I. INTRODUCTION AND STATEMENT OF PROBLEM

Each year, Americans donate roughly $300 billion to charitable organizations, which supports private philanthropic work domestically and overseas (Kaplan 2007). This work supported by the private sector sometimes intentionally dovetails with United States government (USG) efforts, while at other times both public and private funds are devoted to similar tasks with little or no coordination between funders. In an environment of increasingly urgent international challenges and finite public and private resources, there is a compelling policy interest in better understanding the interactions between the two sectors’ efforts and learning how to promote more effective collaboration.

Responding to this compelling interest, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (DHHS) has contracted with Mathematica Policy Research, Inc. to undertake the study, “Maximizing Federal and Private Philanthropic Spending At Home and Around the World.” The study is comprised of three major tasks: (1) a review of data on domestic and international philanthropic grantmaking and USG aid spending; (2) a review of literature on the development of such initiatives by and the shape of interactions between USG agencies and philanthropic entities; and (3) case studies of up to 10 of these organizations or initiatives. The study will examine U.S.-based private philanthropic foundations and those USG agencies most involved in foreign and domestic aid initiatives, focusing primarily on health and social services efforts.

This review of literature synthesizes the current state of knowledge about USG-foundation planning and interaction and lays the groundwork for the in-depth case studies that will follow in the subsequent tasks. [1] Given the relative importance ASPE placed on international efforts, the literature review focuses heavily on international organizations and initiatives. Domestic efforts are addressed to the extent that these can enhance the understanding of a given issue or provide useful examples. Similarly, efforts in the health sector are given priority, although not to the exclusion of other social services.

A. FRAMEWORK: KEY TERMS AND OVERVIEW OF FOUNDATION AND USG PHILANTHROPY

This study and the present literature review reflect study parameters and priorities established in the study specifications and early discussions with ASPE. To frame the literature review, we have implemented these parameters and priorities by defining the study’s scope and focus. This included developing operational definitions, and deciding which private and public philanthropic entities and activities to examine.

For purposes of this study, we use the term “philanthropy” to refer to an active effort, usually taking place over an extended period of time and involving the contribution of money, goods, time, or other resources, to promote human welfare. Philanthropy may have charitable or public policy purposes and goals and may involve private donations or taxpayer funds. This stands in contrast to more conventional uses of the term, which typically refer to charitable giving. For simplicity’s sake, throughout this review we use “philanthropy” in referring to both private and public aid efforts.

In delimiting our approach, we focus on philanthropic initiatives. We define an initiative as a course of action, system, or program deliberately developed by an organization, under which action is taken to achieve some specific philanthropic objective. Initiatives can be defined broadly to include the provision of aid or assistance through ongoing program activities or, more narrowly, as individual projects focused on specific geographic regions or target populations and implemented over a limited period of time. This more narrow definition will be appropriate when selecting case studies, but for this literature review, we use the term in both broad and narrow senses.

Our understanding of public and private philanthropy and philanthropic initiatives also requires some explanation. While private philanthropy can also encompass the volunteer efforts and charitable giving of individuals, religious groups, and corporations, we limit our scope to the philanthropic efforts of foundations. Foundations have the capacity to develop and fund major domestic and international initiatives, and unlike individuals, foundations have the capacity to interact and collaborate with USG. While foundations have always played an important role in domestic philanthropy, over the last decade, U.S.-based foundations have significantly increased their grant funding for international activity (Renz and Atienza 2006).

By definition, foundations are nonprofit corporations or charitable trusts established to give grants to organizations, institutions, or individuals for scientific, educational, cultural, religious, or other charitable purposes. The Internal Revenue Service makes a distinction between private and public foundations. Private foundations derive their wealth from an individual, family, or corporation, whereas public foundations rely on donations from multiple sources, including the general public. Almost 90 percent of private foundations are independent foundations established with a gift from an individual or family. The other two types of private foundations are operating foundations, which implement their own programs, and corporate foundations, which receive their wealth from a publicly held company. Public foundations, often termed “public charities,” primarily make grants and typically receive their assets from multiple sources; this may include private foundations, individuals, government agencies, and/or fees for service. To retain their status as public charities, public foundations must continue to raise funds from diverse sources. While most of the foundations we will consider are independent private foundations, there are a few notable public foundations that play an influential role in international and domestic philanthropy, such as the William J. Clinton Foundation and Ashoka.

Foundations vary dramatically in size and influence. Many independent foundations are small family-run entities with no endowment. Only 6 percent of the independent foundations tracked by the Foundation Center have any staff (Collins 2008). While the charitable giving of small foundations is certainly an important piece of global philanthropy, most do not sponsor initiatives that could serve as useful comparisons to the efforts of the public sector. Instead, we focus on the largest independent foundations as defined by levels of annual giving, as well as several others identified in the literature as significant innovators or influential agenda-setters.

We limit our investigation of government-sponsored philanthropy to those efforts most comparable to the private philanthropic initiatives of most interest—that is, those focusing especially on international efforts in the sectors of health, human services, the environment, education, development, and relief. USG’s international assistance takes five major forms: bilateral development aid, economic assistance supporting U.S. political and security goals, humanitarian aid, multilateral economic contributions, and military aid. In fiscal year 2005, the largest share of the U.S. foreign aid budget was allocated to bilateral development aid (35 percent) followed by military (24 percent), economic and political security (22 percent), humanitarian (13 percent), and multilateral development aid (7 percent) (Tarnoff and Nowels 2005).

The most prominent agency for international public philanthropy is the U.S. Agency for International Development (USAID). USAID has primary responsibility for managing bilateral development aid, including economic growth, global health, and democracy programs. Additional bilateral development aid is channeled through other USG organizations, including the Peace Corps and the Millennium Challenge Corporation (MCC). MCC directs large grants towards countries that are on a specific developmental trajectory and have also met criteria such as commitment to good governance and economic freedom. The State Department manages the bulk of the humanitarian aid, as well as funds allocated to support U.S. political and security goals. The Treasury Department directs U.S. contributions to multilateral organizations, such as UNICEF and the World Bank. For this review, our examination of international public philanthropy focuses heavily on USAID and MCC because these entities pursue philanthropic initiatives most comparable to the efforts of foundations.

Defining domestic public philanthropy is somewhat challenging. DHHS is responsible for significant health and social service initiatives, but many other federal departments also engage in philanthropic efforts in multiple areas including, for example, education, the environment, housing, and community development. Our emphasis again will be on specific USG efforts comparable in their intent and operationalization to the efforts of foundations.

A final issue requiring some explanation is the role of intermediary organizations in public and private philanthropy. Examples of prominent intermediaries are the United Nations, the International Red Cross, and the Carter Center. Intermediary organizations may receive both public and private funding. While they may implement initiatives of their own, they are more important to this study in their role as advocates and conveners. By making issues part of public dialogue and bringing stakeholders together to discuss them, they can play an important role in setting the agenda for philanthropic efforts, though they are not the focus of the study.

B. RESEARCH QUESTIONS

This literature review provides a basis for understanding public and private philanthropic efforts, including decision-making and measurement approaches among, and interaction between, USG and foundations. The review will address three sets of research questions (detailed below), focusing primarily on the first set of questions.[2] The second set of questions, while addressed in the review, will be informed further by the case studies developed under later tasks. While the literature review will begin to address the third set of research questions, these will be explored more fully in the final report, drawing from an in-depth examination and cross-cutting analysis of the case studies.

