But despite Bill Gates’s prediction at a press conference to mark Buffet’s pledge that there was now “No reason why we can’t cure the top 20 diseases”2 observers are starting to question whether all this money is reaping sufficient rewards. For although the foundation has given a huge boost to research and development into technologies against some of the world’s most devastating and neglected diseases, critics suggest that its reluctance to embrace research, demonstration, and capacity building in health delivery systems is worsening the gap between what technology can do and what is actually happening to health in poor communities. This situation, critics charge, is preventing the Gates’s grants from achieving their full potential.
As one of the Gates Foundation’s three main focuses, along with global development and its US programme, global health projects receive a substantial amount of the charity’s annual spending. To date, almost half of all awards have been in this area, a total of $6bn. When the Gates Foundation first started this generous spending in 2000, it was greeted with enthusiasm as a refreshing alternative to the staid, sluggish agencies that had until that time dominated global health. More nimble than the bureaucratic intergovernmental organisations of the UN system, including the World Health Organization, the Gates Foundation won respect for prioritising research gaps, promoting new financing mechanisms, and embracing partnerships with key global health actors.
However, the foundation’s business-like approach has also gained its fair share of detractors. A commitment to results oriented spending ensures that money is linked to measurable and demonstrable outcomes. But although this strategy makes accounting easier to handle, it has perpetuated vertical, disease specific funding strategies that damage health systems in developing countries, according to David Sanders, director of the School of Public Health at the University of the Western Cape, South Africa.
These vertical programmes, which are a long standing feature of many global health initiatives, lead to fragmentation of health systems because they require separate planning, staffing, and management from other health services….
This well-referenced analysis from the medical journal BMJ attempts to answer some of those questions. It also has a profile of
Where the money goes
Vaccine preventable diseases $1.9bn
HIV and AIDS $1.1bn
Child health $164m
Acute diarrhoeal illness $89m
Acute lower respiratory infections $239m
Reproductive and maternal health $522m
Other infectious diseases $596m
Breakthrough science $448m
Emergency relief $61m
Grants from 1995-2005 listed in Gates Foundation Global Health Program Fact Sheet (March 2006)