Once a strategy has been selected, responsibility for execution rests with the Foundations program leaders, known as presidents. They have the authority to find the partners, programs, and activities that will allow them to achieve desired results. Program staff may work with an organization to put a new initiative into place or contribute funds to expand work already underway. To maximize the financial resources that can be devoted to the issue, the Foundation works to leverage additional funding from a variety of outside partners, which it did in the case of malaria.
The Gates Foundation often targets projects designed to have a breakthrough impact. Much of the Foundations health funding is therefore directed toward prevention research, such as developing vaccines. In cases where they provide funding for low-tech solutions, such as treated bed nets, they do so in countries where the anti-malaria initiative promises to serve as a model for other countries to follow.
Once a grant has been awarded, an assigned program officer works with the grantee to ensure that the work performed is in sync with the vision and goals of the Foundation. Program officers are typically seasoned experts who not only oversee grant activities, but also provide technical advice to help shape the project. Program officers and grantees operate as formal partners with regular dialogue to develop approaches to the project. When needed, program officers may include other substantive experts at the Foundation to provide guidance and support. However, the assigned program officers maintain primary decision-making authority.