Q&A with Melinda Gates and Dr. Sipho Moyo
To coincide with World Aids Day 2010, our guests were Melinda Gates and Dr. Sipho Moyo, from the Gates Foundation and campaigning organisation ONE. They took on your philanthropy-based questions, from international aid and HIV to malaria and Make Poverty History, among others.
Melinda Gates (right, top) is the co-chair of the Bill & Melinda Gates Foundation, a not-for-profit organisation she and husband Bill founded in 1994. Its aims include combating extreme poverty and poor health in developing countries.
Dr Sipho Moyo (right, bottom) is the Africa Director for ONE - a grassroots advocacy and campaigning organisation that fights extreme poverty and preventable disease, particularly in Africa, by raising public awareness and pressuring governments, and has more than 2 million members worldwide. One of its current campaigns highlights the shocking statistic that more than 1,000 children are born with HIV every day.
Q. Beebee: What does the Living Proof campaign have to say about corruption aid going 'missing', or getting in to the wrong hands and being misused by officials? This seems to be something that comes up whenever I talk about aid/charity with friends, and it's a major concern for the UK public. Plus, only last week, the Wikileaks cables reported that a senior member of the government in Afghanistan had flown into the US carrying several million dollars in cash. Can you help me to reassure people that their money is being spent on humanitarian projects rather than presidential palaces?
A. Melinda: I get questions on corruption a lot, and it's one of the leading reasons a lot of people are sceptical about aid. Of course, corruption does exist in developing countries, and it's something that donors should be (and are) tackling, but it doesn't mean that most aid is wasted.
Unfortunately, many people's perceptions of aid are based on outdated models, such as the West's propping up of corrupt dictators like Congo's President Mobutu. It is true that a lot of this kind of aid support happened during the Cold War years when many donors wanted to buy influence in developing countries and frankly didn't care as much about what actually happened to the money. But since the end of the Cold War, there has been a shift towards aid that can help countries overcome poverty and track their results.
One great thing about aid that's focused on the poorest people is that you can follow where the money is going. You can count the number of vaccines purchased. You can count the number of children immunized against polio. And when you see some of the large numbers - like the fact that 250 million children have been vaccinated, saving over 5 million lives since 2000, and 42 million more kids in Africa are in school - you know you're getting a good return on investment.
A. Dr Sipho Moyo: As an African I get asked this question a lot too Beebee. I'd echo everything Melinda has said. While we know things aren't perfect, there is a host of evidence to show that aid is getting through to the people that need it.
Just one good example is the Global Fund to fight AIDS, tuberculosis and malaria – a very effective fund to which a number of recipient countries, private sector and donor governments, including the UK, contribute. The Global Fund is an example of new, smarter aid which is carefully audited and measured for the results it achieves. It places a lot of emphasis on dealing with potential misuse of its funds, and conducts regular investigations. It will suspend or cancel funding to particular programmes if there are concerns that money isn't being spent in the intended way. As a result of this rigorous approach, the Fund helps to save about 4,400 lives every single day from the killer diseases of AIDS, tuberculosis and malaria
Of course there are still corrupt or ineffective leaders, and we must never be complacent, but the good news is there are also a great many brilliant and dedicated African crusaders at all levels that are fighting against corruption. They include grassroots civil society organisations, NGOs and even government leaders such as Nigeria's Ngozi Okonjo Iweala who, as finance minister in her country, fought tirelessly against corrupt officials. As did Donald Kaberuka, the former finance minister in Rwanda, who focused on building institutions that strengthened good governance by forcing transparency and accountability and thus served as a strong deterrent to corruption. Kenya's John Githongo, a member of ONE's Policy Advisory Board, fought against corruption when he headed the Kenyan branch of Transparency International. And we also have Mo Ibrahim from Sudan who has dedicated the fortune he made from telecoms in Africa towards promoting good governance on the continent
Across Africa and beyond, there are countless individuals working around the clock to make their governments better and more accountable. In many cases they are being supported by smart aid funding, projects to promote good governance and democracy, all essential building blocks for development.