How do foundations and USG agencies identify needs, develop initiatives, and measure progress toward their goals?
- How do public and private sector organizations set priorities among possible choices for beneficial work? How do their decision-making approaches differ?
- What kinds of metrics are used to measure success against goals?
- What innovative approaches to decision-making and outcome or impact measurement are being used?
- What are the relative strengths and limitations of foundation and USG decision-making processes, funding mechanisms, and program approaches?
What is the nature of existing USG-foundation interactions regarding international and domestic health and social service initiatives?
- What types of current foreign and domestic philanthropic ventures include USG-foundation interactions? What types of interaction occur?
- Under what circumstances do foundations or intermediary organizations (organizations that rely on both USG and foundation funding to coordinate and lead initiatives) tend to coordinate with USG efforts domestically and abroad?
- When coordination occurs, how is it structured?
What approaches to USG-foundation decision-making, results measurement, coordination, and collaboration have positive potential for future application?
- What decision-making processes, funding mechanisms, and program approaches used by private foundations could USG philanthropists adapt, and vice versa?
- What factors might affect the desire and ability of USG and foundation funders, as well as intermediaries, to target and address needs, and to coordinate their efforts in doing so?
- How might foundations and USG combine efforts in developing, implementing, and evaluating initiatives to deploy their strengths most effectively?

C. APPROACH TO THE REVIEW

To ensure a systematic and comprehensive examination of the literature, the research team approached the review in three phases: search, review, and analysis. First, through discussions with a project consultant with expert knowledge of the foundation world and preliminary library and web-based searches, we identified authoritative sources from government, foundation (including professional consortia), and academic spheres (including university centers and think tanks). We then conducted a broad scan of literature from these sources, using keyword searches as appropriate, and compiled a database of potentially useful documents. Given the growth in the foundation sector and the changing priorities of USG, we focused mainly on works published within the past decade, 1998-2008.

The study team then assessed the quality and salience of the documents and selected between 5 and 10 from each type of source for detailed review. In the second phase, reviewers read the documents and entered information into an analytic guide, which was linked conceptually to the research questions. Finally, the task leader examined the guides for all of the reviewed documents to develop a detailed outline for the review. Where she identified gaps, researchers conducted another search and review for the specific topic in question. The search protocol and review guide are included in Appendixes A and B, respectively.

Concurrent with the literature search and review, the research team also examined non-peer reviewed or “gray” literature on specific foundations and USG agencies, as well as their domestic and international health and social services initiatives. These organizations were identified variously by ASPE, by the project consultant, and by the research team during the review of literature. In a process similar to that described above, researchers compiled a database of organizations and initiatives to serve as the pool of potential case studies. Some of these cases are discussed below, but they are used as illustrative examples only, with the final case studies to be determined in consultation with ASPE.

D. ORGANIZATION OF THE REVIEW

Chapter II provides an overview of the successes and challenges that have marked the development of public and private philanthropy for health and social services in the U.S. and abroad. It focuses on the contexts, practices, and processes that appear to support successful initiatives. It also describes the challenges faced by both public and private philanthropists in planning for and implementing such initiatives, calling attention to the relative strengths and weaknesses of the two sectors. Chapter III specifically addresses research question 1 by examining how foundations and USG agencies identify needs, develop initiatives, and measure progress toward their goals. Chapter IV turns to research question 2, describing existing public-private interactions in the arenas of health and social services in a general sense, and introducing specific examples to illustrate these principles and examine potential models for future initiatives, as indicated in research question 3. Finally, Chapter V presents an analytic framework based on the literature reviewed, which will serve as the foundation for the case studies.

II. SUCCESSES AND CHALLENGES IN PRIVATE PHILANTHROPIC AND PUBLIC AID ACTIVITIES IN HEALTH AND SOCIAL SERVICES

While many questions remain open regarding the contexts, practices, and processes that best support philanthropic and aid initiatives at home and abroad, there is some consensus in the literature about a few basic issues. These include characteristics of successful initiatives and persistent challenges in adopting best practices to achieve philanthropic goals. Reviewing these, and considering the relative strengths of private and public funders, provides a foundation for understanding the more nuanced issues of USG and foundation strategies and interactions that are the primary focus of this study and addressed in Chapters III and IV.

A. CHARACTERISTICS OF SUCCESSFUL INITIATIVES

1. Local Ownership

First—and probably foremost—policymakers, practitioners, and scholars alike agree that local “ownership” of programs and initiatives is critical to their successful roll-out, as well as their effectiveness and sustainability (HELP Commission 2007; Hudson Institute 2008; MCC 2008b). The importance of local ownership appears to hold for both public and private initiatives, and leaders in the foundation world are striving to encourage recipient buy-in and ownership through a host of strategies. For example, both the Bill & Melinda Gates Foundation and the Rockefeller Foundation have required heavy involvement from local governments, businesses, and nongovernmental organizations (NGOs) at all stages in the development of their multi-million dollar agricultural initiative, the Alliance for a Green Revolution in Africa (AGRA). Domestically, the Edna McConnell Clark Foundation (EMCF) requires that recipients of its operational grants for youth development undergo a detailed business planning process, such that participants at all levels of the organization have a stake in the successful implementation of the grant (Balin 2003). In the public sphere, the federal government’s bipartisan HELP Commission (U.S. Commission on Helping to Enhance the Livelihood of People around the Globe)—which was statutorily charged with examining how to better structure U.S. foreign aid to achieve better results—suggested as one of its 10 central recommendations that a “new business model” should focus on “building local management capacity and leadership skills” to ensure that programs are adequately adapted to and adopted by recipient nations (2007). Such ownership is also a cornerstone of the MCC approach to determining where to direct aid (MCC 2008a). While MCC’s rationale is structured above all to support transparency and accountability, recipient governments must not only embrace the agency’s goals, but also take the lead in developing a plan for reaching them.

2. Appropriate Technology

A second point of agreement about the conditions for successful philanthropy regards the use of technology. While the search for “silver bullets”—in nearly every area of assistance, from agriculture, to public health, to economic development—is ongoing (Kramer 2007; Sandfort 2008), there is a consensus that any technology important to an initiative must be powerful enough to justify its introduction, yet simple enough to put in place under trying circumstances (HELP 2007; Hudson Institute 2008; WHO 2008). Even in touting the importance of new technologies in shaping public-private strategies around the delivery of human services, however, the Three Sector Initiative cautioned in its report, “Working Better Together,” that technology could be divisive, as it may leave users vulnerable to institutional (especially government) manipulation (Fosler 2002). In a different but related vein, Brookings Institute scholars Raj Desai and Homi Kharas have voiced skepticism about many of the newer foundation actors’ “abiding faith” in technological solutions to complex social problems (2008). This may be linked to the fact that much of the “new” foundation money comes from the technology sector. In any case, Desai and Kharas note that there is a potential for private donors to shift rapidly from one “popular” issue to the next, and that their efforts may not be large or cohesive enough to have significant impact.

