Gates discovers (at last) that vertical health programs don’t work?

The Wall Street Journal reports that Bill Gates may now see that we need to invest in health systems, not simply fight individual diseases:

That question goes to the heart of one of the most controversial debates in global health: Is humanity better served by waging wars on individual diseases, like polio? Or is it better to pursue a broader set of health goals simultaneously—improving hygiene, expanding immunizations, providing clean drinking water—that don’t eliminate any one disease, but might improve the overall health of people in developing countries?

The new plan integrates both approaches. It’s an acknowledgment, bred by last summer’s outbreak, that disease-specific wars can succeed only if they also strengthen the overall health system in poor countries.

We already knew that, right? The big philanthropic foundations pride themselves on trying new approaches, and not being constrained by conventional thinking. Great. But it is a pity when they have to reinvent the wheel themselves.

9 thoughts on “Gates discovers (at last) that vertical health programs don’t work?”

  1. I remember talking to a representative of one of the big donors about our EpiSurveyor software ( which allows anyone to collect form-based data on mobile phones. I was especially enthusiastic about the general nature of the tool: that it could be used to collect data on *anything*.

    Donor: So you can use this for any disease?

    Me: Yes, that’s the great part: it can be used even when priorities and needs change, to collect data on whatever is important.

    Donor: Oh, well, we’re really looking for something more malaria-specific.

    [moment of shocked silence on my part]

    Me: Can I ask: do you have a malaria-specific email program?

    It’s good to see them coming around.

  2. The one positive on this is that at least the Gates Foundation is recognizing the need to change their approach and is not locked into one ideology. Too many aid organizations can become dogmatic in their approach, limiting their effectiveness.

  3. I’m not a big advocate of eradication programs for many of the well-recognized reasons such as the cost per case averted when one gets close to eradication. There is a very sensible case to be made that the most efficient use of funds is through a well-designed control strategy rather than eradication. However, I think that the case of polio eradication that you (and the article) specifically refer to does have its upsides as well. Being able to eradicate a disease completely offers the direct benefit of global cost-savings but also the much less tangible and tricky to quantify issue of a success story. An achievement like this can stand out to the public at large in the complex and often murky world of what constitutes a success in international development. Having said that, there’s no reason that a specific polio effort can’t be accompanied by other efforts from the Foundation to support health systems.

  4. Well, better late than never, I suppose. There’s a reason people call it “The Gutless Foundation.” Thus far Gates has seemed interested only in funding what it imagines to be sure things, hence the obsessive focus on technologies and toys. The tech focus is understandable, given where he came from, and obviously magic bullets have their place. But what’s odd is that unlike in Microsoft’s early days, in this arena Gates has shown zero appetite for high-risk/high-reward action. As a result, the BMGF has been condemned to repeat every single mistake in the development playbook, starting with those that everyone else got over in the 1970s. The only question now is, will the foundation now repeat all the health systems mistakes that others have already made, or will it be learning to swallow some pride and learn from the many organizations big and small that are making promising progress in this area?

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  6. Thanks for this post. It is, no doubt, a bit too easy and pleasurable to gloat about the Gates Foundation. But I would suggest that the cult of “innovation, new idea, and thoughtleaders” has been a disease of the last decade. I would like to see a new foundation (Clinton, Gates, and many more from the IT world) just once not declare how they are going to transform aid, development, and the planet as we know it, but just say “We plan to be a damn good foundation and invest in what we know already works — and hopefully make a difference.” The hubris of all these people assuming no one knows anything!

    I’m all for innovation and new ideas. Yet we lack sustain investment in things that work. I was at a conference recently where Dr. Malcom Potts said, rather testily, we’ve known for 30 years how to lower birth rates and save maternal lives through good family planning programs — but these are only now being funded again.

    Owen replies: David – thanks. I agree.

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