Q. policywonk: I'd like to know what the Gates Foundation thinks about the increasing emphasis within DFID and USAID on the prioritisation of 'conflict' countries. It seems to me, as someone who fully supports the ringfencing of development funds and the 0.7% target, that this encroaching focus will see development money hijacked for projects that are more properly the concern of defence or foreign policy departments.
A. Dr Sipho Moyo: It's true to say that aid is most effective when it is spent on poverty eradication projects, however it is also clear that security and development are inter-related. Economic development is the most cost-effective means of conflict prevention and many of the world's poor live in fragile states. The best case scenario is that by helping these countries become healthy, stable and well-run it will serve development and national security interests. This is why ONE thinks it's right to focus on fragile and conflict states and recognise that it doesn't have to be a choice between development and defence - the smart thing is to see them as two sides of the same coin, in trying to end extreme poverty and make the world a safer place for all of us.
You're right to be concerned though. There are risks that development's mission to fight poverty might become secondary to foreign or military concerns, particularly when government funding is so tight. That's why it's important in the UK for the role of DFID the Department for International Development) to be clear when working with the Foreign Office and Ministry of Defence, and when aid is being spent DFID should play the leading role.
Q. Maggie50: I have to say I admire you both for the great work you're doing. I often wonder what I can do, and if people like yourselves ever get overwhelmed by the problems you are trying to deal with. I reckon it's important we all try and do our bit, but I often don't know how best to. What if anything at all do you think an individual like me and other Mumsnetters can do to help?
A. Dr Sipho Moyo: What actually keeps me going (and I know this is true for many people who work in development) is both the innate desire to do something about the profound injustice of extreme poverty and preventable disease suffered by so many, and the fact that significant progress has been made in the fight against the vices of extreme poverty, disease and ignorance. Development efforts and resources have made an incredible difference when it comes to saving lives, transforming communities and simply restoring hope where none was left. These are the things that remind me every day that there is no limit to what is possible in our mission to improve the lives of those less fortunate if only we can all join hands and play a part.
One of the most powerful things that individuals can do to help is to use your voice to call for policy and other changes which will help reduce poverty and preventable disease. Let me invite you right away to join ONE and lend your name and voice to our petition for no child to be born with HIV by 2015 . Along with over 2 million members worldwide, we'll keep you updated on other simple ways you can add to collective pressure to influence policies and practices that can help the world's poorest.Because ONE is an advocacy and campaign organisation and not a project implementing one, we ask simply for your voice, not your money. However many people would like to donate money to development charities that have projects on the ground in developing countries.
A. Melinda: It's true, sometimes I get overwhelmed when I think of the scale of people's needs, too. But more often, I get really inspired when I see all the progress that's happening, when I meet people who are alive because of all the great work in health and development. That's why I think you're already playing a key role, by participating in conversations like these. In addition to what Dr Moyo has said about giving your voice and joining ONE, another important thing an individual can do is spend some of their energy and time learning about - and talking about - the issues.
Once more people understand, for example, that we are 99% of the way to wiping polio off the face of the earth the world will make even more progress, faster. You are part of a movement that is bringing these vital issues to people's attention.
Q. Innotime: I supported Make Poverty History in 2005 (as I'm sure a lot of other Mumsnetters did) which was a big moment here in the UK for awareness raising and campaigning on global poverty. So I'd like to know what you think the benefits of that where, and what do you think have been the major achievements in development in the last few decades?
A. Dr Sipho Moyo: First of all, thank you for getting involved with Make Poverty History back in 2005. This made a huge difference and was an historic turning point in the fight against poverty and disease. As you'll remember it the campaign, jointly run by hundreds of organisations across the UK, targeted the G8 Summit in Gleneagles, Scotland, with demands for increased and improved aid, debt cancellation and fairer trade rules.
As an African, my memory of Make Poverty History is that of an amazing outpouring of solidarity and concern by the British people, and those in many other countries, for the plight of fellow human beings on my continent and around the world. A direct result of that campaign was that G8 leaders pledged to double aid to Africa (from 2004 levels), with a target of reaching an extra $25 billion per year by 2010. The G8 also agreed to cancel remaining debts for the poorest countries (to date 22 countries have since qualified for this) and to strive to provide access to life-saving treatment for all AIDS patients and education about the disease for all children.
