Can the World Health Organization Meet the Challenge of Bill Gates?
Every year delegates meet at the United Nations World Health Organization (WHO) in Geneva to discuss goals in health. This year electronics czar Bill Gates addressed the 192 delegates and joined in discussions. The Bill and Melinda Gates Foundation has focused on saving lives in Africa through an intensive research program that has so far spent more than six billion dollars. The importance of the WHO as a global meeting ground for health practitioners is beyond any question. It is therefore the principal forum for Bill Gates to explain the strategy of the Gates Foundation and hear about problems at first hand from the delegates.
However, with an annual budget of 1.65 billion dollars and its heavy bureaucratic and political impediments, WHO can only loosely be called a collaborator of the ambitious, massive, and dynamic Gates Foundation effort. It is in many ways deemed too cumbersome by the results oriented Gates Foundation that retains complete control over all the funds they spend in the effort to remove the curse of infectious diseases in Africa and other stricken areas.
At the same time the foundation is pursuing a high tech approach, arguing that the discovery of a vaccine for malaria, for example, will ultimately be the simplest, direct and most cost effective way of preventing the ravages of this disease. On the other hand, African doctors and other health field workers stress that environmental and infrastructural improvements could have a more immediate effect. The health status of any community depends on a wide variety of conditions that begin with adequate water and diet, moving on to competent, reliable, and continuing care.
Michael Specter in a recent ‘New Yorker’ article on the Bill and Melinda Gates Foundation cited what is called the difference between efficacy and effectiveness, the difference between what you see in the clinical world and what you find in the field, “the real world”.
This is where WHO can play an important role by bringing this message to member states, particularly to the rich donors among them.. The African countries, short on financing, infrastructure, trained personnel, are deficient in all of the conditions necessary for maintaining acceptable health status.
In an article published in the last edition of the “New England Journal of Medicine” Dr. Fitzhugh Mullan, a professor of medicine and public health at George Washington University, found that the United States depends significantly on immigrant doctors and that the greatest losers are the poor African and Caribbean countries whose need for trained medical personal is the greatest. While the Americans claim as cause for this brain drain that US medical schools were not training a sufficient number of doctors, other reasons were brought to light in a study by the WHO.
The working conditions for training doctors in Africa are both daunting and discouraging. It is not only that the trained health workers are being lured away by better salaries and better working conditions elsewhere, they are also being driven out by insufficient budgeting in their own countries. It was at the WHO conference that African and Caribbean doctors cited data from the Gates Foundation about the dreadful lack of hospital beds, diagnostic equipment, and sufficient training in their respective countries.
Public health leaders in Africa have already pledged to reform their ailing systems. Dr. Francis Omaswa, former director general of Uganda's health service, is now a special adviser to the World Health Organization on human resources for health. At the initiative of the Gates Foundation he is devising a campaign to ease the staffing crisis and improve health care in poor nations, which WHO will be expected to spearhead with funds and expertise from public and private sources.
Rather than compete with Bill Gates WHO must respond to the challenge he represents by joining forces with his foundation and occasionally accepting its lead.