Health is key to economic gains – Bill & Melinda Gates

As one of the largest development organisations in the world, the Bill & Melinda Gates Foundation has been making substantial investments across Africa for many years. New African spoke with Rodger Voorhies, Executive Director of Global Growth & Opportunity, to get a sense of the Foundation’s focus and to take stock of its impact thus far.

Since moving into your new role as Executive Director of Global Growth & Opportunity, what would you identify as the three biggest bottlenecks to the Sustainable Development Goals (SDGs) that emerging economies are facing?

One of the first bottlenecks is the right kinds of available data to understand if we are actually ticking a box or making progress; if we really are having impact on the ground. The indicators that have come out in many areas are strong; but, for example, one indicator that doesn’t seem to exist is gender-disaggregated data. When we made a commitment, in 2016, of $80m to gender data, it was really because gender data wasn’t available at a country level or even within some of the large global surveys.

So we’ve invested in the UN but also more broadly within other organisations to bring gender-disaggregated data to the surface. 

The second factor is that it’s hard to move from aspiration to achievement at a country level. If we want to solve agricultural productivity, close the financial inclusion gap or provide primary healthcare, the technical capacity has to be in place to consistently deliver for those outcomes.

So translating the SDGs into what I call the development stack: the right policy, the right infrastructure and technology, is key.  Saying that, there are some countries where we are seeing tremendous progress in agriculture and nutrition. In Ethiopia you’ve seen the number of extreme poor in rural areas drop by half.

In Rwanda, agricultural transformation has lowered the number in extreme poverty by one million people. So there are many examples of hope but the question is how we make that universal – continent-wide. And so I think that’s the third area: how do we actually focus continent-wide on progress.

In terms of agriculture, we partner with the Alliance for the Green Revolution in Africa (AGRA) to understand where countries are in their commitments to the SDGs and the Malabo Declaration.

The same is true for our global financial inclusion work. The Global Findex came out in the spring meeting and the progress on financial inclusion has been excellent. 1.2bn people have been added but it still leaves out another 1.7bn people, with some countries doing well, others not. So the question is, what do we do with those that are left behind?

 

In terms of data, how can we strengthen systems at a local and country level to ensure that policy is based on empirical information?

In one way, you get what you measure. And I think there are two ways to address that. One is that global surveys that actually represent the indicators that are transferable across countries do not exist. So we make a big investment in the Living Standards Measurement Study (LSMS), which we think provides incredible information at the household survey level – though then, how does that translate to national housing policy?

Another area where we are focused is how to get consistency at the country level with some of the international surveys. And how does new technology work in terms of survey and data acquisition? Are there new models which are cheaper?

And I actually think that there’s good progress being made in translating data into the right policy, with various organisations helping to provide analysis and a set of recommendations around it.

 

What will be the biggest driver of change in Africa?

From the Bill & Melinda Gates Foundation’s perspective, we think there are a couple of priorities that really matter. People are not statically poor; they rise and fall through their ability to buffer shocks that push people deeper into poverty or help them hold onto and grab economic opportunities to bring them out of poverty.

The vast majority of these shocks are health shocks so I strongly believe that health is a key driver of economic gains, but also social and human rights gains. We’ve seen child and infant mortality drop tremendously over the last few years. The under-five mortality rates continue to go down in many countries.

If you then look historically, almost all countries which have inclusive economic growth in the early growth stages have been driven by an agricultural transformation agenda and that’s why it’s such an important feature for us. 

So health and agriculture are the top two priorities at the Bill & Melinda Gates Foundation. Let’s drive health outcomes that work for low-income people and then see about how we build an economic model for smallholder farmers.

 

Much has been said about making development work for women and the youth. To what extent has progress been made?

If you look across development spaces, women are differentially left behind. Poverty in many ways is sexist. When you have shocks, women suffer first, suffer longer and recover last. That’s why we have women as a main priority within the Foundation. In terms of agricultural gains, the Food and Agriculture Organisation (FAO) has said if women simply had the same access to opportunities that men do, you would see a productivity enhancement of 20% to 30%.

The problem is threefold. Women need to have access to assets if they are to be productive. Only 27% of women in Africa have access to modern inputs and in some countries only 9% have access to formalised credit, so you need to have access to the right assets to be productive.

The second is that women get to control and direct the benefit of the assets. When they actually have control, their influence over household decisions goes up. The studies about financial inclusion show that women who have their own bank account experience greater equality with their partners and that’s when we see a sort of doubling down on closing the economic empowerment gap.

 

How have spending patterns changed within the Bill & Melinda Gates Foundation over the years? Agriculture and women are a key focus at the moment – but it wasn’t always so. How do you ensure you are tackling the right problems?   

We look for situations that are catalytic. We ask ourselves, why do markets fail to provide? So when we first started out in the financial inclusion space, we said to ourselves, micro-credit has had some levels of success but what would be more transformational? This was about a decade ago. Four years into it, we said we’re not getting the outcomes on financial inclusion that we want. We have a super-rigorous review process where we review the strategy against its processes and leadership; Bill and Melinda said “we believe in savings and financial inclusion but it’s not having the impact we want”.

So we asked questions differently. Why do financial services matter for poor people and why do the existing tools not work? Then we overhauled the whole strategy to focus on lower-cost payments; on trying to take a digital approach to inclusion – and that’s where we’ve seen the numbers grow tremendously, especially with incredible progress in Kenya and Tanzania as well as parts of West Africa.

I think that’s where the foundation tries to find the balance, between tackling big catalytic problems that we are interested in for the long term and measuring our tactics and holding ourselves accountable on what’s working and what is not working. So our refocusing allows us to be flexible. Let’s try and tackle the problem for the long term and let’s rigorously measure our outcomes and decide where we are making the right progress and are on the right track.

 

Appetite for donor funding is waning in the West as organisations look towards private investment for greater impact. How would you defend donor engagement in emerging economies?

There’s always the question of what outcome people are getting for their development dollars. People underestimate the progress that has been made in the last 20 to 30 years. We have actually seen absolute poverty numbers fall by half, with many countries moving out of extreme poverty into middle income. The Foundation has predicted that in the next 30 years, there will still be poor people but no more extremely poor countries. One thing to bear in mind is that there are some great success stories and a lot of it is being driven by donor intervention.

The economic crisis caused people to think differently. There’s a place for returnable capital and there’s a place for donor funding. Going forward, we’ve seen countries like the UK continue their 0.7% of GDP, and while the appetite has waned, new donors are coming online.

China is setting up its development organisation and we are seeing non-traditional countries come into the space. We are big proponents and believers of the right kind of smart aid and we hope that countries will continue to support it while simultaneously appreciating the impact that returnable capital is having. I would resist the temptation to be too binary. NA