Questions submitted to #askbillg:
Following your visit to Lucknow, do you have any thoughts on the cost of India’s space & nuclear programs?
I’m asked this question often, particularly in countries that may have made foreign aid commitments and are trying to find ways to reduce the budget burden. I’m pretty passionate about this topic and wholeheartedly tell people that they shouldn’t reduce their aid commitments, and neither will the foundation.
Our decisions to invest in a particular country or program are based on analysis of where we can have the biggest impact. We don’t take the view that governments shouldn’t spend on particular priorities. Our focus is on where we have a unique ability to contribute expertise and technology in ways that governments can’t. For example, we can try new types of programs, create prototypes and can afford to fail. These are limitations that governments often have, which we don’t.
For perspective, despite the various funding and political priorities of the U.S. government, the foundation still spends a lot of time and money working on U.S. education issues. We are fully committed to education because we believe we can help catalyze change by working with thought-leaders, subject-matter experts, and innovative technology. Does the U.S. space program limit our commitment? Absolutely not.
The other way to think about the issue is that everyone has something important to contribute. Philanthropic organizations like the foundation can bring innovation and expertise to help catalyze efforts. Foreign donors help by providing large sources of funds. And governments are great at scaling solutions and programs that we all develop together. This is the kind of collaboration and leverage necessary to solve tough problems.
Do you or your foundation have any plans for Pakistan?
We do spend a lot of time thinking about what strategies that have worked would have the most impact in Pakistan. The number of deaths of children under five is a key indicator of how a country is doing on child health and nutrition, but also more broadly to address social and economic issues. Over the last 50 years, Pakistan has made significant progress reducing deaths of children under five—the most vulnerable part of the population. But still, it is among the five countries with the highest number of under-five deaths—423,000 in 2010.
We spend a lot of time thinking about what work is necessary in Pakistan. By far our largest commitments in Pakistan are to GAVI. Their efforts to improve coverage of vaccination are ongoing. It’s tough, but there is great progress being made on polio and we’re encouraged.
We also have been making investments in maternal and neonatal care and reproductive health. Obviously, the increase last year of polio cases in Pakistan is also an ongoing priority, and they are using new innovative approaches that are making a difference.
My belief is that a focus on healthcare early in people’s lives will eventually allow the youth of Pakistan to achieve their full potential – that will be transformative for Pakistan.
Can the US learn from India’s healthcare system?
Absolutely. It’s always helpful to look at other successful models to see what we can learn. One area that is worth looking at is the high-volume care centers in India where high quality work is done at low cost. In particular, I’m thinking about things like clinics that focus on doing things such as cataract surgery or cardiac care. They have great outcomes, but lower prices due to the volume of procedures.
I think this might be one of the reasons why we are starting to see the beginnings of a medical tourism industry in India. In general, as India and other middle income countries start to innovate and figure out how to serve such large populations, we can learn a lot from the high quality solutions that have worked for them.