by ANDREW BOWMAN
Philanthropic funds are common among the super-rich in the US; they enable tax avoidance provided five per cent of net investment assets are given away annually. What quickly set Gates’ fund apart was its orientation towards the poor – rather than élite culture or religion – and its sheer size.
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The Foundation’s achievements are undoubtedly impressive. Through supporting vaccination programmes, for example, it claims to have saved nearly six million lives. With rich world enthusiasm for foreign aid wavering, on 26 January this year Gates committed a further $750 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria – an organization he claims saves 100,000 lives a month. Admirers credit the Foundation with putting global health back on world leaders’ agendas and, through Gates’ Giving Pledge initiative, encouraging several other US multi-billionaires to pledge their wealth to charity. What’s not to like?
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According to Gates, ‘our net effect should be to save years of life for well under $100; so, if we waste even $500,000, we are wasting 5,000 years of life.’ Under these terms, the best results are achieved through ‘vertically’ funded projects – interventions targeted at specific diseases or health problems, largely bypassing existing health systems. The pay-offs from ‘horizontal’ integration with public-health systems can, in contrast, be comparatively slow to materialize and hard to measure.
A study in the Lancet in 2009 showed only 1.4 per cent of the Foundation’s grants between 1998 and 2007 went to public-sector organizations, while of the 659 NGOs receiving grants, only 37 were headquartered in low- or middle-income countries.
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Research by Devi Sridhar at Oxford University warns that philanthropic interventions are ‘radically skewing public health programmes towards issues of the greatest concern to wealthy donors’. ‘Issues,’ she writes, ‘which are not necessarily top priority for people in the recipient country.’
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