The UK has kept its Gleneagles promises and has committed to meeting its aid target, and while not every G8 country's promises have been met (Italy under Silvio Berlusconi being notably weak), those that have been kept have contributed to some incredible, positive results that only show how much more can be achieved if all G8 countries kept their promises. Increased aid and debt relief has given developing countries greater financial space and resources to spend on basic service like health and education.
This has contributed to some significant progress, e.g. deaths of children under the age of five have fallen dramatically from 10.5m in 2004 to 8.1 in 2009. That means 2.4 million fewer children died last year than 2004 (the year before Make Poverty History) or in other words 6,500 fewer every single day. Not nearly enough, but commendable progress all the same. More still needs to be done, and we need to recapture the spirit of Make Poverty History because only with the support of people like you, who united against poverty in 2005, can the progress continue and scale-up.
Q. jonicomelately: I really applaud the work you are doing. As someone in business who believes passionately in 'giving back' I wish to start a charity with similar aims (at local level and in the world) because I also aim to model the best examples. Do you have any tips on how best to proceed?
A. Dr Sipho Moyo: Congratulations on this laudable goal to start such a worthy cause. At ONE we don't see poverty reduction as charity, but as an injustice that needs to be addressed. I think it is this understanding that helps to motivate staff and supporters of ONE – a problem that together we can work to correct. I think clearly identifying the issue you plan to work on, engaging others and using your enthusiasm and dedication to spur others to action is key.
On a practical level, I checked with my ONE colleagues in our UK office who advise that the best thing to do is check out the Charity Commission's website as a first step. They are the body that regulates and advises charity organisations, and their website explains the legal requirements you must consider and the questions you need to think through before setting up a charitable organisation. Here's a link to their site.
Q. Platanista: How do you and the foundation balance innovation versus long, long-term commitment? And do you think there is a danger of spreading yourselves too thin by working with as many partners as you do? On a more personal level I would dearly love to know how it feels to literally hold the purse strings to changing people's lives, but knowing you can't possibly fix everything; I find myself thinking that that can't really be a comfortable position to be in.
A. Melinda: Bill and I both learned a lot about how innovation works in our business careers, and we're trying to apply many of those lessons to our philanthropic work. As you suggest, one of our guiding principles is that "we take big risks," but another is that "we're in it for the long haul". We think that philanthropies have a really unique opportunity to try innovative things - and to stick with them long after businesses or governments might have been forced to give up because of the realities of the balance sheet or election cycles.
We believe that we should use our resources to act as catalysts, to work with our partners to trigger new and better solutions. To take one of my favourite examples, we fund an innovative program called Grand Challenges Explorations for scientists and researchers who have a nascent idea about how to solve the world's biggest problems. We give grants of $100,000, based on a two-page proposal, to see where the ideas lead. We know that many of these ideas will fail. But for every 10 or 20 failures, one idea will succeed over the long term. It's those long-term successes that have the potential to change the world
We hope that our resources and often risky investments can then uncover new ideas and prove new concepts so that our partners - non-profits, governments, and businesses – can efficiently scale-up some of these concepts. For example, if we can put the seed money in to develop a new vaccine, then governments may be able to introduce this vaccine by incorporating it within their routine immunisation programs - thus ensuring the money will go further and save more lives.
Q. Bluedogs: I guess you could term what I want to do as micro-philanthophy. I have £50 a month to donate and want to know what is the way to get the most "bang for my buck" in terms of impact in aid work in a developing country. Should I donate the money to an established organisation already working for causes that I support or should I attempt some kind of direct giving to an individual/organisation locally? How does the Gates Foundation choose its partners?
A. Dr Sipho Moyo: ONE only asks people for their voice, not their money. That's only because we are an advocacy and campaign organisation rather than one that supports or implements development projects on the ground. However, we believe firmly that individuals giving money to causes of their choice is an important way to make a difference and it's great that you are interested in doing so.
A. Melinda: As we rely on organisations on the ground to carry out our work, we understand the importance of choosing our partners wisely. We believe that to maximise our impact, we need to work with our grantees in the spirit of true partnership, rather than through one-off donor-grantee transactions.
