What links the efforts to reduce maternal and child mortality in Bihar, the battle against cassava plant diseases in Brazil and tuberculosis interventions in South Africa?
While one would be tempted to assume these are United Nations or World Bank initiatives, it is a ‘purely private sector’ supported organisation that drives these projects — the Bill and Melinda Gates Foundation.
Bill Gates, the Foundation’s head and Chairman of Microsoft Corporation, commands the kind of attention among global policymakers that World Bank executives would envy. Releasing his annual letter to policymakers this week, he said in an India-exclusive print interview with The Hindu that one word summed up the guiding principle of his foundation in pursuing its broad, multi-pronged agenda: measurement. At a time of shrinking aid and development budgets in many Western economies, Mr. Gates’ emphasis on ‘measurement’ is timely. Not only is it rooted in an urge to ramp up project efficiency across the developing world but it is also, as he admits in his letter, a response to “governments... rightfully demanding effectiveness in the programs they pay for”.
Apart from the sheer scale of resources — the Foundation, with an asset base of $32.6 billion, tops 104 of the 190 nations ranked according to nominal GDP by the World Bank — Mr. Gates said a sharp focus on “quality metrics” and keenness to deploy technological firepower set his approach apart from standard public-sector strategies.
“Measurement is something that comes naturally to the private sector, because they have to have a theory about how their business works,” said Mr. Gates. Though governments and philanthropic groups had not done much measurement “the good news is that measurement is easier to do in a world of satellite photos, cell phones, cheap software and databases”, he added.
His point resonates well in India, which has seen the breathtaking effectiveness of the polio eradication campaign. Earlier this year, the nation marked two years since a child was crippled by polio — an impossible outcome had it not been for millions of volunteer vaccinators fanning out across the nation during immunisation weeks.
Lavishing praise on one of India’s “biggest accomplishments in the last decade” in his letter, Mr. Gates points to the importance of micro-level delivery mechanisms the country adopted.
However, India has a long way to go in other areas, according to him. “The quality of execution is a limiting factor,” he said. But he cited Kerala as an example of a State that achieved “great health results not so much by putting in a lot more money than other places”.
When pressed on specifics regarding challenges to India’s policy implementation, Mr. Gates revealed as much about his familiarity with the signs of failure as he did about his impatience to bring technology on board to mitigate the situation.
“Does grain for the poor get diverted corruptly?” he asked, “Do teachers show up? Are health-worker jobs filled? Are they properly trained? Why don’t kids get vaccinated? We should be able to register them digitally and follow up digitally.”
This last innovation of “digital vaccines”, Mr. Gates said, had actually taken root in Bihar after the Foundation ran the project in pilot districts and then handed it over to the government to propagate. But to ask whether the Foundation can boost effectiveness of government policy implementation is to raise an even bigger question: Is it possible to harmonise private and public sector strategies when they are often driven by different motives and represent varied stakeholders?
Mr. Gates, at least, is unequivocal about this. “A lot of what we are able to do... is hire what we call strategy units... analytical-type personnel, create the right tools and salary structures for them and connect them up with a government activity like vaccination coverage or spending or getting contraception out and make sure that the increased government investment is actually being used appropriately.”
Sure enough, the Foundation works with an impressive analytical arsenal. Convinced by the data on the financing of their worldwide polio eradication drive, the organisation keeps a steady eye on the year-on-year requirement of $1 billion. Any less, warns Mr. Gates, and “hundreds of thousands of polio cases” will start cropping up.
Nigeria and Pakistan
Similarly, the Foundation soldiers on to meet vaccination targets in the two countries that have proved the most dangerous for vaccinators — Nigeria and Pakistan. Nigeria witnessed a crisis due to religion-based objections to vaccines and fears and misinformation about negative effects. In December, militants in Pakistan “stalked and killed” nine women polio workers prompting the United Nations to suspended its anti-polio drive and risk a public health crisis.
When queried about this, Mr. Gates praised his staff’s bravery, saying, “I am afraid of unrest and instability... But it doesn’t mean we are not going to do our best to eradicate polio and partner with our government to try to save those million lives. By persevering we honour the people in Pakistan who died. The benefits of getting rid of these things are so clear.”
This points towards the core debate on large-scale philanthropic interventions that sit beside government policies: can the private sector model be applied anywhere to developmental issues without severe modifications to suit local idiosyncrasies?
In Mexico, for example, where Mr. Gates argued that the status quo in the education sector was “highly defended by the teachers’ unions”, is there some way that the Foundation mantra of “personnel system reform and technology” could assuage concerns over employment, equity and poverty?
While it may sound like the perfect blueprint for a profit-driven firm such as Microsoft, Mr. Gates believes both the model and the skills behind it ought to be deployed more widely in development policy.
Indeed, along with Co-Chair and wife Melinda, he has launched what is called the ‘Giving Pledge’ (GP), Mr. Gates said with a twinkle of pride in his eyes. GP is a fund-raising drive aimed at tapping the resources and skills of billionaires across the world for the express purpose of philanthropy.
Until 2013, it was focused on ultra-high-net-worth individuals in the U.S. and there were at least 91 dollar billionaires who had pledged to give the majority of their wealth away during their lifetimes or through their wills.
Mr. Gates appeared enthused, holding firm to the view that philanthropy ought not to be “a passive thing that you should do through your will but... an enjoyable thing that you do with the same skills that helped you make the money”.
“Just this year we are recruiting internationally... but it will be a long time before there are as many non-U.S. GP members as U.S. members, even though there are more international billionaires than U.S. billionaires,” he explained. While there were “wonderful, giving people, such as Azim Premji in India”, Mr. Gates said, “it is just less of a tradition”.