Tag Archives: gates foundation

Putting the Gateses’ mission shift in context

I could really use a pie chart here, showing all the promised slices of international aid that remain missing or get removed as global priorities shift.

In the previous post, I noted Melinda Gates’ clarion call — and her accompanying $1.5 billion philanthropic pledge — for more to be done for women and children’s health worldwide. The Gates Foundation, Obama Administration and other governments or donor organizations appear to be turning more philanthropic and foreign aid attention to the terrible inequity of maternal and child deaths worldwide.

This a very worthy cause, but of course there are many worthy causes. And not all of them are receiving the funding or attention they deserve. AIDS was once the world’s top global health priority, but now it appears that funding for many existing projects aimed at battling the pandemic will remain flat or decline even as the number of those afflicted continues to increase.

The Gates Foundation claimed this is not so much a shift in focus as an expansion of an existing priority, but most observers did see it as a shift and a new focus. Some also noted that when you decide to emphasize one thing, it often means you de-emphasize something else.

The Gates Foundation has, for example, decided not to renew funding for a number of projects it helped launch years ago looking for an effective AIDS vaccine. The Global Fund for AIDS, Tuberculosis and Malaria is now struggling to merely respond to existing needs — trying to convince donors not to reduce funds and pointing out it needs something like $15 billion merely to keep on pace for the next few years. Meanwhile, people still die from AIDS and HIV still spreads as most still don’t receive the drugs they need to survive and prevent transmission.

This kind of “cause inequity” and mission shift is often shrugged off as inevitable given we do not exist in a world of unlimited resources.

But what is perhaps less excusable is when donors and governments make promises they don’t keep. In her Monday remarks, Melinda Gates noted that later this month leaders of the most powerful nations on the planet will convene in Canada at the G8 summit in Muskoka, Ontario. The Gateses and members of the Obama administration say they intend to especially push for new commitments to invest in improving maternal and child health.

Maybe someone should take a hard look at how many members of the G8 kept their previous global health commitments — and whether these new commitments represent true progress or sort of a shell game.

Side note: I couldn’t find any illustration showing all of the broken promises, but for those who like to think the U.S. does more than others when it comes to foreign aid, below is a bar chart that shows otherwise. We give much less, per capita and as a percentage of our GDP, than most developed countries:

U.S. Provides Comparatively Less Foreign Aid, Source: OECD



What We Mean When We Talk About Women & Children’s Health

The Gates Foundation on Monday announced that it planned to give $300 million every year over the next five years, a total of $1.5 billion, to programs that are devoted to improving the health of women and children worldwide. This now becomes one of the foundation’s largest initiatives.

“Women and children have finally moved up on the global agenda and I’m here to tell you that’s where they’re going to stay,” said Melinda Gates, speaking on the same day at a star-studded conference in Washington D.C. called Women Deliver. “Policymakers have treated women and children, quite frankly, as if they matter less than men.”

My friend Kristi Heim at the Seattle Times wrote a good story that tells you all about the grant announcement so I won’t repeat it. I had noted earlier that the philanthropy was shifting in this direction – which they claim is not a shift but merely an expansion of an existing priority.

Putting aside the question about whether the Gates Foundation can, in fact, guarantee what will be high on the global agenda (is there a global agenda?), it’s perhaps worth considering if women and children’s health issues really have been neglected as a matter of policy and agenda-setting. And if so, how?

Most global health initiatives that battle diseases like AIDS, tuberculosis and malaria benefit both genders and all ages since the bugs don’t discriminate.

I can’t think of any global initiatives devoted to men’s health but we have a number of organizations like CARE, Planned Parenthood and the Global Fund for Women focused on women’s health issues worldwide. We have even more organizations devoted solely or mostly to children’s health such as Save the Children, World Vision or the United Nation’s Children Fund (aka UNICEF). The Gates Foundation’s biggest project, GAVI, gets vaccines out to children worldwide.

And women, even women in poor countries, tend to live longer than men. So what are we talking about when we say women’s health is a neglected area?

We’re mostly talking about childbirth.

“When people talk about women’s health, they are often talking about maternal health,” said Emmanuela Gakidou, professor of global health at the UW’s Institute for Health Metrics and Evaluation. Women who survive childbirth may or may not live longer than men generally, Gakidou said, but the number of young mothers and children in poor countries who die from complications associated with childbirth is hugely disproportionate when compared to developed countries.

For example, she said, Italy sees an average of four mothers die in childbirth for every 100,000 live births while in places like Afghanistan or Malawi it is more like one maternal death out of every 100 births.

“These deaths are almost entirely preventable,” Gakidou said, adding that the new momentum on this front is because more people recognize “that women should not be dying while they are trying to have a child.”

Amy Hagopian, also a UW professor of global health, said she welcomed the Gates Foundation’s increased interest and investments in maternal health. But the most fundamental need of women in poor countries, she said, is a functioning health system with nurses, midwives and doctors.

“Women are dying because of the lack of these health services,” said Hagopian, adding that the Gates Foundation has so far shown little interest in funding efforts aimed at improving health services. “We already have lots of NGOs working on women and children’s health. Adding more people running around Africa claiming they have come to improve women’s health won’t solve the fundamental problem.”

Hagopian was among a number of people who recently advocated for and won passage of a resolution at the World Health Assembly in Geneva aimed at improving health worker retention in poor countries.