Q. Expatinscotland: I'd like to ask what, if anything, the Foundation is doing to prevent AIDS transmission by birth via the improvement maternity and childbirth care in developing nations. Are they also providing or trying to put in place postnatal care for women in these countries? A recent article in the BBC highlighted the all-too-common scenario in which women sustain injuries in childbirth (such as fistula injuries) and are then ostracised from their communities and unable to obtain treatment.
A. Melinda: The health and wellbeing of mothers and their young children is critical in the overall health of communities, and that's why I spend so much of my time and energy on this issue. Earlier this year, I gave a speech focusing on some of the things I've learned about family health. As I said in the speech, when I meet mothers in developing countries, I am always struck by the similarities between us. Like me, what they want most is a happy and successful future for their children. That's something that all mothers, everywhere, have in common. Tragically, one thing we don't all share is the ability to help their children realise their potential, and that's what our investments in women and children are all about
You're also right to point out the connection between HIV and the health of newborns. HIV testing should be a standard part of prenatal care for women. Similarly, family planning and prenatal care needs to be easily accessible to HIV-positive women. We are working with partners to promote both of these areas.
Q. Funnyperson: What plans, if any, does the Gates Foundation have to help fund vaccine research for childhood vaccines in Europe? I ask because I think there is a massive expertise in vaccinology, particularly in the UK, with European and world collaboration, but dwindling funding.
A. Melinda: We like to say that vaccines are miracles, because just a couple of doses protect a child for a lifetime. We now have vaccines that prevent seven of the nine biggest killers of children in the developing world. And there are companies from all over the world working on new vaccines—for malaria, and one day for HIV.
Many of our partners are based in Europe, precisely for the reason you point out – that's where so much of the expertise is located. For example, we are working closely with GlaxoSmithKline on a new malaria vaccine, RTS,S. Another great and very recent example is a collaboration, led by the US-based organization, PATH and the WHO, working alongside a manufacturer in India (the Serum Institute), SynCo BioPartners in the Netherlands, and the Center for Biologic Evaluation and Research/Food and Drug Administration in the US, which have come together to develop, manufacture, and deliver a Meningitis A vaccine. It took a 10-year commitment from those partners, but now there is a vaccine that costs less than 50 cents a dose and will protect millions of children from a deadly, disabling disease.
Q. Themasterandmargaritas: As a person living and working in Africa for quite some years, I can appreciate all the time, energy and effort that have gone into HIV awareness programmes and improved accessibility to testing, counselling and antiretrovirals from some of the world's leading donors. Whilst all this time and money has led to a reduction in prevalence rates in most African countries, it is not as great a reduction as was forecast.
Should the Gates Foundation not be focusing on preventing other diseases that kill far more people (mostly children) than HIV does and are cheaper and easier to prevent? Malaria, for example, is hugely underfunded and a greater killer of children under the age of five than AIDS. And what of waterborne diarrhoeal diseases? Also how does the Gates Foundation/ONE work with governments to tackle the underlying causes of poor health that may make a person more susceptible to contracting a communicable disease?
A. Melinda: AIDS is a tragic disease that has a huge impact on people across Africa. The global health community has been working hard for a decade now to reduce the burden of that disease, and I'm excited to say there's been some striking progress in treating and preventing the disease recently. There are millions of people with HIV/AIDS living today because of this excellent work.
Unfortunately, as you point out, there are a whole host of issues and diseases that affect people in Africa. At the foundation, we are able to invest in a number of these diseases, including polio, malaria, tuberculosis and many neglected tropical diseases. Our goal is to have the biggest impact possible, so we decide where to focus by analysing how we can maximise our resources. We start by asking ourselves two questions: Which problems affect the most people? And which have been neglected in the past? The idea is that by concentrating on problems that have been neglected, we can be catalysts and help spark innovative solutions that will help millions, tens of millions, or even hundreds of millions of people.
The ONE Campaign is an important partner to our foundation. We work together to promote public health policies such as integrating HIV and TB services and delivering vaccines to children across the globe. Bill and I have learned how important it is to work with governments and policymakers to ensure they are fully informed of the impact investments in global health can have. We consider these advocacy and policy investments as important as our investments in clinical research.
