Bill and Melinda Gates and Warren Buffet: Reshaping Global Health
Indian TB patients stand in a line at a tuberculosis treatment center in New Delhi. (Photo: Manan Vatsyayana / AFP-Getty Images)
The recent announcement by multibillionaire investor Warren Buffet that he will give a substantial part of his fortune to the Bill and Melinda Gates foundation has the makings of a watershed moment in global health. By giving what Fortune magazine estimates to be $37 billion in today's value, Buffet is beefing up the already deep pockets of the Gates foundation, which had more than $30 billion as of June 2006. Since more than 60 percent of the Gates foundation programming is in the area of global health, the implications of a steady source of funds for many years to come cannot be overestimated.
Bill and Melinda Gates and Buffet through this joint effort have the capacity to dramatically change the scope and breadth of global health. 1n 2005, the Gates foundation, easily the largest global philanthropy, reportedly made grant awards of $1.36 billion and plans to spend at least $1.5 billion this year. Buffet's contribution will give the Gates foundation at least $1.5 billion additional resources for the first year.
In addition, Buffet lists three conditions in his giving that may likely enhance the effectiveness of his gesture. First, either Bill or Melinda Gates must remain alive and be "active in the policy-setting and administration" of the foundation. Second, the Gates foundation must continue to satisfy legal requirements that qualify his gift as a charitable contribution. Third, the value of his annual gift must count separate from the annual 5 percent spending of the Gates foundation's net assets. In addition, by 2009, Buffet expects the Gates foundation annual giving to equal at least the value of his previous year's gift plus the expected 5 percent giving of the foundation's net assets. Consequently, at the barest minimum, within the next few years, it is conceivable that the Gates foundation may likely give grants of $5 billion a year, with 60 percent or more going to global health projects. This scenario will be truly remarkable as major global health issues often play out in some of the most resource challenged environments.
Perhaps one of the most enticing possibilities of this remarkable joint partnership is the potential for the Gates foundation to deepen its current catalytic role in creating opportunities for experts, policy makers, and advocates to find solutions to global health problems and remove obstacles that impede access to global health goods and services. By supporting the creation and sustenance of international public, private, and civil society alliances dedicated to single or interrelated health conditions, the Gates foundation is creating lifelines for basic researchers, clinicians, clinical researchers, public health experts, and advocates to jointly tackle specific global health problems. Some of these well funded alliances include the ongoing effort to develop an H.I.V. vaccine, to end the scourge of malaria and tuberculosis, and to make lifesaving childhood vaccines available to children in resource challenged environments.
However, with the extraordinary opportunities presented by this joining of forces by the Gates foundation and Buffet comes the impetus to dramatically increase the leverage of partners in advancing global health and meeting the needs of target population. It would be ideal for the new funding opportunity to become a fulcrum for increased attention on unresolved issues in global health.
These unresolved global health issues include:
1. The deteriorating state of health in Africa. Of all the continents, Africa appears to be stagnating or doing worse on critical health indicators. Fragmented strategies, weak domestic health systems, limited financing, national and local governance issues, and less than ideal coordination of externally financed programs continues to plague health remedial efforts in the continent. A dedicated public, private, and civil society alliance on Africa's health with long-term financial support for strategic thinking and targeted interventions can bring all partners together and sharpen attention on consensus areas of need.
2. Understanding the knowledge, attitude and perception (K.A.P.) of the target population in resource challenged environments. The new funding opportunity may create opportunities to systematically entrench the use of valid target population K.A.P. in all phases of global health — from conceptualization to design, implementation, monitoring, and evaluation. This will ensure that global health initiatives, policies, and programs reflect the felt rather than perceived needs of target populations.
3. Finding and scaling up successful local health programs. After more than four decades of bilateral and multilateral technical assistance in developing regions of the world, it should not be difficult to find and nurture successful local programs, expand their reach and export their best attributes to other comparable regions and nations. The inability to scale up successful local programs is one of the weakest links in modern global health. A steady resource flow should be dedicated to this vital effort.
4. Resolving the health human resource crisis in many poor countries of the world. The 2006 World Health Report of the World Health Organization makes the case for comprehensive strategies and interventions to counter severe shortages of various categories of health staff in many poor countries. Most of the countries facing dire shortages of health personnel are in the forefront of the battle against deadly diseases such as H.I.V./AIDS, TB, and Malaria. The additional funds could be deployed in three distinct areas. First, establish and sustain regional and sub-regional training hubs for health personnel. Second, create and sustain platforms for mobilizing the diaspora of various developing regions to participate in health remedial efforts. Third, take advantage of the thousands of clinical, public health and development students and faculty in U.S. and other Western-based universities to address specific health worker shortage issues. Without a comprehensive response to these shortages in staff complements, it would be difficult to sustain domestic and international health remedial efforts.
5. Paying attention to health program outcomes at individual and community levels. All deep-pocketed organizations, whether public, private, or philanthropic eventually discover that it is absolutely critical to show program outcomes at individual and community levels. The disconnect between well meaning international intentions and the reality on the ground and eventual program outcome is well known. The ongoing H.I.V./AIDS pandemic is a major pointer in this regard. Today, despite all the flurry of domestic and international activities and initiatives, more than 6 million individuals living with H.I.V./AIDS in poor countries who are clinically qualified to receive antiretroviral therapy are unable to access these lifesaving medicines. Many of these individuals will die although these medicines are available and there is an unprecedented domestic, regional, and international policy and program action on H.I.V./AIDS. As funding shortfalls remain significant in global health, the issue of program outcomes looms large. Improving the outcome of global health programs is beyond the capabilities of one organization. However, a renewed focus on global health outcomes is likely to bring greater attention to the needs of target individuals and communities. This renewed focus requires long-term, sustained financial support. This is critical in the vital but often unglamorous work of matching program intentions with expected outcomes.
The joining of forces between the Gates foundation and Buffet is a remarkable development in global health. The next big challenge is to create sustainable platforms and alliances that can meet the health needs of individuals and communities in need. The challenge is daunting and the need immense. The key is to focus on specific issues or initiatives and unleash a strong interplay of hard-nosed financial, technical, and logistic resources for a well defined program outcome. For the Gates foundation that is "guided by the belief that every life has equal value," the joining of forces with Buffet presents an extraordinary opportunity to making a lasting difference in global health.
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