Let’s Get Some Credible Critique of the Gates Foundation

Bill and Melinda Gates made the independent and widely-applauded decision to spend down their  foundation 50 years after their lifetime. In fact, foundations who elect to attempt perpetuity are often criticized for their ego.  But the decision to sunset means they have to spend a few extra billion dollars each year. This is the down side of sunsetting: you have to get the dollars out the door. I won’t bother to ask for your sympathy over how hard it is to give away money, but I will at least ask that the global health community at large withhold the snark and judgment evident in a study as unhelpful as the one just published in the Lancet.

In one example of absurd critique, the authors of the study note that “65% ($5.82 billion) of all Gates Foundation global health funding was shared by 20 organisations, including five global health partnerships—such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI Alliance, which together received a quarter of all funding through ten grants.” The study expresses concern that so few organizations receive such a large chunk of the funding.

If the foundation didn’t give large, multi-million dollar grants to trusted intermediaries, they would be attempting to get to know hundreds of smaller organizations, administer thousands of grants each year. To reach $2 billion–the amount the foundation distributed in 2007– in increments of $250,000, you’d have to give out 8,000 grants.  The staffing needed for Gates to do due diligence, coordinate the logistics and effectively gather data from 8,000 smaller organizations would be overwhelming–and the “watchdog” community would be frothing at the mouth over the “wasteful overhead.” The Gates Foundation offers this explanation on its web site: “Most of our grantmaking goes to large intermediary partners—organizations that in turn provide funding and support to those doing the work in the field. This lets us take advantage of expertise that others already have, and it builds up expertise among people in the field rather than simply on our staff.”

A Question of Influence

In reality, the use of well-respected, widely-connected global health partnerships and intermediaries like the Global Fund is the only viable option for distributing billions in philanthropic funds.  At the same time, after first criticizing them for being too narrow and playing favorites, the authors then fault the Gates Foundation for being too widely-connected to the global health community:

“The Gates Foundation funds a wide range of contributors to global health, extending from UN agencies to global health partnerships, the World Bank, universities, and non-profit and non-governmental organisations. All the key contributors to global health have an association with the Gates Foundation through some sort of funding arrangement. Coupled with the large amount of money involved, these relations give the foundation a great degree of influence over both the architecture and policy agenda of global health. Through its funding of non-governmental organisations and policy think tanks, the foundation also confers power and influence on a selected number of organisations and in doing so, establishes some leverage over the voice of civil society.

These observations are pertinent because the Gates Foundation is not a passive donor. The foundation actively engages in policy making and agenda setting activities; it has representatives that sit on the governing structures of many global health partnerships; it is part of a self-appointed group of global health leaders known as the H8 (together with WHO, the World Bank, GAVI Alliance, the Global Fund, UNICEF, the United Nations Population Fund [UNFPA], and UNAIDS); and has been involved in setting the health agenda for the G8.

Actually, this coordination role of the Gates Foundation is in some ways its most important function.  A private foundation has the luxury of independence.  Without the need to raise money like the charities or earn votes like the government actors, the foundation has its own endowment that provides seed money for a thorough investigation of the problem.  In the worst case, that can mean a foundation operates at the whim of the founders but in the best case it means that the foundation can play an important coordinating role among many actors.

“Strategic Philanthropy”

I used to work for the Pew Trusts, a foundation that develops their programmatic strategies with input from a cadre of experts, drawn from academic, practical, public and private organizations.  They assess the problem, look for the points where the infusion of money and know-how can make a difference, evaluate the capacity and reputation of organizations in the field, and get the various pieces all moving in the same direction.  Where many actors on the public stage have a particular capacity, and they may execute their programs exceptionally well, few have the independence and wide-ranging expertise to handle all aspects needed to create systemic change. Foundations can bridge these worlds, between academic research, front-line service delivery, grassroots community development,  grasstops advocacy, for-profit entities, and so many other silos, to get all the oars rowing in the direction of an achievable solution.

Let’s be realistic: most foundations aren’t operating in such rarefied air.  That why we like to critique them for not being as effective as they should be at creating (supporting?) measurable social change. And yet, whenever foundations actually do this, when they are actually effective at influencing society, somebody starts attacking them for being influential.  Damned if they do, damned if they don’t.

