Elsevier

The Lancet

Volume 373, Issue 9675, 9–15 May 2009, Pages 1645-1653
The Lancet

Health Policy
The Bill & Melinda Gates Foundation's grant-making programme for global health

https://doi.org/10.1016/S0140-6736(09)60571-7Get rights and content

Summary

The Bill & Melinda Gates Foundation is a major contributor to global health; its influence on international health policy and the design of global health programmes and initiatives is profound. Although the foundation's contribution to global health generally receives acclaim, fairly little is known about its grant-making programme. We undertook an analysis of 1094 global health grants awarded between January, 1998, and December, 2007. We found that the total value of these grants was US$8·95 billion, of which $5·82 billion (65%) was shared by only 20 organisations. Nevertheless, a wide range of global health organisations, such as WHO, the GAVI Alliance, the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, prominent universities, and non-governmental organisations received grants. $3·62 billion (40% of all funding) was given to supranational organisations. Of the remaining amount, 82% went to recipients based in the USA. Just over a third ($3·27 billion) of funding was allocated to research and development (mainly for vaccines and microbicides), or to basic science research. The findings of this report raise several questions about the foundation's global health grant-making programme, which needs further research and assessment.

Introduction

The Bill & Melinda Gates Foundation (henceforth referred to as the Gates Foundation) is the largest private grant-making foundation in the world.1 It has three main programmes: a US programme that focuses on secondary and post-secondary education; a global development programme that focuses on hunger and poverty (with an emphasis on small farmers and financial services for the poor); and a global health programme. The total amount paid out by the foundation for all grants in 2007 was US$2·01 billion, of which $1·22 billion (61%) was for global health.2

Although there is a long history of private philanthropic funding in global health—notably by the Rockefeller Foundation and the Ford Foundation—the influence of the Gates Foundation is of a different order. In 2007, the amount spent by the Gates Foundation on global health was almost as much as WHO's annual budget (approximately $1·65 billion),3 and was substantially more than the total grant spending of the Rockefeller Foundation across all programmatic areas in the same year ($0·17 billion).4 The Gates Foundation's effect on global health is evident in malaria research. In the late 1990s, only $84 million was spent on malaria research yearly; since 2000, the Gates Foundation has helped to roughly treble this amount.5 However, there have been concerns about the role, effect, and lack of accountability6, 7, 8 of the Gates Foundation (and of private foundations in general9, 10). So far, the foundation's global health programme has not been properly assessed. In this report, therefore, we describe and discuss the foundation's grant-making programme for global health. Although we do not assess the impact or cost-effectiveness of the programme, this analysis provides a useful starting point.

Section snippets

Analysis

We used information published on the Gates Foundation and Grand Challenges in Global Health websites to identify all global health grants awarded by the foundation from January, 1998, to December, 2007. For each grant, we entered the name of the primary recipient, the size and length of the grant, and a brief description of the grant (as found on the websites) into a Microsoft Excel spreadsheet.

After we had completed an initial analysis, the Gates Foundation changed the way in which it

The Gates Foundation's grant-making programme

Between January, 1998, and December, 2007, 1094 grants were awarded for global health by the Gates Foundation; the total value of these grants was $8·95 billion. Table 1 shows the number and total value of new global health grants awarded every year, and the actual expenditure on grants per year. The amount of funding committed to new global health grants fell from 1999 to 2002, before rising until 2006 and then falling again in 2007. Although the number and value of new grants awarded in 2007

Discussion

The findings presented here should be interpreted with caution. First, some assumptions and interpretations had to be made about the nature of individual grants. Second, we report on the amount awarded for each grant, not on final expenditure. Third, the system of classification is imperfect because of the overlapping nature of the categories used. Finally, we do not account for the sub-recipients of Gates Foundation grants, which means that the number of beneficiaries from developing countries

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