3. Consideration of Scale

There long has been a tendency for foundations to focus on small-scale, innovative projects with the intent that programs will be scaled up later under local or national government leadership (Benedict 2003a; Kramer 2007; Sandfort 2008). Yet, as organizational scholar and consultant Mark Kramer notes (2007), few foundation-initiated programs have actually been scaled up by governments, and successful initiatives require a consideration of scale that goes beyond this historical pattern.

In fact, many USG initiatives are themselves quite small in scale, and gaining support for large initiatives requires a level of political consensus, will, and resources that may be difficult to achieve. Moreover, mere adoption of an initiative by government does not guarantee its successful extension to a large population. At a very basic level, the initiative itself must be scalable (which, in many instances, is related to the simultaneous power and simplicity of technology, as noted above). Functioning markets and institutions, too, typically are necessary for widespread success; while government can play a role in providing incentives to encourage broad adoption of technologies or programs, it cannot ensure that the markets will work (HELP 2007).

In the philanthropic world, these lessons also appear to be taking root. One of the most prominent recent innovations in philanthropy, “venture philanthropy”—by private funders who approach social initiatives in a manner akin to that of investors, including heavy involvement and an expectation of results—concerns itself with scalability before almost all else (Desai and Kharas 2008). Such actors rarely engage in initiatives that they view as lacking the potential for widespread adoption. This is not to say that small-scale projects are without merit, but rather that scale is an important consideration in planning for and rolling out initiatives.

B. PERSISTENT CHALLENGES

Despite apparent consensus by both public and private funders that certain practices support the success of philanthropic initiatives, many have not regularly been adopted. Suggested practices include measuring progress, providing reliable funding, and avoiding fragmentation of efforts. Transparency and accountability, also considered a boon to effective programming, are also sometimes given short shrift.

1. Inadequate Measurement

Measurement of outputs, outcomes, impacts, and/or influence is a necessary—but exceedingly thorny—endeavor (HELP Commission 2007; Kaufmann and Searle 2007; Porter and Kramer 1999; Sandfort 2008). While some organizations have developed innovative approaches to measurement, many more are lacking in this respect. First, funders must decide what to measure. Measurement may seem straightforward on the surface, but it often masks complex tensions. For example, there is a tendency among foundations and some USG agencies, to focus measurement on outputs (the products of program activities) rather than outcomes (changes in participants or program targets that follow from outputs) (HELP Commission 2007; Porter and Kramer 1999). This may occur because it is much simpler to measure, for example, the number of persons served than the extent to which a person’s life has improved. Some have even argued that “foundation culture” is hostile to measuring outcomes, not to mention impacts that can be causally linked to the program, which require more rigorous, costly methods as well as practices some groups find objectionable, such as random assignment to treatment and control groups, to demonstrate. As Michael Porter and Mark Kramer point out in their seminal article, “Philanthropy’s New Agenda,” foundations’ own internal processes provide the wrong incentives for adequate measurement: “Failure risks censure,” they note, “but success adds no reward” (1999, p. 129). Similarly, bureaucratic government procedures may require monitoring of outputs for accountability purposes but rarely do they monitor outcomes with the same vigilance, or provide resources to help do so (HELP 2007, p. 92).

Even in instances where resources and support are available to measure something beyond outputs, appropriate metrics may be unavailable (Sandfort 2008), and inconsistency between those metrics, such as in the measurement of social return or social value, makes comparison across programs difficult (W.K. Kellogg Foundation 2003). Moreover, philanthropic missions—as well as many of the broader USG aid goals, such as democratization and support for civil society—often are focused primarily on influencing whole social systems, rather than the impacts on discrete individuals or communities. Metrics for such influence are, however, only in a formative stage at this time (Kaufmann and Searle 2007).

2. Lack of Reliable Funding

There is consensus in the literature that both the magnitude and consistency of funding over time is critical for the success of philanthropic and aid initiatives, but the literature also indicates that both private and public funders often are unwilling or unable to commit adequate resources. Among foundations, there appears to be a common mindset that their resources are best used for quick, responsive, and/or innovative efforts (Balin 2003; Benedict 2003a; Porter and Kramer 1999), a position which overlaps with the notion, discussed previously, that government will pick up where foundations leave off. Yet critics—from both inside and outside of the foundation world—have voiced concern that such strategies may undercut initiatives’ potential for sustainability. Moreover, inconsistency of resources can put unnecessary strain on the organizations that actually implement funded programs, diverting their attention from quality program implementation or service delivery to budgeting and management concerns (Balin 2003; Benedict 2003a; Desai and Kharas 2008).

The problem is perhaps less urgent among publicly funded initiatives, but it is not wholly absent in this area, as neither the availability of funds nor the priorities for spending are constant (HELP 2007; Kharas 2008). Brookings scholar Homi Kharas echoes the concerns described above about the burden on recipient organizations, noting that when organizations rely on multiple funders, they must direct resources to more “donor requests for studies, individual meetings with country officials, establishment of separate project management units, [and] multiple procurement practices for the same products” (p. 15). Interestingly, those in the public sector concerned about shortsightedness or lack of commitment to providing adequate resources sometimes point to foundations as potential partners in addressing the problem (USAID 2007; U.S. Department of State 2007). More often, however, attention is directed to private, for-profit efforts, like many of USAID’s Global Development Alliance partnerships, to encourage sustainability (MCC 2008b; USAID 2007).

3. Fragmentation

Closely linked to resource stability, fragmentation of aid efforts is a continuing problem, as pointed out by scholars studying both public and private initiatives (HELP 2007; Kharas 2008; Porter and Kramer 1999; Sandfort 2008). While the “prevailing culture of independence among foundations” often is viewed in a positive light (see below), Porter and Kramer (1999) note that it also can impede the development of best practices in a given field, as foundations may not communicate what they have learned to one another or to the outside world. Kharas expresses a parallel concern about public aid initiatives (2008; p. 15), and the same concern prompted the HELP Commission to make its first recommendation the development of an “integrated approach” to foreign aid, where all USG efforts would be coordinated through a single cabinet-level position and agency (2007).

4. Lack of Transparency and Accountability

Concerns about transparency and accountability have been raised with regard to public and private, as well as domestic and international initiatives. Indeed, as noted above, such matters were at the very heart of the development of the MCC and its approach to developing aid initiatives. Still, problems with transparency and accountability probably are more pronounced in the private philanthropic sector, as there often is a sense that foundation decisions are opaque or even capricious, and that both internal and external accountability measures are minimal (Guidice and Bolduc 2004; Porter and Kramer 1999). While private philanthropists are, in the words of the former president of the Ford Foundation, Susan Berresford, “managing money that involves a public trust” (“15 Minutes with Susan Berresford” 2003, p. 17), they are not accountable to the public in the same sense as USG agencies.

C. COMPARATIVE ADVANTAGES OF THE PUBLIC AND PHILANTHROPIC SECTORS

As this discussion of successes and challenges indicates, USG and foundations bring different strengths and weaknesses to their philanthropic efforts. Foundations appear to be advantaged by their independence, agility, flexibility, and ability to take risks and innovate. In contrast, USG possesses resources, influence, relatively more stringent accountability structures, and long time horizons.

