Within the Global Health Program, five key divisionsPolicy and Advocacy, Global Health Discovery, Infectious Disease Development, Integrated Health Solutions Development, and Global Health Deliveryadminister and carry out initiatives within the 11 focal areas. For each area, including the malaria program, a strategic planning team comprised of staff from each of the divisions develops an overall strategy and monitors implementation and outcomes. These teams are also instrumental in determining how to invest resources to obtain the greatest impact. This structure provides an opportunity for staff to interact and plan by focal area and by type of strategy or intervention. The teams meet at least monthly to develop priorities and monitor progress.
In each program area, the Gates Foundation conceptualizes their grant-making as a series of activities that use inquiry and feedback to select and guide investments with the best chances of advancing Foundation goals. The four key stages, or steps, of the Foundations grant-making process are: (1) develop strategy (formulation and planning), (2) make grants (implementation), (3) measure progress (evaluation), and (4) adjust strategy (impact). These map well to the conceptual model of philanthropic approaches described in the literature review for this project.
1. Developing StrategyFormulation and Planning
The Gates Foundation engages in an intensive and collaborative process to formulate strategies for areas in which they plan to invest. When strategies are being developed, the Foundation co-chairs, Bill and Melinda Gates, work closely with the leadership teams to develop a long-range plan. The Foundation gathers data from as many sources as possible and engages experts and potential beneficiaries. Once the area has been established, the strategic planning team takes responsibility for ongoing planning, bringing in the co-chairs and leadership team when needed.
The Gates Foundation often involves a variety of partners, practitioners, and leaders in the strategy development process. Teams define the problem of interest as clearly as possible, then conduct research to understand what is being done to address the problem and by whom, and to identify any potential barriers to change. They routinely seek outside input through listening sessions with experts and those affected by the issue and consider short- and long-term solutions. In developing their role, the Foundation aims to identify where they can have the most impact. For malaria, they have allocated resources to expand the use of chemically treated mosquito nets (a short-term solution) and also provided substantial funding to develop a vaccine for malaria (a long-term solution). Once Foundation leadership agrees on overall strategy and tactics, focus area leaders recommend how much money should be allocated to an initiative. Strategies usually are put into place for three to five years.
In the case of malaria, the Gates Foundations short-term goal is to significantly reduce malaria deaths by 2015. Its long-term goal is to eradicate the disease. To achieve these goals, the Foundation has chosen to focus its efforts on:
- Developing malaria vaccines and other new prevention strategies
- Developing new drugs for treating malaria
- Developing improved methods for mosquito control
- Expanding access and funding for malaria control
- Increasing public awareness about malaria and advocating for effective research and control
2. Making GrantsImplementation
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.
3. Measuring Progress and Adjusting StrategyEvaluation and Impacts
The Gates Foundation has a formal internal process for evaluating grant initiatives. It requires grantees to report on their work and the strategic team to evaluate the overall progress toward outcome goals. As part of this process, the strategic planning team conducts a periodic refresh to evaluate milestones achieved and redefine priorities for the program Refreshes occur every six months to three years, depending on the initiative.
An external advisory committee oversees each main program areaglobal health, global development, and U.S. domestic programs. These advisors review the Foundations strategies and efforts to implement them. Advisory committees are intended to ensure that Foundation efforts are examined from a holistic perspective and to help make midcourse corrections.
In addition to internal evaluation, the Foundation relies on formal research to identify needs and impacts. A recent grant to the University of Washington for more than $100 million helped create the Institute for Health Metrics and Evaluation (IHME) to obtain more consistent and accurate data, improve data analysis, and identify needs for specific interventions. Evaluations conducted by IHME also document the effectiveness of targeted health interventions and disseminate evaluation findings to inform policymakers.
The Gates Foundation reports that over the past five years its malaria initiative has had a significant effect on efforts to address the disease, by raising awareness and recruiting resources and global commitment to the initiative. According to the president of policy and advocacy at the Gates Foundation, the malaria advocacy community has expanded from a few members to an active, worldwide community, largely in response to the Foundations leadership and funding. An editorial in the New York Times (December 14, 2008) gave the Foundation credit for a long-awaited breakthrough in developing a malaria vaccine.