Little investment in nutrition by Gates Foundation

Summary of editorial¹

A recent editorial in the Lancet praises the Bill and Melinda Gates Foundation for the massive boost to global health funding that it has given since its inception in 1994. The Foundation is congratulated for adding renewed dynamism, credibility and attractiveness to global health and with an annual expenditure of around US$3 billion, for challenging the world to think big and to be more ambitious about what can be done to save lives in low-income settings.

However, the editorial also challenges the Foundation to be more transparent over its investments. There have been criticisms that the Gates Foundation has given most grants to organisations in high-income countries with a heavy bias towards malaria and HIV/AIDS but relatively little investment in tuberculosis, maternal and child health and nutrition - with chronic disease being completely absent from its spending portfolio. A study of grants allocated between 1997 and 2007 show that these do not reflect the burden of disease in poor countries and there is concern that important health programmes are being distorted by large Gates Foundation grants.

The editorial makes five 'modest' proposals for the Gates Foundation:

1. Improve governance and visibly involve diverse leaders with experience in global health, in strategic and operational stewardship.
2. Increase transparency and accountability in decision making. Explain the Foundation's strategy openly and change it in light of advice and evidence.
3. Devise a grant award plan that more accurately reflects the global burden of disease, aligning the Foundation more with the needs of those in greater suffering.
4. Do more to invest in health systems and research capacity in low-income countries, leaving a sustainable footprint.
5. Listen and be prepared to engage with 'friends'. The Lancet was sorry that the Foundation declined an invitation to respond to a recent paper and to set out the Foundation's vision for its role in global health.

¹The Lancet (2009). Editorial - what has the Gates Foundation done for global health? Vol 373, May 2009, pp 1577