1. Foundation Strengths

In their report for the World Bank on public-private partnerships, Eleanor Fink and Katrinka Ebbe (2005) sum up the comparative advantages of the private philanthropic sector: “Due to their independence and flexibility, foundations can engage in cutting edge research, move quickly to capitalize on development opportunities, test innovative ideas, and take risks” (p. 8). While foundation independence sometimes may impede communication, as noted above, it is also a significant source of strength. Put succinctly by another author, “they [foundations] alone possess significant flexible resources that can be invested without regard to public deliberations or market restrictions” (Sandfort 2008, p. 541).

The other clear advantage of foundations over government is their ability to take risks and test innovative practices (Fink and Ebbe 2005; Kaufmann and Searle 2007; William and Flora Hewlett Foundation 2008). This characteristic is linked to their relative independence and ability to act without engaging in complicated political and administrative processes, as compared to USG. Foundations are at liberty to take risks and innovate both in terms of their grantmaking processes and in their programmatic approaches. For example, in the late 1990s and early 2000s, the Edna McConnell Clark Foundation (EMCF) engaged in a deliberative review of its grantmaking strategy, which resulted in a complete organizational restructuring. The Foundation refocused its programmatic approach to include only youth development, moving away from a broader “laundry list” of program areas including poverty, child welfare, and education. The Foundation adapted their grantmaking to an “organization centered theory of change” whereby they would fund proven providers rather than programs that seemed appealing (Balin 2003). While such operational grantmaking is not entirely new, The Foundation’s complete reorientation bucked a distinct trend in the foundation world and their hands-on, business planning approach to nonprofit development is different from that of most operational grantmaking.

2. USG Strengths

While foundations can in general act more quickly and independently than government, it is important to note, as one author does, that the “magnitude of private foundation funding… is dwarfed by governments’ significant investments” (Sandfort 2008, p. 541). Even the most well-funded foundations typically expend close to the minimum 5 percent of their endowment required by law of tax-exempt charities (Porter and Kramer 1999), whereas USG outlays on health and social services consistently reach into the hundreds of billions, and can be counted on to do so in the foreseeable future.

In addition to its capability of funding large initiatives, USG has the ability to commit to an initiative over the long term. With financial resources comes influence, and USG can rely on its power to persuade governments, as well as entities in the for- and nonprofit sectors, to do their part in supporting an initiative’s success. In the same vein, USG has permanent, well-funded structures in place (for example, through the military or the Federal Emergency Management Agency) that allow it to act on a large scale with relative speed, when circumstances warrant it. Finally, while imperfect in many instances (HELP 2007), USG accountability structures are typically much stronger than those in the foundation sector (cf. Desai and Kharas 2008; Guidice and Bolduc 2004). This is, perhaps, the positive side of USG’s relative lack of independence: Direct answerability to the public demands some degree of accountability, and in recent years USG has put great effort into developing accountability structures.

III. HOW DO FOUNDATIONS AND USG AGENCIES IDENTIFY NEEDS, DEVELOP INITIATIVES, AND MEASURE PROGRESS TOWARD THEIR GOALS?

The processes by which funding organizations identify problems, develop and implement solutions, and monitor progress appear to be influenced by diverse factors, some of which are common to both the foundation and USG sectors, while others are distinct to one or the other sector. Moreover, individual organizations may engage in innovative or noteworthy practices in each phase. This section first addresses commonalities among organizations within each sector, then details the specific organizational processes of some exemplary foundations and agencies.

A. IDENTIFYING NEEDS

In a very basic sense, both sectors recognize the same essential life cycle of an initiative, which the U.S. Department of State describes as having five steps: formulation, planning, implementation, evaluation, and renewal/termination (2008). Similarly, Kennette Benedict, former director of international peace and security at the MacArthur Foundation, maps out the life cycle of a philanthropic initiative in three stages: creation, change, and closure (2003a). She could have begun with another stage, however: “choosing” which problems to address. Indeed, she cites the selection of problems actually amenable to philanthropic intervention as one of the greatest challenges foundations face.

This contrasts somewhat with the USG position on problem selection, as government often is charged with addressing problems that will, in some sense, never be “solved” definitively—for example, national security and public health (Tarnoff and Nowels 2005). This explains the State Department’s use of the term “renewal/termination” (which allows for continuation, or renewal, of initiatives) as opposed to the MacArthur Foundation’s use of the term “closure.” As detailed above, foundations often approach problems with the explicit intent that government will eventually assume responsibility for the initiative; for this reason, the end of foundation involvement in an initiative may coincide with government’s entry into the arena. Foundations also work in arenas that do not provide a natural fit for government infrastructure, such as leadership development or high-risk ventures. In this way they are supplementing the work of the government toward the solution of larger social problems. (It is worth noting, however, that in a few high-profile cases, this may be changing. With the recent tremendous increases in foundation resources, and the simultaneous focus among philanthropists on “results” [Renz and Atienza 2006], a few select initiatives may be poised to solve problems definitively. Perhaps the clearest example of such a case is the Bill & Melinda Gates Foundation’s work on malaria.)

At a basic level, how foundations and USG agencies prioritize and decide which problems to address also depends, in great part, on their organizational missions. While foundations have been criticized for spreading their resources too thinly across a host of programmatic areas (Porter and Kramer 1999), most do specialize in just a few programmatic and sometimes geographic areas, and will consider intervening only in areas they view as germane to their interests. There is, of course, great diversity in the number and nature of programmatic areas on which foundations focus. For instance, the MacArthur Foundation’s stated mission is to support “creative people and effective institutions committed to building a more just, verdant, and peaceful world” (MacArthur Foundation Web Site), which could conceivably translate into activities in almost any area of human or community development. In contrast, The EMCF focuses on “advancing opportunities for low-income youth (ages 9 to 24) in the United States,” specifically through “grantmaking to provide growth and capacity-building capital to exemplary organizations that have evidence of the effectiveness of their youth services” (EMCFweb site).

The programmatic purview of federal agencies is to some extent more transparent, compared to foundations. Agencies’ roles are, of course, typically articulated by public law, circumscribed by public political and budgetary processes, and further refined through on-the-record administrative actions. Still, preferences of political stakeholders can influence the process. The question of accountability to the public and the consequent systematization of processes raise a further point of contrast between foundations and USG agencies. At the beginning, when identifying problems worthy of consideration, foundations often are motivated by the personal interests and proclivities of their individual founders and/or leaders (“15 Minutes with Susan Berresford” 2003). Agency heads, in contrast, may be very influential in terms of the direction their funded initiatives take but they are less likely to drive decision-making in their agencies in the way that a single, well-funded philanthropist can shape his or her foundation’s approach. The broader implication is that foundation strategies often are mapped out less explicitly than at agencies, where decision-making is defined more typically with respect to transparent chains of bureaucratic authority (U.S. Department of State 2007; cf. Porter and Kramer 1999)

As part of its goal to influence the problem identification process across USG agencies (at least among those involved in international initiatives), the Department of State’s “Foreign Assistance Framework” (2007) delineates five broad objectives for all U.S. foreign assistance: peace and security, governing justly, investing in people, economic growth, and humanitarian assistance. The framework includes more specific programmatic objectives within each broader objective and highlights those viewed by the administration as most critical for the trajectory of assistance in that category. Although the framework does not delineate funding levels, the highlighted categories mark the programs that should receive greatest budgetary priority. While some agencies, such as USAID and MCC, have fairly broad programmatic portfolios, their internal bureaucratic mechanisms can delimit potential areas of involvement considerably. For example, MCC has clearly articulated procedures whereby governments seeking to enter a bilateral aid agreement must first demonstrate their competitiveness on a host of indicators of their nation’s governance, social investment, and entrepreneurial capacities.

