Commentary on LA Times article: "Unintended victims of Gates Foundation"

The LA Times today came out with a full-featured investigation into the Bill & Melinda Gates Foundation and how their investments have had what the LA Times believes are unintended negative side-effects. The full article can be found here.

My work is primarily in global immunizations so it the article was intriguing to me because it mentions GAVI a number of times; GAVI is the main funding body for immunizations worldwide and is largely funded by Gates. The major takeaway from this LA Times article is that investment into single or "vertical" interventions (i.e. vaccinations only or HIV/AIDS treatment only) damages the rest of a developing country's health system because that heavily funded vertical program sucks away all resources (doctors, other health personnel, equipment, vehicles, additional government funding etc).

I'm still up in the air on this type of conclusion. I have done literature reviews on strengthening health systems and integrating immunization services with other health services in developing countries and I have found that it can be quite difficult to integrate or merge various services if they are incompatible with one another. Yet when programs are quite compatible (say, for instance, the distribution of deworming tablets and the distribution of vitamin A) the barriers to achieving a positive synergy can be quite low. Integration is THE hot topic of the moment across the Global Health community and, to me, it echoes the calls for building primary healthcare systems which were quite high in the 1980s but which largely failed....because countries were just not ready for it. Why weren't they ready? My opinion is because country governments were still quite unstable and the building of the primary healthcare systems spread out the health resources of these countries far too thinly. So, very weak primary health care systems were created...and they failed.

So along came the vertical healthcare initiatives like the Expanded Program on Immunization. A very dedicated group of organizations and people focused just on this initiative and all of its necessary components such as vaccine delivery, training of healthcare workers and more. And, over the past 25 years, EPI has succeeded in building multiple strong immunization services across the world and in many countries it is the most successful health intervention.

So, now the call for integration to build upon its success. Yet, one of the difficulties in making integration work is how funding is allocated i.e. funding from organizations like Gates. The LA Times, then, is right to point out to Gates that they need to somehow diversify their funding so that it supports and can be used for multiple interventions, otherwise integration will never work. All stakeholders need to support integrated (and well-designed) initiatives.

Well thats my two rambling cents for now.

LA Times Article link: Unintended victims of Gates Foundation generosity