25 January 2010

Africa is Innovating in Financial Services, Food Sciences, Health - Bill Gates

Photo: Gates Foundation
Polio vaccination in Nigeria.

In the second annual letter he has issued to the public to discuss his and his wife's philanthropic work through the Bill and Melinda Gates Foundation, Microsoft founder Bill Gates issued an upbeat assessment on the prospects of overcoming the challenges faced by the world's poorest people – many in Africa – in the fields of health and agriculture. Gates discussed the letter, released today, and the work of the foundation in an interview with AllAfrica's Tami Hultman.

Let's begin with the topic of innovations in the delivery of development assistance since that's what you want the foundation to embody. Everywhere I travel in Africa, heads of state, ministers of health, clinicians and small NGOs, as well as international development specialists talk about the lack of information about who is doing what where, with whom, to what purpose. The president of Liberia is among those who wants that data, because she's determined to get development right, despite scant resources. Do you see this lack of information as a challenge – and is it an area where you think innovative approaches could make aid more effective?

Well, there are some areas where it is pretty well known what's going on: vaccine delivery systems or malaria, or distribution of bed nets. "Malaria No More" knows all the different grants from World Bank or from us or from Global Fund [to Combat Hiv/Aids, Malaria and Tuberculosis] and what the status of those is. So it's pretty well coordinated.

If you step outside that, [into] the broad aid issues, then the amount of paperwork and the ability to see all things going on - there hasn't been full advantage taken of what can be done on the Internet yet. Even as am writing something like the Foundation Letter - tracking down the latest ODA [Overseas Development Assistance] numbers and looking at the definitions that OECD [Organization for Economic Cooperation and Development] happens to use and trying to do some adjustments, it's surprising that the possibilities of making information more up-to-date, easier to understand, able to pivot on a per country basis and look at what's going on [aren't better utilized].

There are some improvements that can be made. I wouldn't hold it out as something that is going to double the effectiveness of aid, but it's cheap enough and simple enough, now, that there should be more online understanding and less paperwork, particularly for the countries themselves.

Right, that's always a challenge for the recipient countries. You mentioned malaria. That's one of the areas in your letter where you discussed the need for partnerships. It's a place where, as you've indicated, a lot of effort goes into collaborations. Do you think that the integrative process has gone as far as it needs to and as it can - or should it go further? Are there ways you see that innovations can encourage greater cooperation among more partners and actors?

Well, malaria is a case   where I give the international community a very high grade for cooperation. There's bilateral money, like what was called the President's Malaria Initiative. I'm not sure if that's been re-labeled, but that's the U.S. program. The Global Fund, particularly in the last few rounds, has done big money. The Roll Back Malaria Coalition has been very good on that. The [Bill and Melinda Gates] Foundation focuses on funding a lot of upstream science, as well as delivery. So there we can bring the people working malaria vaccines all together and make sure that the efforts are pretty well complementary.

We're not at the center of the actual delivery challenges - say around bed nets. But it's clear those [nets] are going to get out there.

Bed nets alone won't eliminate malaria, but we're going to get penetration to the households in Africa that can use them. It's over 50% today, but over the next three years they'll get to close to 90% of the targeted households! Now we hope, in parallel with that, we're inventing new insecticides and new medicines and eventually a vaccine, so that we're not putting so much reliance on the bed nets, which is the story today.

The upstream science on both malaria and HIV/AIDS - you indicate some optimism about that. But there are still lots of challenges, huh?

Yes. The malaria story - five years ago, there wasn't much bed net activity, and the so-called Artemisinin-based drugs weren't being used in Africa at all. Today, there are a substantial number of bed nets there and the new drugs are starting to get out.

It's hard. Those drugs are more expensive and so we've given to a [project] that is going to subsidize the cost of the Artemisinin drugs. You know, there's always these discussions about whether you make things free or you have a small charge - what exactly the delivery should be.