The people who start attacking them, though, always seem to be the people whose personal passion, or whose pet project, wasn’t funded.  People who disagree with the foundation’s conclusions.  That is, because the Gates Foundation didn’t choose their preferred program areas, they assume there was no legitimate process for selecting program areas. Ironically, if they actually did examine and analyze the foundation’s method for selecting program focus areas, THAT would be relevant and useful.  Given the inevitable influence of the Gates money, it’s important that their decision-making process be carefully designed. Did the Gates Foundation solicit input from a wide range of medical practitioners, scientists, global health experts, international development organizations, etc.? Or is their circle of advisers too insular? Did they successfully explain and defend their analysis of the problem? Or were they drawn too early toward one theory, like a homicide cop focusing on one suspect without properly investigating the others? What assumptions are built into their decision-making, and is there evidence to defend those assumptions?  What is their basis for believing their portfolio of grants will make a meaningful impact on the problem? Are they watching for signs of success, of failure or of unintended consequences and reacting to them? Or do they set the programs in motion and wait and hope they have the intended impact?*

Process Evaluation

With these questions in mind, this paragraph from the Lancet study is one of the most egregious: “Grant making by the Gates Foundation seems to be largely managed through an informal system of personal networks and relationships rather than by a more transparent process based on independent and technical peer review.”  Well, that sentence “seems” to be largely conjecture from someone who didn’t have a seat at the table. You don’t like the conclusions (the authors think they focus too much on vaccines and technology instead of infrastructure and want more money for maternal health) so you start trashing the process, an unfortunate logical fallacy. It’s legitimate to ask about the process, if a bit too early to conclude that it was insufficient. What do we know about their process?

On their own web site, the Gates Foundation lays out its decision making at a fairly high level.  You can read an entire document dedicated to explaining how they make decisions, but here are a few excerpts:

“Long before we make a single grant for any given issue, we listen and learn about problems that cause great inequity. Whether the challenge is low-yield crops in Africa or low graduation rates in Los Angeles, we begin by immersing ourselves in information about problems that cause great harm and get far too little attention.”

“As we learn about an issue, we ask whether we can make a difference with our money and our ability to bring partners together. We get involved only if we believe we can make a unique contribution.”

“For each opportunity, a program area considers its cost, the risk associated with it, its long-term viability, and, most important, its potential impact on people’s lives. Based on the answers to these criteria, and after extensive discussion, the program identifies a strategy, which includes a budget, the results they hope to achieve, and a plan to measure those results over the short and long term.”

This general explanation of process is a nice start, but if the Gates Foundation wants to counteract this criticism (and avoid being compared to evil genius Dick Cheney and his secret meetings with anonymous energy advisers) more specific transparency about the foundation strategies, who was consulted in developing them, what approaches were considered and discarded and why, etc. would be a great set of information to release to the global health community. The problem is, I’m honestly not sure what the Gates Foundation gets out of it.  People will take potshots at the experts they consulted, complain that their personal expertise wasn’t represented, disagree with the foundation’s assessments (and complain loudly that they were scaring away other funders) and generally be a pain in the ass. Practically speaking, it’s hard to overcome this set of disincentives.

Let’s Get Good Critique

I agree with some comments from study co-author McCoy that, given the huge amount of influence wielded by the Gates Foundation, it’s important to our collective global health that we have some degree of comfort with how this private entity makes their funding decisions.  That said, I’d be far more interested in an analysis of Gates Foundation activities by fellow change makers. By someone who truly understands the context of a U.S. private foundation, the realities of distributing huge amounts of money, and can ask the right questions about whether the foundation’s decision-making process is sufficiently robust to overcome the challenges of getting good information when everyone is motivated to tell you what you want to hear. On their own, the foundation has established a set of best practices for strategy development and grant selection, one I think the global health community would find quite acceptable, if only they’ll read it.  It’s that process to which they should be held accountable. If it’s all talk, the Gates Foundation gets an F and should be shamed into doing better for all of us. But if they walk the talk, we can argue about their conclusions and try to change their mind but we have to respect that they went through a good faith process.

Perhaps the answer here is to call on the Gates Foundation to hire someone to undertake an independent evaluation of whether they have followed their own process and how they could make their process more rigorous. Ask them to publish those findings and follow up on the recommendations.

In the end, I can’t help but wonder if that widely-applauded decision to sunset the foundation–the fact that’s forcing them to shovel billions out the door each year–might be reconsidered in light of the fact that so much money creates so much influence for a private actor.

“Disclosure: I was briefly a consultant to the Gates Foundation in 2004 and 2005 as they considered these questions and how to evaluate and hold themselves accountable as the world’s largest grantmaker. I also used to work in Planning and Evaluation at The Pew Trusts and was one of the authors of the document linked above.

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12 Responses to “Let’s Get Some Credible Critique of the Gates Foundation”

  1. Gates Keepers Says:

    It is incorrect to say: “The people who start attacking them, though, always seem to be the people whose personal passion, or whose pet project, wasn’t funded.” Always? Gates Keepers knows many critics of the Foundation who are funded by the Foundation. But they speak quietly. Bill Chill.

    If you think that credible criticism is needed then why don’t you author some and post it on your blog? Have you signed a confidentiality agreement while you were a consultant with the Foundation?

