Lessons for Bill Gates from Jim Grant

Although coming from very different backgrounds and different life experiences, Bill Gates and Jim Grant seem to share many convictions in common.

Jim Grant’s interest and commitment to human development came from his own first-hand personal experience of living and working in many developing countries, witnessing great human suffering as well as success stories such as the bare-foot doctors in China, the Green revolution in India and Turkey, Sri Lanka’s great progress in human development despite low level of economic development, and many such examples.

It is said that Bill Gates’ interest in human development issues was triggered by reading the 1993 World Development Report on health. Gates was apparently shocked to learn about the enormity of the deaths, disabilities and human suffering in the world caused by readily preventable diseases and ailments. But he was apparently greatly inspired by the tremendously under-utilized potential for making huge impact on improving human health and well-being.

He had then concluded that it would be unconscionable for him to wait until his retirement to begin philanthropic activities to tackle such urgent problems, as he had originally planned. Instead he decided to immediately dedicate himself to becoming an activist leader and investor in global health.

Though coming from such different angles at a different times, Gates seems to share Grant’s deeply held philosophy that morality must evolve and march in tandem with our capacity; that in terms of scale, the solutions we seek must be commensurate with the great problems we seek to tackle; that we must harness the power and potential of today’s science, information and communication technologies to reach the unreached; and that we must do what we can do today, rather than waiting for some elusive holistic solutions in the future, or making perfection the enemy of the good.

Gates and Grant would have made an extra-ordinary pair and a formidable force for human advancement – with Gates’ technological genius and business acumen, and Grant’s knack for inspiring and mobilizing world leaders and governments; with the brilliance of Microsoft’s applications and outreach, and popular legitimacy and efficacy of UNICEF’s bully pulpit; and the shared commitment and passion of both to pursue ambitious, measurable goals for human development.

Alas, Grant is not alive, and the world cannot benefit from a joint venture of these remarkably visionary leaders. But Gates can certainly apply some of Jim Grant’s techniques to bolster the effectiveness of his own creative ideas and commitment.

Here are seven ideas that Gates could emulate from Grant’s approach, adapting them to his own unique personality and preferences for the greater good of humanity.

  1. Inspire leaders to pursue ambitious but achievable goals:

Bill Gates has access to many world leaders. He commands their attention and respect. He is already doing much to influence them to invest in alleviating human suffering, and promoting health and human development. Perhaps he could use some of the techniques applied by Jim Grant to further bolster the impact of his advocacy.

A key to Jim Grant’s success was his ability to motivate and inspire leaders he met – Heads of State and Government, Ministers, Governors, media moguls, etc. – to commit to investing in and achieving measurable development goals. Whenever he met leaders, he would first start by complementing them on some of the development successes in their country or region. Then he would ask some pointed questions about the status of key development indicators and service coverage and their trends over time nationally and sub-nationally.

It is amazing how ill-informed most political leaders are about development indicators in their own country. A knowledgeable visitor can attract leaders’ attention by empathetically pointing out their own countries’ exceptional successes and shortcomings.

A useful technique Grant applied was to cite comparable figures from neighbouring countries, provinces or districts to illustrate how faster progress is possible, and challenge leaders for a healthy competition with their neighbours. To motivate leaders, he would sometimes offer UNICEF’s help with some seed-funding or matching contributions (but never to fund the whole project), and to mobilize additional support when demonstrable progress is made and the country commits to going to scale.

A corollary to mobilizing support would be to get the leaders to personally and publicly monitor progress using quantifiable indicators, and reward well-performing districts, municipalities, provinces or ministries.

After meeting with leaders, and before leaving a country, Grant would always leave behind a “thank you” and challenge letter to the leaders he met outlining the key agreed follow-up actions. UNICEF country offices would be tasked to follow-up and report on progress regularly. This approach often worked wonders.

Given Bill Gates’ access to leaders, he could easily emulate this practice to very good effect.

  1. Support innovative mechanisms for discovery and development

The Gates Foundation emphasizes discovery, development and delivery as key planks of its support for development programmes, including in global health, nutrition and immunization. As governments are generally reluctant to fund discovery and development, it is often left to the academia, research institutions and private sector to invest in discovery and development.

