Good Generation

Reference:

“Does Global Health Funding Respond to Recipients’ Needs? Comparing Public and Private Donors’ Allocations in 2005-2007″ (Daniel Esser and Kara Keating Bench) - published in World Development #39, 2011, summarized in Stanford Social Innovation Review Volume 10, Number 1, Winter 2012

Key Ideas:

• There is no question that private foundations, especially large ones like Bill & Melinda Gates Foundation, are contributing huge sums to fight good causes

• But, Esser and Bench ask, why do diseases like HIV command so much interest and money by these foundations, although such diseases rarely register as a top national health priority for the affected countries? As an example, HIV/AIDS only contributes to 3% of total disease burden in Asia but was second most highly funded category

• It seems to be widely known that diarrheal diseases for example are a much larger “killer” than HIV, but all the media campaigns, celebrity focus and at last, foundation efforts seem to keep pointing us towards the latter instead of the former. Why is that so?

• Esser and Bench suggest that diseases like HIV are highly visible, infectious and “ownable”; they refer to the aid architecture being rather “vertical”, meaning donors can insert themselves in clearly definable areas, claim a role and impact for their money, e.g., prevention campaigns, providing treatment kits, etc.

• In other words, Esser and Bench claim that HIV causes receive attention because it is easier for funder to claim credit for it

• The article ends with an appeal towards greater accountability for foundations like B&MG towards actual local needs and aligning this better to funders’ activities

My view:

• Personally, it always makes me uneasy when the question of claiming credit and ego mix with the goal of solving the most urgent social problem, so this article caught my attention in that it further supported my suspicion why we repeatedly keep hearing about HIV campaigns and drives despite AIDS not being a main preventable cause of death compared to other conditions

• However, my immediate next reaction was that a private foundation like B&MG can do whatever it wants in legal bounds. Take, its Guiding Principle #1: “This is a family foundation driven by the interests and passions of the Gates family”; hence, why NOT HIV, if they care so much about it? Further, read Guiding Principle #5: “Our focus is clear—and limited—and prioritizes some of the most neglected issues”; well, if you presume HIV is considered neglected BECAUSE it causes fewer deaths in numbers, it does not seem to me that B&MG is inconsistent to its guidelines

• That said, I do give more credence to the argument that accountability should become a greater priority for huge foundations such as B&MG in coming years. It is one thing to be an individual spending a few hundred or thousand bucks in some foreign country; but given that B&MG apparently spent in 2007 on healthcare ALONE more than the World Health Organization’s ENTIRE ANNUAL BUDGET, we are suddenly talking about real possibilities for local market distortions.

• As a last datapoint, Esser and Bench used a survey of people in 27 countries to identify what the top national priorities should be and found that private foundations essentially did not care at all since they tend not to fund any such priorities. This supports the concern that even if funders like B&MG have a right to pursue their family’s passion areas with their own money, they may be more helpful in carrying out their goal of saving more lives if they started paying more attention to local priorities. After-all, the first sentence on B&MG’s website states “Our belief that every life has equal value is at the core of our work at the foundation.” If that is true, then redirecting efforts towards greater killer diseases may just give B&MG slightly more bang for the buck, won’t it? Thank goodness perhaps for Guiding Principle #15: “We leave room for growth and change.”