In this two-part article, Global Giving Matters explores how the Bill & Melinda Gates Foundation is mobilizing dynamic partnerships on the ground to deliver lifesaving vaccines -- and sustainable healthcare solutions -- to some of the most remote and impoverished communities in the developing world.

In less than 10 years, the foundation has become a major force in philanthropy, both in the scale of its giving -- about $600 million annually in global health alone -- and its emphasis on effective multi-sector collaborations. It has introduced a new model of cooperation by crafting a series of incentive-based investment partnerships such as the Global Alliance for Vaccines and Immunization (GAVI), which provide support to governments in the developing world based on demonstrated results in the grantee's healthcare system. About 80 percent of the foundation's grantmaking in the area of global health is undertaken with strategic partners.

While providing vital funding for development of vaccines and other therapies, Bill and Melinda Gates also recognize that medicines alone are not the entire solution, and support partnerships with organizations that deliver and sustain the advances that their foundation makes possible. One such organization is VillageReach, profiled in part 2, which is literally connecting the "last mile" in the circle of giving to bring healthcare -- and hope -- to some of the most remote communities in rural Mozambique.

"We see partnerships every single place we turn"

As the President and Co-Chair of the Bill & Melinda Gates Foundation, Patty Stonesifer is one of the most influential forces in philanthropy in the United States, if not the world. Along with Bill and Melinda Gates and Bill Gates, Sr., Stonesifer controls a foundation with an endowment of approximately $26 billion, dedicated to reducing inequity in global health, improving high school education in the United States, expanding public access to information through libraries, and improving the lives of the most vulnerable members of the Pacific Northwest community.

A technology multimillionaire as a result of her previous work at Microsoft, Stonesifer takes no salary for her executive role at the Bill & Melinda Gates Foundation. She is an active community volunteer, donating both time and resources to a number of regional nonprofit organizations including the YWCA of King County, Washington and the Seattle Foundation. She also serves on the boards of Amazon.com, Viacom Inc. and the Smithsonian Institution.

In a recent conversation with Global Giving Matters, Stonesifer spoke about her own background and personal philosophy of giving and the foundation's approach to philanthropy, which leverages resources through innovative strategic partnerships.

The evolution of a philanthropist

Like her boss, Bill Gates, whose parents were both active in the United Way when he was growing up in Seattle, Stonesifer's strong sense of social responsibility stems from the circumstances of her youth. Growing up in Indiana, the sixth of nine children, she was surrounded by a family in which charitable activity was the norm.

"I came out of a childhood in Indianapolis in which my family members were very significant community activists in the social service sector, in direct giving. We didn't have the resources to be philanthropists," she said. "My early memories are of my mother cleaning off my high chair to give to another child who needed it. My family ran a soup kitchen on Sundays because all of the others in the community were shut down that day. So I came with the belief that one individual's efforts can have a big impact."

Bill Gates and Stonesifer have worked together since she joined the staff of Microsoft in 1988. In 1997, Stonesifer had just retired from Microsoft, where she had been senior vice president of the interactive media division, when her friend and former employer enlisted her to return to work for him -- this time as head of a new philanthropic effort aimed at bridging the "digital divide."

A few years later, this effort was merged with a foundation directed at improving access to global health, run by Bill's father. What emerged was a greatly expanded philanthropic entity whose mission focused on global health and education -- the Bill & Melinda Gates Foundation. Stonesifer was tapped to be President and also serves as Co-Chair with Bill Gates, Sr. The final decision on all grant applications is made by the members of the four-person inner circle comprised of Bill and Melinda Gates, Bill Gates Sr., and Stonesifer, the only non-family member.

To carry out their foundation's ambitious global health agenda, Bill and Melinda Gates have assembled a top-notch team of public health authorities who have played a leadership role in prevention and treatment of diseases that afflict the developing world. Heading the effort is Dr. Rick Klausner, Executive Director of the foundation's global health program, who previously served as director of NIH's National Cancer Institute.

Klausner guides a distinguished team of experts including Dr. Helene Gayle, Director of HIV, TB and Reproductive Health, who led the Center for Disease Control's (CDC) efforts in those areas; Dr. Regina Rabinovich, Director of Infectious Diseases, the former head of the Malaria Vaccine Initiative; and Dr. David Fleming, Director of Global Health Strategies, who served as deputy director of CDC for Science and Public Health. The foundation also benefits from the expertise of senior fellow Dr. William Foege, who led the successful global campaign to eradicate smallpox.

Hands-on approach to grantmaking

The foundation receives as many as 3,000 proposals a month; on average, about 300 of these qualify for serious consideration. Stonesifer personally reviews and takes action on requests of more than $1 million, and is frequently on the road, visiting applicants, grantees and partners, abroad and at home.

Perspectives on the Gates Foundation Approach

Mark R. Kramer is managing director of the Foundation Strategy Group (FSG) and founder of the Center for Effective Philanthropy. He has co-authored a series of influential articles on strategic philanthropy, most recently, "The Competitive Advantage of Corporate Philanthropy", published in Harvard Business Review, December 2002.