Some have criticized the USG approach because they view it as overly fragmented—a critique typically applied to foundations. For instance, Kharas (2008) takes issue with the increasing prevalence of “vertical funds”—resources directed at a specific issue or population, such as the Global Fund for AIDS, Tuberculosis, and Malaria. With such funds, “channeled more and more through specialized agencies, dedicated to particular targets, like HIV/AIDS or malaria, instead of through traditional agencies,” Kharas is concerned that there will be little support for “broad country development programs” (p. 2). The result, according to critics such as Kharas, is a complex and convoluted approach to aid, which does not capitalize on precisely those advantages unique to USG: influence, accountability, and long time horizons.

In contrast to USG foreign aid, the framework that guides the identification of problems for targeting assistance in the domestic sphere is perhaps more fragmented. As noted, elected officials and high-level appointees typically bring their own sense of agency priorities to office; these then are filtered through legislative and administrative procedures, delimiting the nature of those problems agencies are in a position to address and the methods to address them.

B. DEVELOPING INITIATIVES

In shaping the type of support they will provide, foundations and USG face several common considerations. The literature reveals foremost among these a great deal of tension around the relative utility and potential for the success of initiatives that provide program support (resources specific to a programmatic intervention) versus those that provide operating support (resources for the organization implementing a program) (Balin 2003; Huang, Buchanan, and Buteau 2006). An oversimplification of the issue would have foundations focusing heavily on program support (given their comparative advantages in innovating and taking risks by funding cutting edge programming), whereas USG would emphasize operating support (given its superior resources and staying power). Reality, of course, is more nuanced than this characterization, and many foundations do provide operating support, even as USG funds some programs. Moreover, the approaches are not mutually exclusive; a single initiative could comprise both types of support (Balin 2003; MCC 2008b). Rather than advocating any particular approach, the literature suggests that an organization’s strategy should consider how one or the other type of support dovetails with organizational objectives (Balin 2003; Porter and Kramer 1999).

Another theme in the literature that describes decision-making around the development of USG and foundation initiatives is the question of whether, and with whom, to partner. Such considerations typically are driven by the comparative advantage of the groups involved and very often center on the question of an initiative’s sustainability (Fink and Ebbe 2005; MCC 2008b; U.S. Department of State 2008; W.K. Kellogg Foundation 2003). Some of the benefits that foundations, in particular, might seek from partners include technical expertise; in-country knowledge; connections to academe, the private sector, and civil society; knowledge of public policy and public institutions; and resource mobilization networks (Fink and Ebbe 2005; U.S. Department of State 2008). Similarly, USG often seeks connections and networking opportunities from partners and is especially interested in organizations and individuals who can “find markets” for an initiative; that is, who can support widespread adoption of whatever programmatic elements an initiative may offer (MCC 2008b; U.S. Department of State 2008).

The literature indicates that both private and public sector actors are keenly interested in cross-sector collaboration and developing partnerships, but obstacles exist that hinder their progress. Successful partnerships require that all parties involved understand the interests, capacities, and approaches of the other actors (Fosler 2002). Yet a State Department study found that private sector partners felt the USG did not understand their interests and looked to them only to “fill gaps” (2008). Respondents also felt that USG was overly suspicious of private sector motives. This same study revealed that USG actors felt they were ill-equipped to deal with private sector partners and that bureaucratic structures hindered the development of partnerships. While these issues present challenges, the United Nations Foundation suggests that intermediary organizations might occupy a particularly good position for overcoming such problems and facilitating partnerships, as they “have a foot in both worlds,” public and private (2003).

C. MEASURING PROGRESS

While the literature reviewed here supports the general contention that measurement remains a challenge for both federal agencies and foundations, both sectors appear to have embraced the challenge to some degree, and successes in this area are not entirely uncommon. Interestingly, both sectors appear to have moved beyond the notion of measurement as primarily a means of demonstrating accountability or impact and also are seeking to measure progress to inform their own broad decision-making processes (Kramer 2007; MCC 2008a). This tendency seems more pronounced in the private philanthropic sector, where one survey of foundation leaders revealed little evidence that evaluations were used to determine grant renewal or termination decisions (Kramer 2007; p. 15). Rather, grant programs often have critics or supporters within the organization who may influence decision-making more heavily than evaluators. The survey revealed that the most useful evaluations for foundations’ purposes inform planning and implementation, as well as tracking the progress of the organizations’ broader goals (Kramer 2007; cf. Guidice and Bolduc 2004; Levinger et al 2007; William and Flora Hewlett Foundation 2008). Toward these ends, the Robert Wood Johnson Foundation developed a system of “comprehensive performance measurement” (a system of measuring progress against the foundation’s theories of change and indicators of performance); the William and Flora Hewlett Foundation (WFHF) developed an “expected return metric” (a quantitative process for evaluating potential investments based on consistent metrics); and the Annie E. Casey Foundation (AECF) embraced “results-based accountability.” On a much larger scale, the Bill & Melinda Gates Foundation has dedicated significant funding to the Institute for Health Metrics and Evaluation at the University of Washington for the development of data systems to support the monitoring of public health issues at a societal level. In the public arena, MCC seeks to implement “results-based management,” which uses data to inform aid giving and management, even as it focuses on results; and MCC’s core indicators have been used by other agencies, including USAID, to guide decision-making. Each of these will be discussed in greater detail below, but it is worth noting here that the literature suggests foundations may achieve their best successes when applying metrics at earlier points in the continuum, while USG appears to apply metrics more consistently at all stages, with emphasis on evaluation for accountability. This is illustrated by the example (presented at the beginning of this section) that the State Department’s (2008) conception of an initiative’s “life cycle” explicitly includes a phase for post-implementation evaluation; whereas MacArthur’s (Benedict 2003a) “change” phase may imply an evaluative component that is not given the prominence it receives from USG agencies and is not necessarily linked to accountability.

D. INDIVIDUAL FOUNDATION PROCESSES AND PRACTICES

Beyond the broad sector-specific trends in decision-making discussed above, individual foundations and USG agencies often engage in planning and development processes specific to their organizations. These are addressed briefly in this subsection, as well as in Chapter V, where we report on a few examples of organizations and initiatives that could serve as case studies. Such issues will be addressed at length in the case studies themselves.

EMCF has been cited as an example of a foundation that has engaged in a very deliberate rethinking of its approach to decision-making. In the late 1990s, the Foundation chose to move away from several broad programmatic areas (poverty, child welfare, education) to a single area (youth development). This decision was innovative and potentially effective, at least insofar as it responded to the criticism, voiced regularly in the literature, that foundations tend to spread their resources across too many areas. Moreover, EMCF’s movement away from program to operating grants appears to have gone against the grain in the private philanthropic sphere. Another interesting aspect of the new The EMCF approach is that it applies strategies from the for-profit sector to the foundation’s grantmaking process, including due diligence, business planning, and organizational performance tracking. Again bucking a foundation trend, The EMCF emphasizes multiyear grants to allow for the sometimes painstaking work of organizational development. Finally, the Foundation’s close relationship with its grantees—including the provision of technical assistance—reflects the broader trend of venture philanthropy, where emphasis is placed on hands-on work with grantees to ensure their success. None of these strategies is innovative in and of itself, but the comprehensive shift coming from within the foundation world represents a new way of envisioning the donor-recipient relationship. This shift is responsive to some of the common criticisms of private philanthropy.

