“By 2035, there will be almost no poor countries left in the world”

Bill Gates, Annual Letter 2014, p 7

Bill Gates is a self-proclaimed Impatient Optimist, and he makes bold statements about the world’s future. Yet for us, from an academic institution, his 2014 annual letter strikes a chord including the three myths covered:

1. poor countries are doomed to stay poor
2. foreign aid is a big waste
3. saving lives leads to overpopulation.

Working to reduce inequity in healthcare within poor communities

The foundation invests in trying to improve conditions for women and newborns in places with the worst statistics for maternal and newborn health and survival. These are also some of the poorest places in the world and, strikingly, even within the context of poverty, there is considerable inequity in health care. In a recent survey in Gombe state, Nigeria, in the “richest” households we surveyed only 8% had electric or gas cooking fuel. And yet even here, the poorest households were worse off with only 18% women from these households getting the 4 pregnancy care visits they should, compared to 65% women from the “richest” households.

Our research will find out whether health care becomes more equitable as Gates-funded projects implement their work, which sometimes means targeting those with the odds stacked highest against them. For example, India’s Community Mobilization project is using community self-help groups in some of the poorest areas of Uttar Pradesh State to educate families about good health practices. We will have evidence to show whether there have been improvements in equity when we conduct our endline surveys over the next two years.

The value of “foreign aid”

As public health professionals living in cash-strapped times, how many times have we heard the argument that “foreign aid” is a big waste? Just last year, the UK national press featured quotes supporting this argument from Godfrey Bloom, an ex- Minister of European Parliament for the UK Independence Party:  “How can we possibly be giving £1bn a month, when we’re in this sort of debt, to Bongo Bongo Land is completely beyond me.”

It is credit to the foundation that they have funded the IDEAS project to ask, does the aid money given by the foundation have the intended effect of saving the lives of women and babies? Using rigorous quantitative and qualitative methods we will look at whether and how foundation funding results in health care practices and behaviours that are known to save lives.

In short, the IDEAS project will generate evidence to help ensure the foundation’s future investments are spent on cost-effective ways to save lives.

Saving lives and planning families

The projects we working with in Ethiopia, Uttar Pradesh, India, and North East Nigeria are not introducing revolutionary concepts.  Instead, they are bringing basic, fundamental knowledge to front line health workers, families and local communities about:

• how to improve the health and survival of mothers and newborns, for example through low-cost, simple approaches such as. breastfeeding, keep the newborn warm, cutting the cord with a sterilised knife, looking out for danger signs during pregnancy), and
• how women can take control of and plan for a healthy, sustainable future for their families.

As Melinda demonstrated in the annual letter (see the Save The People video below), success in saving lives does not lead to overpopulation, and we see maternal and newborn health improvement initiatives integrated with education about family planning.

Our work will end before Bill’s predictions are due to reach their targets, yet we are encouraged by our experience of the foundation’s efforts to interrogate and strengthen its approach to investment.  A collective effort of researchers, donors and policy-makers to work with ‘impatient optimism’ and use a solid evidence base for decision-making can surely only help to move us in the right direction.