery system.

Lingui Li, director of Ningxia Medical University’s Public Sector Management Centre, delivered an overview of strategies to recruit health care workers in rural areas. He emphasized the need to balance primary public health service with primary clinical service and highlighted the dearth of doctors in villages.

Jinglin Yue, deputy dean of the Zhongshan University’s Institute of Public Administration, presented about his experiences establishing a hierarchical treatment system that aims to bring more people to primary care before pursuing treatment at hospitals. He explained the various incentives of the diverse interest groups involved, and emphasized the need for future government policies that support a 2-way referral system.

Xiaoguang Yang of Fudan University’s School of Public Health also described efforts to create a two-way referral system, based on his research of an integrated health system in Shenzhen. This initiative, using a people-centered reform paradigm, introduced the concept of “community of common destiny” to Luohu, China. The reformers tried to manage supply and demand using financial incentives to help providers including hospital groups coordinate in promoting a more integrated system.

Xiaoyun Liu of Peking University examined the efficacy of a new national program that contracts with students to commit to practicing medicine in rural areas in exchange for free medical school tuition. Using surveys, he gathered data on why students chose the program and where they chose to become rural doctors, among other factors. He then used this data to propose changes to enhance the effectiveness of the program.

Guanyang Zou, a researcher at Queen Margaret University, presented an overview of international experiences or “models” of health and social care that catered specifically to aging populations. These models included the integration of ambulatory medical care and aspects of social care and long-term care services.

Bei Lu of the University of New South Wales took an economic approach toward addressing the issue of long-term care for elderly populations. In her research, she worked closely with policymakers in Qingdao, China, and used a model to estimate how long-term care insurance could be structured so that the elderly could get optimal care without imposing a disproportionate financial burden on young taxpayers and fairly compensate providers.

Each presentation contributed important knowledge toward understanding primary care in China and elicited substantial discussion. This forum would not have been possible without the participation of the numerous speakers and the generous support of the Asia Health Policy Program and Chinese affiliates.