As mentioned above, a few foundations have made noteworthy inroads on tracking their own broad organizational performance. The metrics developed by the Robert Wood Johnson, William and Flora Hewlett, and Annie E. Casey foundations are innovative in that they present a new way of examining success at the foundation as opposed to the program level. The Robert Wood Johnson Foundation’s system of comprehensive performance measurement is multifaceted, and at least three aspects deserve specific mention. First, the Foundation developed a Scorecard; this is released annually and reports outputs at the foundation level, outcomes from key grantees and foundation-wide, and changes at the population level in the broad health indicators their programs seek to address. Second, the Robert Wood Johnson Foundation developed and implemented internal assessments for each of its own programmatic teams, as well as employee surveys to gauge attitudes about the Foundation’s work. Third, the Foundation set up a public archive of all the data from its sponsored research. A case study of the Foundation’s focused and sustained attention to organizational assessment, coupled with its willingness to make data public, points to improved focus and strategy in grantmaking, increased innovation, and better alignment of board and staff goals (Guidice and Bolduc 2004).

The William and Flora Hewlett Foundation developed its expected return metric to support the systematic selection of grantees, specifically by considering their foundation’s comparative advantage in a given area, as well as the presence of other funders. Expected return is calculated by multiplying the benefit (of an intervention under optimal conditions; usually drawn from extant data), times the likelihood of success (calculated internally), times the foundation’s contribution (adjusted for varying roles in each situation), divided by the program’s total cost. The metric is fairly straightforward, although data for each input may be of varying availability and quality. Because expected return considers other funders in the equation, the consistent use of such a metric by more foundations could support sector-wide improvements in effectiveness.

The Annie E. Casey Foundation’s results-based measurement approach was developed through an iterative process—not unlike the Robert Wood Johnson Foundation’s development of comprehensive performance measures—with heavy involvement from foundation leaders and staff. The Annie E. Casey Foundation’s process is also noteworthy because it involved grantees—a step taken intentionally to gain support for new reporting requirements. Identifying performance measures required the Foundation to articulate the strategy for each program area with great precision. As one leader at the Foundation put it, “In order to measure how we were doing, we needed to be as clear as we could possibly be about what we intended to do” (Kaufmann and Searle 2007, p. 7). As such, the process proceeded, to some extent, in reverse order “with the concept of measurement driving [their] thinking about what results should be” (ibid.). The system considers “results” in three categories: impact (the direct effect of a grant on beneficiaries), influence (the effect on behaviors of people not directly touched by the grant), and leverage (additional support beyond the Annie E. Casey Foundation’s contribution that the grant built or attracted). The Annie E. Casey Foundation’s framework does not allow the Foundation to overcome some of the challenges (already cited) associated with measurement—for example, availability and consistency of measures— but the process appears to have strengthened program strategy and enhanced thinking about different levels of performance. For example, in the Foundation’s Education Program, the process resulted in “a formal expression of the rationale behind the results that the K-12 Education Program sought.” This included a description of their vision for core results; identification of three critical barriers to achieving the vision; elaboration of the consequences of these barriers; and articulation of the specific role of the Education Program in overcoming them, which also spelled out the results for which the Program would be accountable (Kaufmann and Searle 2007, pp. 7-8).

The Bill & Melinda Gates Foundation has sought to address the challenge of measuring progress, not merely at the foundation level, but at the societal level as well. With an initial grant of $105 million in 2007, Gates helped to establish the Institute for Health Metrics and Evaluation. The Institute works to develop and compile data on five areas of public health: health outcomes, health services, resource inputs, metrics for decision-making, and evaluation. The purpose of IMHE’s work is “to put as much information as possible about health in the public domain in a way that is useful, understandable and credible to enable policy-makers and decision-makers to craft the best policies with the highest benefit for their own context” (IHME web site). The institute has recently published statistics that challenge the reporting of the World Health Organization (WHO), which as a public agency could be prone to the interference of politics in its data gathering and reporting (The Seattle Times, April 9, 2008).

E. USG AGENCY PROCESSES AND PRACTICES

Probably the most well-known and well-developed process by which a USG entity identifies needs, develops initiatives, and measures progress is MCC’s process to select, implement, and evaluate bilateral aid agreements. In its core elements, the MCC approach directly embraces many of the characteristics of successful aid initiatives identified in the literature, including those that remain a challenge for both the public and private sectors. “Local ownership” of MCC initiatives is supported explicitly through the requirements of the application process, as well as recipient countries’ role in providing performance assessment frameworks and conducting evaluations with input from local institutions. MCC applies relatively consistent and well-developed metrics throughout all phases of its decision-making—such that other agencies often rely on MCC indicators (USAID 2007; U.S. Department of State 2007). These metrics have been developed independently by third parties, such as the World Bank, the United Nations, and other international agencies, lending the process both credibility and transparency in the international sector.

MCC agreements are multiyear, with clear requirements for continuation, so funding is relatively reliable once a nation enters into a compact. Broad country coverage and the potential for applying successful initiatives in other countries also are considered in evaluating potential compacts, which speaks to the importance of scale in MCC’s approach. A prime motive for long-term funding is the idea that much of what is undertaken by MCC compacts can be considered reform, and so often require structural and policy changes. For example, the MCC-World Bank collaboration in Mozambique’s water and sanitation sector required changes in the legal authority for local sanitation services (MCC 2008b). These require time for changes to become effective, and resources and technical support to ensure that the changes are successful. The MCC is committed to making these foundational investments, which require a willingness to focus on long-term objectives. MCC’s aid, however, is tied to performance on a yearly basis, which suggests that the achievement of shorter-term objectives is still necessary. Indeed, one of the most common critiques of MCC is that it has disbursed aid too haltingly (Chassy 2005). As it continues to support current compacts and establish new ones, MCC may need to balance a demand for quick results with investments in the broader goals of prosperity and stability.

Another example comes from USAID’s recent reform of its policy framework. According to USAID, studies of USG foreign aid often have highlighted the government’s overarching agendas and the lack of coherence in goals across aid programs to meet those agendas (2006). The numerous accounts responsible for foreign aid have been isolated, with different standards and methods of measuring progress. To address this issue and provide guidance and coherence in the application of assistance, the USAID now uses a policy framework based on five core goals for foreign aid: promoting transformational development, strengthening fragile states, supporting strategic states, providing humanitarian relief, and addressing global issues and other special concerns. For each goal, the framework provides guidance on program planning, resource allocation, and evaluation. The framework builds on the concept that different goals require distinct approaches to formulation and implementation, and also incorporates USAID’s desire to see more public-private partnerships and other new models of aid delivery as part of its initiatives. The five goals also reflect new directions in foreign aid post-9/11, including the support for fragile states and key allies, and the identification of global concerns, such as HIV/AIDS, which have broad impacts.