For bed nets it works out that making them free is generally the best approach. For the medicines, making them cost something, but having a subsidized price, looks like the best approach, because a lot goes through the private market, and you still want to use those distribution channels. But we need to really get the full eradication. We'll almost certainly need a vaccine.

For both malaria and HIV?

Yeah, HIV, absolutely, because even if we get this daily pill - Tenofovir or some other drug that you take on a daily basis - even that won't eliminate the epidemic. The final elimination pretty clearly requires a vaccine.

And in terms of the science that you fund, in food security, for example, one of the things you mentioned when you spoke in Iowa earlier for World Food Day was that there had been a lot of heat and not much light in the controversies over biogenetics broadly. Your letter makes a distinction among different kinds of science for plant breeding and improvement. Is getting more information out about those various approaches one of the ways that you could see communities coming together to cooperate and find some common ground for the benefit of people who are food insecure now?

Well certainly Africa needs to have a strong regulatory ability to decide - each country for its own sake - the pluses and minuses of allowing in new kinds of crops. We've helped fund groups of African scientists to work with each other and have more capacity as the new seeds come along.

There will be seeds whose benefits are substantial and that happen to use the transgenic technique. The history where these seeds have been used in many countries is that the potential negative things haven't taken place. So each country will decide. Historically the benefits were so modest that it wasn't a big issue. It's only as the science advances that it will become an important issue for the countries to look at.

And, as I say in the letter, I was super impressed with that group in Nairobi I visited BecA Laboratory [Biosciences Eastern and Southern Africa Hub]. Their work does touch marker-assisted selection and transgenic breeding. They have projects with both techniques.

In terms of disease prevention - the thing where you put in a particular gene to interfere with the plant diseases - that is something where transgenics will clearly be way better than conventional breeding.   And people will have to see some examples of that in order to be willing to invest in understanding the safety profile. But that day is coming - in the next three years I would say.

Well, letting people see those advances leads to a question about something you said also in the letter - that the successes need greater visibility . I think there is pretty wide agreement in the development community about that, especially in an environment where books like Dead Aid [blasting international development assistance as a way to address poverty] have gained some traction in the aid debate. When I traveled in November to visit projects of the Kenya Women's Finance Trust, which is moving into savings as well as micro lending, I felt that if people everywhere could just see and know the stories of these women - and what is happening as a result of this work - that there would be more and more resources made available. What innovations can you imagine that could address the need for broader public awareness and therefore greater political will to tackle these tough problems?

Well, certainly the Internet is our friend on getting the word out. You know I just joined Twitter, and I'll be talking about these African success stories and what's going on with the science. I've got a Facebook fan page. The goal of the Annual Letter is to take a topic that many people don't follow on a day-to-day basis, but they care about, and give them a sense of what the challenges are, what the needs are - and yet get them excited that it's really making a difference, as resources have become available.

I was in Kenya in December looking at M-PESA [a service allowing money transfers and bill paying by mobile phone, pioneered by the Safaricom company in Kenya] - which is a phenomenal thing - and the whole way we get that into other countries and use it as the foundation for innovative financial services. That's exciting, because the digital approach allows you to have your transaction fees super low and your accessibility super high.

Although it's going to take a while before we take full advantage of M-PESA and get it into other countries, that's an example of something that really did happen first in Africa. There's no real analog to that kind of digital currency yet in most other countries.

The mobile phone entrepreneur Mo Ibrahim   has encouraged us to give more attention to governance as a key component of aid effectiveness. I was thinking about that in November, when I saw some exciting health innovations in Kwara State, Nigeria where Governor Bukola Saraki, who is a physician, has pioneered a low cost insurance scheme. It's really made rural people feel invested in their healthcare and the new clinics being built. Governor Saraki said there is a lot of interest across Nigeria [in the initiative], but, of course, you really need a functioning government to help scale up these efforts across Nigeria and beyond. I just wondered how you see the issues of governance as relevant to your work to create sustainable development?

Well, governance is the biggest factor completely outside of our control that can make a huge difference. Certainly you have the case of Zimbabwe, where things went backwards because of mis-governance.

