At the close of their three-day Global Partners Forum in Seattle, Bill and Melinda Gates looked back on the past 15 years as they rapidly grew to become a world epicenter for the fight against diseases of poverty, on what they have learned and where they see things headed – in the field of global health and development in general.
Perhaps the biggest news to come out during this confab was a new three-year $75 million grant from the Bill & Melinda Gates Foundation intended to build up and expand a disease monitoring-and-response system across much of Africa and South Asia – the Child Health and Mortality Prevention Surveillance (CHAMPS) network.
Prompted in part by the recent Ebola outbreak that ravaged West Africa, it is intended to have an impact far beyond just protecting against outbreaks.
Some at this confab say it’s another sign the Gates Foundation is now more inclined to invest in ‘health system strengthening’ rather than just focus on targeting specific diseases or problems.
15 years on, Bill and Melinda Gates reflect on past and future of global health.
“The global community moved very slowly on (the Ebola outbreak),” said Bill Gates. Some of this may have been due to institutional or political failures in the West, but Gates said a big part of the problem was also lack of fundamental public health systems for disease identification, monitoring and response.
This new disease detection network, to be administered by Emory University’s Global Health Institute, is to help lower-income countries do a better job at identifying disease outbreaks but also at collecting the basic information about trends and population health, one of the most fundamental criteria needed for establishing an effective public health system anywhere.
“When people talk about building up health systems, they still often tend to be talking about building hospitals or clinics, hiring nurses or doctors,” noted Jeffrey Koplan, a former director of the CDC and now vice-president for global health at Emory.
What the Gateses recognize, said Koplan, is that the most fundamental – and often most effective – investment in improving a health system begins with public health, disease prevention and detection rather than treatment.
Looking back to when they first began exploring how they could use their vast resources to reduce suffering by focusing on the diseases that most burden the poor worldwide, Bill and Medlinda acknowledged being a bit ‘naive’ in their approach – assuming that, for example, the aim of eradicating polio was largely just a matter of money and will. But this also made them ambitious and optimistic.
“We tried to be strategic,” Melinda said. “Bill and I still believe very strongly in the power of science …. What we had to learn was that the second wheel is delivery.”
That is, she said, it was one thing for the young philanthropy to help fund the discovery and development of new tools, such as vaccines or drugs; it was quite another to figure out to get them to the people who needed them most.
“That was a bit of an eye-opener,” agreed Bill. He said the polio eradication campaign has shown the Gates Foundation, painfully, the value of focusing on delivery and not just discovery or development.
Yet technology can still play a powerful and positive role, he added, noting that a project they funded using GPS mapping in Nigeria identified a pattern in how polio vaccinators were failing to reach all the children who needed to be immunized.
“These were children living in communities on the borders of districts,” Bill said, which helped the polio campaign identify the problem. The two adjoining health districts were assuming the other one was covering that community, so neither sent in health workers all the way to the border. This kind of data and strategic thinking, Bill said, has helped make Nigeria and now all of Africa polio-free for the last eight months.
Melinda also emphasized that what they have learned as well is how to adapt their approach to more complex problems that don’t appear to so easily lend themselves to a simple, targeted strategy – like reproductive health. She has especially made this, along with empowering women and girls, a key focus of their philanthropic work noting that childbirth is the second leading cause of death for adolescent or teenage girls.
“That didn’t used to get talked about much,” Melinda said. “Now, reproductive health and these issues are truly back on the global health agenda.” That’s great, she said, but she wants to expand this to incorporate all of the other economic, cultural and political factors that continue to disenfranchise girls and women.
Both Bill and Melinda said they don’t intend to move too far from their original approach, focusing on a few key areas (based on data like the Global Burden of Disease) and seeking to fill in the gaps – whether technological, informational or in terms of public awareness – where they can do the most good.
Asked by moderator Arun Rath, an NPR journalist, how they have learned to work with governments, as one key partner in fighting poverty and inequity. Melinda said government support and co-investment in these efforts are critical to success, but Rath pressed them to be more specific: “Yes, but how do you get them to do this? How cut through all the bureaucracy? Just ask nicely?”
At that, Bill and Melinda both chuckled.
“At the global level, now there we have good bureaucracy,” said Bill, prompting laughter. A few minutes later made reference to the UN’s development agenda – a fairly lengthy and complex document featuring 17 goals and 169 anti-poverty targets – as akin to the Bible, an example of the global bureaucracy.
“Don’t go there,” joked Melinda, who is a devout Catholic.
But in all seriousness, Bill said, the problem in many of the countries most in need of help is that they lack adequate governance infrastructure, or bureaucracy. He said some countries like Nigeria have lots of bureaucracy, but not to much positive effect.
Asked by Rath what they would do right now if they had a magic wand and could solve one global health problem, Bill said he would reduce child malnutrition. The problem of child under-nutrition is stubbornly massive, he said, and won’t be as easy to tackle as some other challenges.
“What I would wish for is empowered women,” Melinda said. With a wand, she would make sure every woman has access to contraceptive methods and the freedom to use them as she sees fit. But more than that, she would magically ensure that women are no longer so abused and discriminated against. “Women’s empowerment plays into all the things we’re talking about.”