Global Giving Matters invited Kramer to assess the impact of the Bill & Melinda Gates Foundation's strategic approach to giving in the area of global health. Overall, he concluded that the Foundation has done an admirable job, not only of giving away money, but of creating value through knowledge and strategy. Following are highlights from Kramer's comments:

"They are committed to solving a well-defined set of problems, not just giving money away to a variety of good causes. That long-term commitment to finding a solution by taking ownership of a problem is the first aspect that distinguishes them from most foundations we see."
"They have used their public profile to signal other funders effectively and brought to the world's attention diseases such as malaria that, although widespread and lethal, were largely overlooked even five or six years ago. When Bill Gates personally spends a week in India and commits $100 million (a figure recently doubled by the foundation), governments and funders around the world take note and respond."
"Their focus on public-private partnerships has broken down many of the artificial barriers between nonprofits, for-profits and governments that impede effective multi-sector solutions. Medicines for Malaria Ventures, International AIDS Vaccine Initiative, and Malaria Vaccine Initiative, all combine philanthropic dollars, government, NGOs and for-profit pharmaceutical companies in a coordinated search for solutions. Working across sectors can be far more impactful than staying within the nonprofit sector alone."
"The Foundation has focused narrowly on a small number of diseases, even with billions of dollars to contribute in the single program area of health. This has enabled Bill Gates himself, along with his father and the foundation staff, to understand the problems they are tackling and become extremely knowledgeable about the issues. As a result, they are able to do an excellent job of selecting highly effective grantees and implementing sophisticated strategies."
"They provide substantial long-term support for their grantees, including general operating support, which has enabled their grantees to build capacity and improve performance over time."

"You have to have a sense of reality on the ground. Getting out there, meeting those you are trying to serve or collaborate with...is absolutely essential, whether the programs are in your own backyard or around the globe," she says.

With a large and growing portfolio in global health, Bill and Melinda Gates also view site visits as an integral part of their philanthropic education. "As donors, the Gateses feel like they need to immerse themselves." After each trip, "they bring back a series of questions to explore with experts and among foundation staff," Stonesifer said.

Bill and Melinda Gates have spent considerable time in developing countries, most recently, on a trip to Botswana, Mozambique and South Africa last September. While in Mozambique, they announced a $168 million program for treatment and prevention of malaria at a remote clinic in Mozambique where they are supporting cutting-edge research on the disease.

Raising visibility and hope

The visit to Africa provided the occasion not only to observe the situation on the ground, but to raise awareness about some of their key foundation priorities. "They wanted to put a spotlight on two major issues: the importance of malaria intervention, and reducing stigma as part of their AIDS plan," said Stonesifer. In South Africa, accompanied by Nelson Mandela and his wife Graça Machel, chair of the Foundation for Community Development of Mozambique, they took every opportunity to combat stigma by speaking "openly, directly and bluntly about AIDS."

In its grantmaking, the foundation has placed particular emphasis on diseases of the developing world that are preventable and treatable but neglected, in large part because industry has had virtually no market incentive to address them in poor countries. While there is no doubt that Bill and Melinda Gates command attention simply by the enormous sums of money they bring to bear on global health, it is how they use this bully pulpit that has the potential to add tremendous value to their philanthropy, according to Stonesifer.

"What we have learned is that Bill and Melinda's visibility in the world can create a sense of urgency" about diseases such as malaria, polio and lymphatic filiariasis, Stonesifer said. "We can put a spotlight on these issues and bring attention to the fact that besides being urgent, they are addressable."

The power of partnership

A hallmark of the foundation's grantmaking has been its ability to leverage resources through strategic collaboration with partners across a variety of sectors. Stonesifer summarizes the foundation's philosophy by paraphrasing an old saying: "If you want to go fast, go alone. If you want to go far, go together."

While there is a sense that the foundation would like to go fast -- but not alone -- in terms of getting promising new vaccines and drug therapies developed and rolled out, there is a recognition that in order to go far, there must be sufficient infrastructure among affected communities to deliver and sustain these advances.

"We look at all of our partnerships to see that there is expertise and connections down to the community level," said Stonesifer, who cited the example of foundation support for a global polio eradication initiative that depends on the members of Rotary International to deliver vaccines in the poorest corners of the world.

Stonesifer said that she is encouraged by the results she is seeing from creative alliances forged by dynamic leaders in all sectors of society. These include the dramatic reduction in trachoma prompted by Pfizer's donation of antibiotics, and the near eradication of guinea worm disease, thanks to former US President Jimmy Carter's spearheading of a global campaign.

In both those cases, "a private action caused the public and philanthropic sector to go a lot further than they would have otherwise," says Stonesifer. To be sure, President Carter had a unique understanding of the public sector, but "you don't need to be an ex-President -- we see partnerships every single place we turn," says Stonesifer.

When Stonesifer agreed to take on a leadership role at the foundation, she made a commitment of four years. That was nearly seven years ago. "It's been amazing these past six-seven years, helping the foundation to shape these programs and roll them out around the world," she said.