    Gates Keepers

  2. Sharon Schneider Says:

    Hey, I’ll gladly change that sentence from “always” to “often.” My point is that it’s a no-win situation for all private foundations who actually manage to have an impact. Inevitably, folks who disagree with your politics will start attacking the idea that private money should be allowed to have public influence. Somehow, though, when it’s the critics’ political ideology that is successfully championed, it’s not such a crime to have private actors working for “the common good.”

    All foundations are working for the common good, but it’s just that they all disagree about what the common good actually is. You might personally hope all foundations supporting pro-life or pro-choice causes are ineffective, but if one of them manages to have an impact it’s hypocritical to cry “foul.”

    And yes, I did sign a confidentiality agreement.

  3. Philippe Says:

    it seems to me there is a strong reluctance from the Gates Foundation (and from many others) to be more transparent. As you write maybe they don’t see what benefits (if any) they would get out of it and there is certainly the will to control any bit of information that is released.
    I think the transparency requirement applies as much to the grantees (that are themselves big organizations): they should be transparent about what they do with the funds they receive.
    From my own limited experience (see below), they don’t.
    It would be easy for the Gates Foundation to require them to be transparent and blogs provide a very effective tool. How do you explain there is not one blog linked to the Gates Foundation but for the critical Gates Keepers? Why are they so totally blogophobic?

    Gates Foundation: The challenge of communicating about $3.8 billion programs. The blog solution.

    The Bill and Melinda Gates Foundation plans to invest $3.8 billion in 2009.
    They have invested $3.3 billion in 2008.
    As far as communication goes they have one traditional website (plus one facebook account) and… that’s it.
    They apparently don’t require that their grantees report on line about how they use the grant they have received.
    Let us take the example of a project I have worked on, the $5 million grant (grant 49.295) awarded in January 2008 to the Canadian crown corporation IDRC to promote tobacco control in Africa, a project Bill has said to be personally concerned about (along with Mike Bloomberg).

    $5 million (over two years) is -by far- the biggest grant ever attributed to tobacco control in sub-Sahara Africa but when compared to the cumulative budget of the Gates Foundation for 2008/09 it is hardly 0,07% of $7.1 billion (over two years).

    How to communicate in a substantial and meaningful way about a $5 million grant when it represents 0,07% of your global budget? The solution is to rely on the grantees to provide this information.

    In the case of IDRC, they devote a few pages on their website to this grant: one for the general presentation, a few about the process to select African grantees, one for the list of the selected grantees where each one is very shortly mentioned. There are also two issues of a very short newsletter in a pdf format (not very userfriendly on the web but they did make the effort to produce both an english and french version).

    Is that enough reporting for a $5 million grant that is -by far- the biggest grant ever attributed to tobacco control in Africa?

    Each African grantee could communicate via a blog that could be edited by an advocate or a local journalist for a very small budget as demonstrated by many ongoing blog projects in Africa. The managers could also blog to share information on a regular basis about what they are doing and the evolution of the project.

    If the Gates Foundation was requiring such blog-reporting by its grantees it would largely reduce its own information deficit and generate a new galaxy of blogs.

  4. Sharon Schneider Says:

    Thanks for your thoughts and suggestions, Phillipe. Even though I find a lot of fault with the Lancet study, if this publicity causes the foundation to be more transparent, that can only be a good thing.

  5. Gates Keepers Says:

    Thank you, Sharon, for the comment on the Gates Keepers blog.

    snip

    “Criticism of what most observers seem to think is a shoddy study is “backlash” against those who criticize Gates? I don’t think you are well-served in your mission to hold Gates accountable by embracing everyone that happens to share your negative outlook of the Gates Foundation. Don’t accept the study as valid just because you like their conclusions. Have some standards, man.”

    snip

    We expect there to be a backlash against any criticism of the Foundation and we will continue to contribute to a critical analysis of their activities. If you look for positive postings about the Foundation’s activities on Gates Keepers you will find them.

    The study was valid enough to be peer reviewed and published in the world’s leading medical journal. That is good enough for us. More importantly, the Lancet editorial outlining suggestions for the Foundation carries the weight of a very critical editorial staff. We are proud to amplify their anonymous voices.

    And we agree the more transparency the better.

    Gates Keepers

    http://gateskeepers.civiblog.org/blog/_archives/2009/5/15/4187087.html#comments

  6. Philippe Says:

    10 months later (from may 2009 to February 2010) what has changed at the Gates Foundation? Bill just opened a personal website that’s not really a blog and is on twitter. Jeff Raikes said to the Chronicle of Philanthropy he is considering an ombusdsman. They have a new communication director. I think my suggestions still stand but is anybody listening? It is impossible to know. They should really have a feedback department…

  7. Colorado Medical Health Insurance Says:

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  8. SonyaRatty Says:

    Hello, please could you link to the Lancet article or give the full title? The current one does not work and I would be interested in reading it. Thanks.

  9. Gates Keepers Says:

    http://www.thelancet.com Vol 373 May 9, 2009 1645 or http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960571-7/fulltext

    GK

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