To further increase the effectiveness of foreign aid and harness the strengths of various agencies within USG, the office of the Director of U.S. Foreign Assistance has piloted a new strategic planning process that brings together those USG agencies delivering assistance within a country to collaborate on the top priorities for that nation (Greene 2008). The agencies collectively produce a Country Assistance Strategy document that outlines the top four or five assistance priorities for that country, taking into account the relative strengths and opportunities that each agency brings to the table and the particular needs of the country in question. This process theoretically minimizes the conflict of goals that can occur when multiple agencies are involved, reduces overlapping efforts, and enables the transfer of knowledge. As of 2008, the process has been piloted in 10 countries. This integration of agency efforts is not surprising, given the 2006 creation of the central Director of Foreign Assistance to oversee foreign aid, but it is not certain whether this process will facilitate a consolidation of the accounts and programs funded with USG aid or an increase in the number of USG agencies involved in international development. It is also unclear what role private organizations will play in this process, although it would make sense to include their efforts for consideration, since some large foundations have as much of a presence in some countries as USG agencies.

In the domestic arena, the Centers for Disease Control and Prevention (CDC) have developed a Framework for Program Evaluation “to ensure that amidst the complex transition in public health, [CDC] will remain accountable and committed to achieving measurable health outcomes” (Milstein and Wetterhall 1999). The framework is a “practical, nonprescriptive tool,” designed for use by public health professionals (rather than professional evaluators), and it encourages the integration of evaluation practices into program operations. Although the framework is focused on the evaluation of individual programs, it is structured to allow CDC to make comparisons across programs. By attempting to build consistent, high-quality evaluation into all of its programs, the CDC hopes to employ this framework to support agency-wide planning and program development, as well as further evaluation.

IV. WHAT IS THE NATURE OF EXISTING USG-FOUNDATION INTERACTIONS ON INTERNATIONAL AND DOMESTIC HEALTH AND SOCIAL SERVICE INITIATIVES?

The interactions around philanthropic initiatives, which occur between the federal government and private foundations, take many forms. It is helpful, however, to attempt some broad categorizations of these interactions, and the literature offers several ways to think about them. Taken together, two such frameworks portray a kind of continuum from minor interaction to intensive collaboration, also calling attention to circumstances where the relationship between USG and foundations is nonexistent, or even adversarial. In addition to shedding light on the important dynamics in USG-foundation interactions in this review, these conceptualizations also can inform case study selection and analysis.

In a theoretical article, public affairs scholar Jodi Sandfort (2008) conceptualizes the role of foundations specifically with respect to their relationship vis-a-vis the federal government. She sees the three main categories of interaction as (1) complementary, where the two entities work together in some way; (2) supplementary, where foundations explicitly seek to act in areas where USG is not acting; and (3) adversarial, where the foundation attempts to move public policy in a particular direction through an advocacy stance (which may or may not be as conflictive as the term “adversarial” typically implies). Adding nuance to the “complementary” category of interaction, it is useful to consider former MacArthur Foundation leader Kennette Benedict’s (2003b) conceptualization of the typical ways in which foundations collaborate with each other. These ways include (1) affinity groups to share information, (2) federations to align resources, and (3) consortia to pool resources and govern projects. Applied to government-foundation interactions, we reconceptualize these three types as communication, coordination, and collaboration.

The center panel of Figure IV.1 depicts this typology of USG-foundation interaction. As the arrows indicate, a single initiative may involve both supplementary and adversarial actions, or evolve from one to the other. Either of these types could also eventually develop into complementary action. In contrast, complementary action is not likely to evolve into supplementary or adversarial action. An important consideration in all types of USG-foundation interaction is the degree to which the interaction is intentional or incidental. The top panel in the figure calls attention to the life cycle of an initiative, as articulated by the State Department (2008) and discussed previously.

The bottom panel in Figure IV.1 presents four key dimensions that determine the shape of USG-foundation relationships, which arise through the combination of Sandfort’s and Benedict’s frameworks. In very general terms, these include the respective levels of communication, resources, organizational priorities, and decision-making for the various institutional actors. At the most basic level, different models of interaction involve different amounts and types of communication between organizations from the respective sectors. Communication may, for example, be frequent or infrequent, direct or indirect, collaborative or adversarial, and it may ebb and flow over the course of an initiative. Second, it is important to consider the extent to which the parties actually contribute resources to the endeavor, as well as the relative size of their contributions, and the proportion of an initiative’s total costs that are met by the various funders of interest.

Figure IV.1
Conceptual Framework for USG-Foundation Decision Making, Implementation, and Interaction around Philanthropic Initiatives

Conceptual Framework for USG-Foundation Decision Making, Implementation, and Interaction around Philanthropic Initiatives D

Related to the question of resources, another dimension of interest is the extent to which the issue or initiative is an organizational priority for the stakeholders involved. Such concerns may influence the organizations’ levels of involvement, their commitment to the initiative over time, and their willingness to interact with other organizations. Finally, decision-making around an initiative is perhaps the most complicated dimension in conceptualizing USG-foundation interactions. Salient questions include the level of decisions being made by the different parties (for example, determining broad goals versus making “brass tacks” implementation decisions); the content areas of the parties’ decisions (for example, drawing on programmatic expertise versus policy know-how); and the degree to which decision-making authority is shared or not.

Below we present examples of several different types of USG-foundation interactions around health and social services endeavors in the U.S. and abroad. We focus on supplementary and complementary activities, as these are more likely than adversarial interactions to provide models for deliberate partnering activities in the future. Each example calls attention to several of the conceptual issues presented in Figure IV.1.

A. SUPPLEMENTARY ACTIVITY

In the philanthropy sector, foundation efforts are generally considered supplementary to the work of government because of relative funding levels. In theory, USG could supplement foundation activities, but this is probably unlikely in practice. This is not to imply temporal order, however: foundations’ supplementary activities may and often do precede USG intervention in a given arena. Indeed, some foundations pursue an active strategy of involvement in areas they view as neglected or unrecognized by government (Benedict 2003a). These include, for example, large organizations, such as MacArthur and Gates, as well as small groups, such as Ashoka.

The MacArthur Foundation also seeks explicitly to act in areas where it views itself as having a comparative advantage, often resulting in a supplementary relationship to USG efforts. Currently, MacArthur focuses on three very broad issue areas: social justice, environment, and world peace. According to an inside observer, “MacArthur would like to position itself as a leader in a new grantmaking and policy domain, so the choice of an area will likely lead the Board to favor those where few other public or private donors are operating” (Benedict 2003a). This same dedication to leading new efforts and affecting policy change sometimes also casts the MacArthur Foundation in an adversarial or advocacy role. A prominent example of such interactions vis-a-vis the federal government can be found in MacArthur’s conservation and biodiversity initiatives. When the Foundation launched the World Environment and Resources (WER) program in 1987, the scientific community had not yet developed a consensus about the importance of biological diversity, and the issue was “just beginning to emerge in public and governmental policy circles.” MacArthur invested heavily in this arena and, according to the same inside source, has encouraged government and other funder activity. Of course, since MacArthur acted independently on WER, decision-making for the initiative fell solely to MacArthur.