And yet it's tricky for a donor - how can you help things? We fund Transparency International. We're funding groups that work on good governance. We funded Tony Blair to go in Liberia and do some transition activities. I follow Paul Collier's writings quite a bit, and I tend to agree with him that you've got to think about governance. But we're an actor outside the country.

Now if you improve health and you improve agricultural productivity, that tends to help with governance. Bad governance and bad circumstances are intertwined. They tend to reinforce each other. When you get good governance, it makes a huge difference, and Africa has some good examples right now.

In our work in Nigeria, we're always wondering: will the government get better or worse? In a thing like polio, Nigeria is the last place in Africa where you have significant disease transmission. We have to work in Nigeria. I think things are tending to improve there, but off of a pretty low base.

If we magically could write checks that would improve governance, that would be a wonderful form of aid. It's not as simple as that.

I love what Mo's done. His prize [the Mo Ibrahim Prize for Achievement in African Leadership] is good. That sends the right message. Mo's actually on the AGRA [Alliance for a Green Revolution in Africa] board, so when I was in Kenya in December, I sat down and talked to him. He's doing great work.

So you think that sustainable development is a tapestry of many threads, and you're trying to use the ones that you're most expert in or can do the most in?

That's right. Health and agriculture and financial services are the ones we've put the most money into. We put some into governance things, and I wish I knew better how to map resources into that. When [South African President Jacob] Zuma took power, we didn't know what he would do on AIDS. I met with him in December, and I was very pleased with his openness and his energy. We should be smarter about governance, but there will still be an element of luck involved as well.

Yeah, magic formulas would be nice. You mention, in the letter, online learning as growing in importance . Do you think Africa can benefit from innovations in this area - teaching materials distributed through mobile devices and that sort of thing? Sometimes people don't think about Africa [in connection with technologies], but it seems to me there are a lot of prospects there.

Well, there's two things we need to do for Africa to get online learning to work. One is to get I nternet coverage to be broader and cheaper - and it is improving in Africa. But Africa is the least connected continent by any measure you look at.

The second is to get this online learning thing working for the world as a whole, and we're at a very early stage on this. T he ideal would be to take the training to do various jobs related to treating AIDS,   providing AIDS drugs, drawing blood, being a community worker or pharmacist. If you could have all that great training online and interactive, your ability to create trained personnel - your capacity - would go up a lot more easily than it does today. So I do think there's a role for online learning in Africa.

Education tends to be very politically driven. It's hard, when you talk about managing teachers and tracking who the good teachers are, making sure they show up and do a good job. That's very difficult to do unless the local governance is very strong. So we think our online learning will be globally beneficial. Even though a lot of it will be in English, it will be easy to translate where there's demand.

The other learning stuff we do is pretty focused on the U.S., to understand how the personnel system should work. Amazingly, rich countries haven't solved the question of how you measure good teaching! There may be some [globally applicable] lessons out of that, but the specific investments in teacher measurement are all in the United States.

Let me finish up by asking you if there are any other things that you'd like to say specifically about Africa?

I'm optimistic about Africa. Part of my being full-time at the foundation means I get [to Africa] at least once a year and see new things. My next trip will be in June. I'll certainly go to Nigeria. I don't know where else I'll go.

Innovation that's done in Africa and other places can make a big difference. I talk [in the letter] about innovation in Africa and agricultural work being done up in Nairobi. The other thing that was stunning for me - it was fantastic - was the University of Kwazulu-Natal, where the Howard Hughes Medical Institute and Bruce Walker [who directs the HIV Pathogenesis Program] are making sure funds are going to help create great scientists and great collaborative work there.

So getting success stories out about Africa is particularly important, because when you just hear the current statistics it can be a little depressing. But the trend line is positive enough and there's enough cool things like M-PESA that, hopefully, as I'm doing new annual letters and being online, the positive stories will get out there more.


Bill Gates Issues Upbeat Take on African Health, Food Initiatives

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Read Gates' 2010 letter in full >>

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