The Lancet's Distressing Conclusion About the Gates Foundation

categories: Global Health News, HIV, malaria

Published May 08, 2009 @ 04:23PM PT

I read the new Lancet study on the Bill and Melinda Gates Foundation. The study confirmed many of my worst fears about the foundation. In short, it's a massive foundation with a huge influence on global health, being run like a small family fund. I'd love to see the foundation go the other way, and embrace the spirit of Development 2.0. Make their decision-making processes public, and include developing countries in those processes. Publish what they fund, and talk about why. Engage in dialogue about their choices.

If you'd like to know how I reached that conclusion, I live-blogged my reading of the study. That's more interesting than a mere summary post, right? I'll give you section headings and my thoughts on each section. Please excuse my punctuation in advance.

Summary

5.82 billion dollars, or 65% of the total Gates global health budget goes to just 20 organizations. Wow. That pretty much disproves everyone's hope that the Gates Foundation would provide opportunities to new players in the field. On the other hand, I bet they're supporting stuff that's proven to work.

Introduction

Cool, Gates has helped to triple funding for malaria. I wonder how they chose malaria as a priority area?

I always forget that Gates Foundation has non-global health activities. My global health obsession blinkers me.

Analysis

I love that they used an excel spreadsheet to do their preliminary analysis of who and what Gates had funded. Research like this, looking at existing data in a new way, always inspires me. I wish, though, that they didn't have do that data entry. Imagine if Gates had simply published the data in downloadable form?

I am not surprised that they had trouble categorizing the grants. I'm a big believer of tagging projects instead of filing them.

The Gates Foundation's Grant-Making Programme

They actually bothered to give a grant for $3500? I wonder if it went to somebody's cousin's new NGO? Maybe a Seattle global health group.

Lots of money to the Global Fund, and to global health partnerships. They are reliable recipients for grant money; you know they run effective programs and do good reporting. GiveWell's been excited about health partnerships lately too.

PATH got $949 million. Yowza. They're a good group, and they deserve it, but that must have some kind of major scale-up in their work. Lots of other big NGOs getting money too, and the World Bank, and big American universities. I think it's appropriate for a new foundation to support big NGOs as they learn the business.

Discussion

Aha, they don't look at sub-grantees. I bet that would change this picture pretty substantially.

The foundation has a great deal of influence over the foundations and architecture of global health. Duh. Adn heavy use of the building metaphor.

Not a passive donor, actively engaged in policy making and agenda setting. We knew that. I guess it's good to see quantitative proof of what we already knew.

I had never heard of the H8 before. Am embarrassed.

Didn't know that McKinsey and Company worked with the Gates Foundation. Makes sense.

"Grant making by the Gates Foundation seems to be largely managed through an informal system of personal networks and relationships rather than by a more transparent process based on independent and technical peer review." That's not good at all.

"Recent changes to collaboration in global health have been characterised by the emergence of loose horizontal networks, where it is unclear who is making decisions and who is accountable to whom. Indeed, the Gates Foundation has helped to promote the emergence of these networks." That's interesting. I need to think more about that. Maybe that's a good horizontal effort, or maybe that's a big murky mess with no accountability.

At least half of all funding went to vaccination. That's a lot. Depending on how they're supporting vaccination, that could be a technological quick-fix or a systems-building effort. You can't vaccinate kids without a health sector that can manage a cold chain and outreach to children and parents.

Prioritization of HIV and malaria over maternal health? Maybe because maternal health is impacted by so many different things and HIV and malaria have identified treatments.

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Comments (3)

Alanna, Great blog. I was distressed to learn quite a while ago that the Gates people (definitely including Gates himself) were mostly of the "we know the answer in advance" type, rather than "let's humbly find what works on the ground" type. The Gateses are also suprisingly naive about propaganda issuing from places like the WHO:

http://blogs.nyu.edu/fas/dri/aidwatch/2009/02/did_bill_and_melinda_gates_cla.html

I wonder if there is any hope that Gates Foundation could change in response to such gentle, constructive criticism?

Best, Bill Easterly

Posted by William Easterly on 05/09/2009 @ 06:38AM PT
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Thanks for this rundown. I shared it with some of my colleagues. It doesn't seem surprising, considering Microsoft's track record, that the Gates Foundation would not be open about its processes or numbers. But it is distressing to see yet another large foundation as an obstacle to doing development in a different (more effective?) way.

Posted by Shannon Turlington on 05/09/2009 @ 11:05AM PT
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It is defintely saddening to know that this money could be soooo much more effective. We need to focus on systems to change global health care. Solving the symptom problems does not create sustainable change.

Further, Bill Gates is doing a lot of good with the money that he has, but he's getting that money in a prety sketchy way. Microsoft is one of the worst electronic companies in regards to using conflict minerals and divesting from places like the Congo.

Posted by Garrett Miller on 05/09/2009 @ 12:40PM PT
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Author

Alanna Shaikh has spent the last ten years immersed in global health; she has worked for NGOs, companies, universities, and the US government on projects that ranged from preventing antibacterial resistance to improving maternal and child health.