Global Diseases, Local Needs

The diseases that get funded tend to be the ones for which funders can take credit.

(Photo by Richard Rudisill Photography/iStock) 

Extraordinary and expensive medical treatments are available to people in poor regions, thanks in large part to commitment and funding from Bill & Melinda Gates and other private foundations. But while antiretroviral therapies help millions with HIV live longer and healthier lives, their neighbors continue to die of simple diarrheal diseases.

Private foundations don’t fund the issues that people surveyed in 27 countries think should be the national priority, says Daniel Esser, assistant professor in the international development program at American University. “Whereas national financial assistance for global health shows a weak but at least significant response to preference,” says Esser, “private foundations seem to be responsive to neither preferences nor disease burdens at the national level.”

A 2007 Kaiser/Pew Global Health Survey of the public perceptions of health problems in developing countries let Esser compare disease burdens and local priorities with funding streams, both public and private. HIV/AIDS contributes only 3 percent of the total disease burden in Asia, but was the second most highly funded health category. Tuberculosis, malaria, and other infectious diseases are the lowest priority out of nine in the Middle East, but received the third most money from 2005 to 2007.

The diseases that get funded tend to be the ones for which funders can take credit, Esser says: They are infectious, highly visible, and in some way “ownable.” With a vertical aid architecture “every donor can plug into the supply chain somewhere, and they can quite easily claim a role and an impact within that supply chain,” Esser says—from financing a particular prevention campaign to providing a certain number of treatment kits or vehicles. Murkier areas like chronic disease and basic health systems strengthening are neglected.

Malaria, HIV, and tuberculosis do in fact kill a lot of people. “The real problem, though, is in the concept of other people deciding for other countries what is in their best interest,” says Eva Harris, professor of infectious disease at the University of California, Berkeley School of Public Health. “One needs to develop partnerships and listen, as opposed to tell.”

The Bill & Melinda Gates Foundation has become a phenomenal force. In 2007 it spent almost as much on global health as the World Health Organization’s entire annual budget. Esser worries that the Gates Foundation’s accountability has not grown as much as its influence. “Now that we have mobilized so much more money for global health,” says Esser, “and now that health is considered one of the key issues in international development, isn’t it time to have a critical look at what the real killers are?” That’s going to be different in every country, he says, and the challenge is to respond to actual local needs.

Daniel Esser and Kara Keating Bench, “Does Global Health Funding Respond to Recipients’ Needs? Comparing Public and Private Donors’ Allocations in 2005–2007,” World Development, 39, 2011.

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  • BY AJ Chen, National Partnership for Action to end he

    ON November 17, 2011 12:44 PM

    Chronic hepatitis is another example of huge health disparity with little funding. Globally, more than 500M people are infected by HBV or BCV, mostly in Asia and Africa.  But, funding to chronic hepatitis is minimal compared to HIV and other high-profile diseases.  It does not even get mentioned in this article.  US HHS has issued action plan to fight chronic hepatitis this year. Hopefully, this new focus from HHS will help increase funding interest in this area from private foundations. The new National Partnership for Action to end health disparities has made a great start in forming public-private partnership, but it needs to reach out to the philanthropy community to make the disparity problem more visible and understandable.

  • A Great Article!  And I applaud you beginning a discussion on this subject, long over due.
    It is time we looked the “gift horse in the eye”. These mega global private family operating foundations such as Gates and Rockefeller, operate under the radar screen and draw less scrutiny that the average smaller 5013c ngos. They are, in fact, corporations operating under the guise of a 5013c. They have a corporate mindset and operate as such for control and domination with the associated pr spin.  Their investments reflect their sentiments:
    “Bill Melinda Gates Foundation Trust Portfolio - 2011 Stock Picks and Performances”
    Hardly “Socially Responsible”, “sustainable” or CSR. 
    Additionally, their programs are often trojan horses for their large donors and corporate partners: BigPharma; BigAg; the pesticide/chemical industries; and governments.
    “Bill Gates and His $10 Billion Vaccine Scam | Foreign Policy Journal “
    They promote and push Big Agriculture and genetically modified food farming into developing and emerging nations taking with the attending huge pesticide/herbicides needed to grow these crops via Monsanto and Syngenta, the ag machinery business; and here there is the issue of patenting of all agriculture seed:
    “How Bill Gates, Syngenta and Rockefeller Became Custodians of the Doomsday Crop Diversity Vault”  I could go on…
    “Bill Gates, Monsanto hijack ‘humanitarian aid’ efforts to push GMO agenda” 
    It is time we seriously questioned the motives and strings attached when these mega “philanthropies” promote their programs as “humanitarian”  They invest billions of dollars in research but for whom, and whose interest and whose ownership? 
    A frontal indepth investigation is needed of how “humanitarian”, “socially responsible” and locally concerned these mega global foundations really are.  As I said earlier, I question their motives when they act as trojan horses for their corporate and government interests.  And that’s the problem.  They front for the USA Government to expand and penetrate markets of interest…#BigPharma, Big Agriculture and the USDA in particular.  Who then, is going to exercise oversight and rein in the horses?
    There are so many small ngos out there working at the local level with the local needs, doing great work and struggling for funds. I find the whole game rather sickening. 
    Again, Thank you for starting a discussion that is long overdue.

  • Nimi Vashi's avatar

    BY Nimi Vashi

    ON February 8, 2012 10:19 PM

    i completely agree with what the article says. Other issue is that any small project or any individual focusing on some X Y or Z protein of HIV which has absolutely no scope to be implemented practically gets funded. But if there is someone genuinely doing something great for what one may call as “Non-popular diseases” do not get anything even after a lot of struggle. That is what we call a real bad situation that needs to be changed.

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