The Lancet's Distressing Conclusion About the Gates Foundation
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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