Most such institutions are starved for resources and are reluctant to invest in risky research and development unless prospects for profits are very promising. That is why, 90 percent of the world’s R & D funding goes to tackling the problems of 10 percent of the most affluent populations, with only 10 percent allocated to tackling the most pressing problems of the world’s poorest majority.

The Gates Foundation is already addressing this issue by investing in operational research, development and cost-cutting measures to tackle some of the most pressing problems of the poorest segment of world population – such as rotavirus, pneumococcal, malaria and AIDS vaccines and their delivery mechanisms. Initiatives like its “grand challenges” need to be further encouraged and supported.

Acting as a venture capitalist, Gates should be prepared to take bold initiatives to establish, support and reinforce existing or new and innovative mechanisms for such R & D work taking calculated risks that others are reluctant to undertake.

Jim Grant always sought to encourage the private sector to take a long-term view and invest in technologies and products that would benefit the masses and create mass markets. There were not many takers of such approach in his days. But Bill Gates has the vision, wisdom and financial clout to support and encourage such investment through his own personal and corporate example and networks of like-minded entrepreneurs.

  1. Empower organizations like UNICEF for advocacy and delivery purposes

While the Gates Foundation should be bold and risk-taking in its support for discovery and development, it should be more cautious in establishing new implementation mechanisms when it comes to delivery of services on a large scale. Preference should be given to supporting and strengthening existing institutions – national as well as multi-lateral – with a track record of success, sustainability and continuing commitment for service delivery on a large scale.

In this context, establishment of the Global Alliance for Vaccines and Immunization (GAVI) was, perhaps inadvertently, a vote of no-confidence in UNICEF by the Gates Foundation and some of its partners. In part, this reflected a perception that after Jim Grant, UNICEF had dropped the ball on immunization. Partly it reflected a legitimate concern that as a major private sector funder, the Gates Foundation would not have important say in the governance of an inter-governmental organization.

In the event, WHO and UNICEF were given important enough role in the governance of GAVI that it benefited from the experience, expertise and infrastructure of these organizations. But at times the Gates Foundation underestimated the critical role of UNICEF field offices, and its Copenhagen procurement centre for the success of GAVI-supported immunization activities in the field.

As more new vaccines and other health interventions are introduced in the future, the Gates Foundation and GAVI will need to give much greater importance to further strengthening and empowering organizations like UNICEF to help governments to implement large-scale immunization and other health services in a sustainable manner.

A case in point where the Gates Foundation could have achieved far greater success than it has, relates to its investment in nutrition. Instead of strengthening existing organizations with proven track records of implementation in the field, such as UNICEF, or even the Micronutrient Initiative, Gates funded the establishment of the Global Alliance for Improved Nutrition (GAIN). While such an initiative might have been useful for discovery, development and even coordination purposes, reliance on it for large-scale delivery of nutrition interventions in a sustainable manner has proven to have serious inherent limitations.

If UNICEF played a catalytic role in the dramatic scale-up of immunization, ORT and other child survival and development interventions during the Jim Grant era, it is now in an even better position to do so. Today UNICEF is several times bigger in terms of staff and resources than it was during the Grant era. It is still the major UN agency with a sizeable sub-national presence staffed by national professionals in most countries. With the advent of new information and communication technologies non-existent in the Jim Grant era, UNICEF with its large field network is now even better poised to reach the previously hard to reach populations and communities.

Under the new Executive Director Tony Lake’s leadership, there is a renewed vitality in the organization. UNICEF’s new priority to the “equity agenda” and the strategies being devised to reach the bottom quintile of the population, augur well for contributing to achieving many MDGs with equity, now bolstered by its rights-based approach to development.

Interestingly, those of us who worked closely with Jim Grant knew all along that universal coverage with equity was his cherished ultimate goal. The approaches he used to dramatically scale-up service coverage were intended to demonstrate that it is not only desirable but possible – and morally imperative – to reach universal coverage with basic services.

Grant would whole-heartedly support Tony Lake’s assertion that, after a certain threshold is reached, it can indeed be cost-effective to programme with an equity focus as the central thrust of all development activities.

It is precisely in this sense that Jim Grant used the metaphor of child survival and development as the “Trojan Horse” for reducing population growth, combating poverty, accelerating economic development, and promoting democracy and human rights.