Similarly, the Bill & Melinda Gates Foundation’s Global Health Program (GHP) targets “diseases and health conditions that cause the greatest illness and death in developing countries, yet receive little attention and resources” (Gates web site). The Bill & Melinda Gates Foundation views GHP as filling the large and urgent gaps in public health worldwide. Again, this supplementary role can have advocacy components, which the Foundation views as necessary “to accelerate progress against the world’s most acute poverty.” Whereas MacArthur tends to use the language of leadership—that is, explicitly placing the Foundation on the cutting edge of important social issues that may come slowly to the fore in the public consciousness—Gates tends to emphasize its initiatives’ potential for high and quick impact on problems it gauges to be addressed inadequately by other organizations.

Ashoka bills itself as “the global association of the world’s leading social entrepreneurs.” This relatively small public foundation’s activities can also be viewed as supplementary to the efforts of USG; however, here the difference is not so much in the programmatic area of investment but in the model of social change. In a very general sense, public development aid often relies on a top-down theory of change, with USG funding typically directed toward the governments of developing countries or relatively large NGOs. (This may be changing, particularly in the domestic sphere, as illustrated by the federal push for increased contracting with small faith-based and community organizations.) Ashoka’s model of social change, on the other hand, works through individuals more than organizations, and from the bottom-up. Ashoka’s main activity is identifying, funding, and supporting social entrepreneurs—individuals who they believe can make a difference in addressing social problems. Ashoka identifies “changemakers” with new ideas and provides these entrepreneurs with the necessary support to increase the scale of their interventions. With relatively few resources, the foundation nevertheless is prominent in global philanthropy because of its innovative approach and ability to leverage other resources.

B. COMPLEMENTARY ACTIVITY

The spectrum of complementary interactions between USG and foundations is broad, and there is variability in the order of the respective sectors’ entry into the field. The dimensions previously discussed for their salience to the shape of USG-foundation interactions—communication, resources, organizational priorities, and decision-making—also are more significant to complementary interactions than to supplementary activities.

1. Communication

Among the models of complementary activities, the communication model (what Benedict [2003b] describes as “affinity groups”) occupies the lower or less intense end of USG-foundation interaction. Here, organizations from both sectors communicate about an issue, but are not involved directly in addressing the problem together. Such interactions typically see an agency or foundation acting in a “convening” role, bringing stakeholders together to discuss the problem and potential avenues toward solutions. The Clinton Global Initiative is a prominent example of a foundation bringing together stakeholders rather than directly implementing projects. As the foundations website describes it, “the Clinton Global Initiative facilitates cross-sector partnerships that, in turn, create and carry out projects of their own choosing.” Clinton Global Initiative participants may come from USG and other governments, foundations, for- and nonprofit organizations, universities, or NGOs.

2. Coordination

Moving toward more intense USG-foundation interaction, the coordination model (described by Benedict [2003b] as “federations”) occupies the middle part of the spectrum of complementary activities. An example of such deliberate alignment of resources with separate decision-making structures can be seen in the West African Seed Alliance. A public-private (for-and nonprofit) partnership, the West African Seed Alliance’s goals are the development of affordable, high-quality seeds for use by small farmers and the development of business networks to support access to such seeds across five West African nations. As part of its “Global Development Alliance,” USAID has partnered with the Alliance for a Green Revolution in Africa (AGRA web site) on this five-year initiative. AGRA itself is probably more aptly described as a fully collaborative effort (comparable to those detailed below), at least with respect to the founding organizations, which include the Gates and Rockefeller foundations, as well as the five West African governments in the Alliance. With respect to USG involvement with the Bill and Melinda Gates and Rockefeller foundations via AGRA, however, the relationship is probably more accurately understood as a coordination of efforts. While the broader AGRA initiative has received hundreds of millions of dollars from the foundations, the West African Seed Alliance’s resources will total just $61 million over five years, with USAID committing $6.1 million. USAID’s role is very limited, relative to Gates and Rockefeller, with the agency responsible primarily for technical and policy decisions directly affecting the roll-out and implementation of the Alliance’s activities on the ground in Africa. The foundations, on the other hand, set the broad AGRA agenda and determine how the West African Seed Alliance fits into it.

In contrast to AGRA, USG agencies are taking the lead in the multibillion dollar President’s Emergency Plan for AIDS Relief (PEPFAR) initiative. Several of the largest and most influential foundations are also heavily invested in HIV/AIDS initiatives. For example, the Bill & Melinda Gates Foundation has allocated significant funding to the search for an HIV vaccine. PEPFAR, on the other hand, provides funding for increased antiretroviral treatments, as well as prevention efforts. Some of this work is coordinated through the Global Fund to Fight AIDS, Tuberculosis, and Malaria, but USG and foundation strategies still are developed and pursued independently.

3. Collaboration

The West African Water Initiative is a good example of this next and highest level along the continuum of USG-foundation interaction. The Initiative is a 13-member partnership primarily funded by the Conrad N. Hilton Foundation and USAID. The partnership, founded in 2002, addresses issues of safe and adequate water supply, good sanitation, and improved hygiene in Ghana, Mali, and Niger. The West African Water Initiative views itself as a potential model for future collaborations between the public and private sectors. It is a particularly interesting example because the partnership has engaged in decision-making processes that deliberately reflect the strengths and weaknesses of the collaboration, prompting periodic changes to improve the effectiveness of the partnership. Hilton has committed more than $19 million to the Initiative over 6 years, while USAID investment is about $6 million over four years. Other partner contributions total $18 million.

Initially the West African Water Initiative was a loose partnership that avoided building a new organizational structure to oversee the collaboration. With time, however, the Initiative has added more governance structures to facilitate collective action and ensure that the partnership produces “results that are greater than the sum of the individual Partner effort” (Doyle and Corliss 2006, p. 2). While the West African Water Initiative has not become a grantmaking body (grants are still distributed separately by the Hilton Foundation and USAID), there is now a greater emphasis on collective action.

While the independence of both public and private actors is preserved in the West African Water Initiative partnership, other public-private collaborations involve the creation of a new entity with decision-making and funding authority. This is true of the Global Alliance for Vaccines and Immunization (GAVI Alliance), a large partnership effort to increase access to immunizations in the developing world. The Bill & Melinda Gates Foundation is a founding partner of the GAVI Alliance, but the Alliance also receives significant funding from USG, as well as the governments of other developed nations. The GAVI Alliance follows the partnership model, where donors pool resources, with the Alliance itself governing the project and allocating funds. This partnership model ensures a unified approach, but individual donors do sacrifice autonomy.

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[1] The literature review was conducted simultaneously with the data review in September 2008; both were intended to inform the case studies and final report. The reviews that are included here (Appendices B and C) were revised, based on feedback from ASPE, in January 2009.

[2] The review of funding data addresses additional research questions involving the levels and distribution of foundation and USG spending.

*Please note INNOVATIVE approaches in all categories, as appropriate. Include page numbers for reference.*
Citation
Overview
“Lay of the land”: Successes, challenges
Comparative advantage (USG/fdns)
USG-foundation interactions
Strategic planning/Decision-making
Metrics (for identifying problem, planning, gauging outcomes/impacts)
Potential case study/studies
Additional observations

Maximizing the Value of Philanthropic Efforts through Planned Partnerships between the U.S. Government and Private Foundations

APPENDIX B:
Literature Review

Contents

Maximizing the Value of Philanthropic Efforts through Planned Partnerships between the U.S. Government and Private Foundations: Literature Review