Q. Hazelhoo: I was really shocked when I heard that over 1,000 babies are unnecessarily born HIV positive each day, so I fully support the campaign to prevent this and appreciate all the hard work that goes into it. I see that much of your work is rightfully targeted at practical interventions to prevent disease and extreme poverty.
As a counsellor I wondered what the foundation does/could do to provide, offer or encourage emotional support for those affected by extreme poverty, poor health and in particular those born HIV positive, and their parents and families?
A. Melinda: Absolutely. It's important to remember that all this work is about helping people live healthy and productive lives. So when we're thinking about the science of treating or preventing HIV and other diseases, we should never forget the human element. Our foundation doesn't directly fund HIV care programs, but we work closely with partners such as UNICEF and Save the Children who do amazing work in that area.
A. Dr Sipho Moyo: Your question is a really important one - it is too easy to only focus on technical interventions, without appreciating the fact that HIV can be an emotionally devastating disease and that both education and counselling are critical pieces of our fight against it. Just a few years ago many who became infected with HIV felt hopeless, largely because the disease was seen as a death sentence; now that we have antiretroviral drugs to allow those who are infected to lead healthy, productive lives, we can restore hope for the future to those who are infected and affected - but counselling is still an important part of this equation.
At ONE, when we advocate for the virtual elimination of mother-to-child transmission of HIV, we include as part of our call a push for improved education and counselling efforts before, during, and post-pregnancy for mothers who are HIV positive. Too many women simply are not aware (or empowered) of how to avoid unintended pregnancies through family planning, and much less, how to prevent the transmission of the virus to the newborn if they decide to have a baby.
Q. Unprune: I would like to ask, with regard to prevention of HIV transmission, how do you feel about the promotion of abstinence? It is very tied up with a moral/religious agenda that isn't very palatable to liberal Western minds. How do you see it being used, and do you think promoting abstinence and monogamy has any practical effect on the ground?
Dr Sipho Moyo: At ONE, we believe that aid programmes work best when the people who are planning and delivering the programmes work with local people to find local solutions to the problems they face The HIV/AIDS pandemic is not the same everywhere - its impact varies across demographics, communities, and geographic regions - so we should tailor our prevention approaches accordingly. For example, if you have a concentrated epidemic among a high-risk population, you should be focusing your prevention resources and strategies there instead of on the entire general population.
If the epidemic is centralized in women, or in urban centres, or in religious communities, the tools we use for prevention should also change. How the promotion of abstinence, or any other individual prevention tool, should be used must depend on this kind of analysis.
Q. Nowit: I've done a brief internet search on the Gates Foundation, and while there is a lot of information about its work on disease eradication, I haven't seen much about poverty reduction. Do ONE and the Gates Foundation have an explicit focus on health, or do they also work in other areas of development (education, infrastructure, agriculture, housing and so on)?
A. Melinda: About half our work is focused specifically on global health. In some cases, we do work on eradicating diseases. We believe that polio can be eradicated in the near-term, and that malaria can be eradicated eventually. But most of our health work doesn't involve eradication. For example, I'm very involved with family health, which includes things like family planning, prenatal care, and nutrition.
About a quarter of our work is focused on global development more generally. The biggest investments we've made in the area of development go toward agriculture. Most of the poorest people in the world make their living by farming small plots of land, and so it stands to reason that helping small farmers grow more food is one of the best approaches there is to fighting poverty and hunger.
I also want to emphasise the point that our work in health has an impact on people's overall well-being. Investments in health trigger a virtuous cycle, in that a healthy mother can raise a healthy baby, a healthy child can get educated, an educated person can thrive in business, and so on. Health is really the foundation for thriving communities.
A. Dr Sipho Moyo: ONE's work on global health is just one part of our wider focus on development. Our mission is to fight extreme poverty and preventable disease in the poorest places on the planet, particularly in Africa. This includes focusing on an equitable growth agenda that encompasses a wide range of issues including health, education, good governance, agriculture, infrastructure, trade, investment, and other drivers of durable development.
Across all these issues we work to hold world leaders to account for the commitments they've made, as well as campaigning for better policies, increased and more effective aid, and reform of international trade. We also work closely with leaders in Africa to support greater democracy, beat corruption and promote accountability and transparency in how their resources are deployed to better benefit their citizens.