Powerful philanthropic organisations such as the Gates Foundation are doing seminal development work. Could they be more accountable to the communities they serve?

I recently did my second interview with Bill Gates, and unlike our first telephonic conversation, this one was face-to-face. As it turned out The Hindu was selected from India to participate in a media blitz unleashed by the Bill and Melinda Gates Foundation on the occasion of what has come to be known as “Bill’s Letter,” an annual missive that sums up Mr. Gates’ and the Foundation’s most vital lessons learned over the past year of development management.

Walking down the corridor of a New York City hotel towards the plush conference room where I'd be meeting him, I couldn’t help but wonder what he’d be like in person. He didn’t disappoint.

Mr. Gates came across not only as thoroughly passionate about the vast expanse of development-philanthropic work that the Gates Foundation is doing across the world; he also displayed a deep technical knowledge of specific development projects and processes including on vaccine development and government health programmes (which he appeared to view as essential but requiring a number of tweaks).

Regarding progress made in India, in particular, Mr. Gates lavished much praise upon the nation for its most stellar accomplishment in recent times – the elimination of polio (at least for two years now – it takes three polio-free years to call it “eradication,” apparently), a benchmark that the Foundation no doubt helped the Indian government pursue vigorously.

He spoke expansively about micro aspects of continued healthcare policy improvements, whether via the National Rural Health Mission’s work in Bihar or step-changes in vaccine coverage in parts of North India.

Yet hearing him speak there was one question – which, alas, the short time available to me did not permit my asking – that came to mind, and it was a sensitive one.

The Gates Foundation marshals and sinks vast resources into development projects in nations with less-than-perfect institutional regulations, and often with a turbulent balance of political power (think rural Pakistan, where polio vaccinators have been regularly ambushed and killed). To be specific it has an asset base of $32.6 billion and tops 104 of the 190 nations ranked according to nominal GDP by the World Bank. So how do the government and public view the immense power wielded by a non-elected entity, or one that is external to the democratic process of the nation it is operating in (assuming it is a democracy, as it mostly is)?

The obvious caveat that springs to mind is that the very fragile nature of institutions in some of the countries where the Foundation operates, and their sometimes-nascent stage of development, suggests that the enormous welfare improvements brought about by the Foundation’s grassroots initiatives, say for vaccine coverage, may in some cases partly obviate the need for questions about popular representation.

To phrase it another way, could it simply be that organisations such as the Gates Foundation are merely complementing the efforts of the State in areas where it has either failed to deliver progress or is doing so at a pace that is insufficient given the intensity of the problem?

From my two conversations with Mr. Gates and my understanding of the Foundation’s philosophy, there is also an emphasis on universal benefits in their programmes, and thus, it would be hard to imagine one entire village being excluded from a vaccine programme in rural Bihar because – an extreme example – they publicly criticised the Foundation’s work.

Yet even given its focus on “pure” developmental areas and universality, the question of representation would likely arise simply because so much in the development world is either un-measurable or unmeasured. In Nigeria, for example, it emerged during the interview, that religious leaders in certain areas had expressed misgivings about the impact of the vaccine and warned the local populace off it. How does one measure the impact of the science-driven work of the Foundation on the religious-cultural fabric of a nation?

At the end of the day, however, it is a positivist perspective that matters on how organisations such as the Foundation operate in developing countries, how they fit in with the local balance of power and whether there is some way for them to be accountable to the communities they work so effectively in.

Just as the invisible hand of the market determines price, so too will the collective will of the common man and the government he has elected determine the proper role of all institutions involved in large-scale resource allocation of any kind. In most frameworks this would allow Foundation-like organisations to continue, even expand, their good work in a safe, accountable manner.