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Three Reasons to Question the Gates Foundation

5 August 2009 One Comment

gates-foundationWriting a paper on how global health governance and financing is changing made me aware of the influence the Gates Foundation has in setting the global health agenda.  As well as learning about its achievements, I also started learning about some of the critiques people have made of the Gates Foundation approach.

The Facts:

The Gates Foundation is a BIG player in global health.  In 2007, the Foundation’s endowment stood at over $60billion, an amount greater than the GDP of 70% of countries in the world.  The money goes to all sorts of programs, including delivering services (eg, vaccinations) and research (eg, malaria).

The Debates:

Within international health, there is some concern about the degree of power the Gates Foundation has in setting the priorities and controlling what gets funded and what doesn’t.

  1. Unlike governments, the Gates Foundation is accountable only to itself.
  2. Programs that focus on very specific aspects of health, like a particular disease, don’t help to build robust and equal health care systems.
  3. The Foundation’s investments sometimes contravene its charitable mandate.

1) Accountability: The Gates Foundation’s endowment is tax free, meaning that if Bill and Melinda and Warren Buffet hadn’t put their money in it, they would be paying taxes on it and the US government would have more cash in their budget.  So, one could argue that they are using public money.  However, unlike public money, the Gates Foundation doesn’t have checks and balances about how they spend their money.  While they have advisers and expert staff, the Foundation doesn’t have a board which they are accountable to, meaning that its basically up to Bill and Melinda where the money is spent.  This becomes an issue because there is so much money involved that the Foundation manages to have significant influence within the global health industry.  As a contrasting example, an organization like the WHO is accountable to its executive board made up of the 193 nations that belong to it.

2) Programs: Understandably, the Gates Foundation wants to be able to see the impact that it is making around the world in a relatively explicit way.  This leads to a focus on short-term, vertical programs with an emphasis on technology.  “Vertical Programs” means focusing on one aspect of health only, usually a particular disease like AIDS or malaria.  It is hard to argue with the value of finding a vaccine for malaria, I know.  But, if you focus just on malaria, what AREN’T you focusing on?  Lets say that in your neighbourhood, there’s a wicked malaria program, but you’re suffering from cervical cancer?  Horizontal programs are those that focus on strengthening the entire health system, so that whatever ailment you might have, you will be able to access health care.  If the Gates Foundation is funding vertical programs, it means that they are not funding horizontal programs.

3) Funding: The Gate’s Foundation endowment (the money that it has been given by Warren Buffett and from Bill & Melinda’s own contribution) is invested each year to make more money.  The idea here is that as long as that money is making interest, the Foundation can continue to keep giving grants (rather than just taking the endowment and spending it until its gone).  In 2007, a group of journalists from the LA Times decided to investigate where this money was invested and found that, “the Foundation reaps vast financial gains every year from investments that contravene its good works.“  They give a poignant example of a young boy in Nigeria who had just been vaccinated by the Gates Foundation for polio, but was suffering from debilitating respiratory problems from nearby industry.  The company causing the air pollution operates with investments from the Bill & Melinda Gates Foundation.

To link to my full paper click here.

Read what others have written here, here, here, and here.

One Comment »

  • José Manuel said:

    Interesting post, interesting blog. Ill keep visiting. There seems to be a lot of social development movements up there in Canada.

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