My Thoughts on the Gates Foundation
Bloomberg recently published an article which discussed whether or not the money spent by Bill and Melinda Gates is making a real difference in Global Health. Some critics feel that their focus should move away from disease-specific funding to programs that would strengthen health systems as a whole. This article peaked my interest and so I would like to take this opportunity to share with you my comments I recently shared in response to this article…
The Gates Foundation is and has been very generous. They deserve to make a bigger impact and get a higher return on their investment in global health. I do not know Dr. Rawaf personally but it is a well known fact in global health that health systems deliver health services. Also, if you want sustainability, donor-funded projects must be designed to effectively improve how the health system works. For example, it is not enough to want to help fight Ebola by training health providers and providing them with protective equipment and uniforms. One must also strengthen the health system that failed to detect the epidemic in a timely manner and that allowed staff to be unprepared to serve patients. We do this by improving the health providers’ job description, their work routines and supervision and support to ensure they will continue to be ready to address Ebola and other prevalent conditions. One must also ensure that the training a donor pays for is transferred to the country’s nursing and medical schools so they can continue training all health providers in Ebola case management and prevention… even after the donor stops the funding. The donor must also coordinate and work with the country’s government and all its partners to ensure there is a line item in the health budget for next year to continue providing health providers with protective equipment and gloves. It is very sad and irresponsible to see gloves run out after the donor leaves, for example.
I agree that the Gates Foundation can get a bigger return if they invest in health systems that are able to deliver care that addresses a country’s most prevalent diseases. The problem is that most donors are not advised properly and confuse health programs (which is the way global health works to control diseases that affect a population) with health services (which is the way healthcare is delivered to meet the most important health needs of a population). Health programs must be translated into health services that meet the population’s health needs. Effective evidence-based healthcare delivery ensure patients get the healthcare they need when they need it. This requires a well-oiled machine (much like how Microsoft delivers its products) to deliver quality healthcare. It is the health system in any country that does the “Translation” and ensures that what the maternal health program says about preventing deaths gets completed.
Consider the health system, through the effective and deficient management of private and government-run clinics and hospitals, that enables a pregnant mother to have access to a number of health services. These services are needed to implement various programs such antenatal care, safe delivery, family planning, nutrition, immunizations, etc. In sum, the projects of the Gates Foundation must improve the health programs of the country they are helping and the health system that delivers the health services required to meet the needs of the country’s population. I wish the Gates a very prosperous and impactful New Year strengthening health systems.
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