Bill Gates could provide this approach a new kind of legitimacy and urgency given his own background, credibility and outreach.

  1. Inspire other philanthropists to invest in education, and empowerment of youth and women

Like Jim Grant, Bill Gates seems to have a deep understanding of the complexities of development, but has a pragmatic approach to focusing on just a few important achievable goals. Grand success in a few important areas is more important to generate a sense of progress and can-do optimism than dabbling in many desirable areas of development without any demonstrable success in going to scale.

Bill Gates has wisely decided to focus on global health in his Foundation’s international programmes, and on education in its US domestic programmes. Such focus sometimes carries the risk of being labeled as “monofocal” and “tunnel-visioned” if global leaders are not seen to be responsive to the broader poverty reduction agenda and the many socio-economic determinants of health and development.

One can imagine the tremendous pressure Bill Gates must face to support many worthwhile areas of development ranging from information technology to agriculture, education to environment, youth employment to women’s empowerment and beyond.

Recently Bill Gates and Warren Buffet have started a commendable initiative to influence other high net-worth individuals to give a big portion of their income and wealth to charitable and philanthropic purposes in the prime of their lives rather than when they approach retirement age. This offers an excellent opportunity for Gates to suggest a menu of options for these billionaire philanthropists to invest in what suits their own personal interest while contributing to the achievement of the broader MDG agenda.

While Bill Gates should stick to his two declared domestic and international priorities, one would hope that he would be able to inspire and encourage other major philanthropists to invest in other priority areas of human development.

Currently, global health is being over-crowded by many donors and investors, whereas other priority areas with huge multiplier effects are being under-funded. For example, Gates Foundation’s own experience in promoting quality basic education in the US has demonstrated how investment in early child development, teacher training and other incentive schemes can greatly impact on better learning and higher earning by students.

It would be wonderful if Gates could encourage other philanthropists to invest in quality basic education, vocational training, employment-oriented internships, etc. in developing countries. There are many other exciting opportunities to invest in agriculture, womens’s empowerment and youth employment that are critically needed for development as well as peace and stability in our troubled world.

  1. Promote participatory monitoring, audit and accountability using new technologies

Poor governance, corruption, lack of accountability and transparency are both real issues and are sometimes unfairly exaggerated to discredit development programmes and effectiveness of international cooperation. On the other hand, being able to demonstrate positive results is the best guarantee to sustain public support, including that of taxpayers in donor countries, and of shareholders in the case of private foundations like BMGF.

The beauty of MDGs and other measurable goals is that progress can be regularly monitored using commonly agreed indicators. But because of widespread cynicism, it is important that monitoring must no longer be confined to specialized expert analysis. It must involve and inform political leaders and the media, NGO activists and local communities. Publicizing progress as well as retrogression, using indicators that the general public can understand, is very essential to generate public confidence and support for development and international aid programmes.

A major challenge in monitoring social development programmes is that relevant statistics are not collected, processed or disseminated with sufficient frequency. UNICEF made major efforts to devise more frequent surveys and other instruments to monitor immunization coverage and other goals for children, especially following the historic World Summit for Children in 1990.

Today with the availability of internet, cell-phones, SMS and GPS technologies, social networks and other means, we should be able to monitor progress in social indicators more frequently and accurately than in the past. We could certainly learn from the private sector like Microsoft that monitor market trends in real time. This might be an area in which the Gates Foundation could make a uniquely valuable contribution.

  1. Recognize and reward good results – 1000 Gates awards for excellence

Most public sector institutions and bureaucracies are ill-equipped to provide incentives for good performance and retribution for failure. Mediocrity is often the norm. The Gates Foundation-supported Global Health Award is one major award that recognizes one outstanding success story in public health each year.

Given the prestige of the Gates Foundation, it would be wonderful if each year it could work with other prestigious organizations to recognize, honour and reward 100 or even 1000 success stories in public health that otherwise go unnoticed and unheralded. If such awards were given following rigourous assessment of performance and results carried out by a board of distinguished professionals and leaders, it could be a great shot in the arm for the many unsung heroes of public health that the world needs to recognize.

  1. Repeat and reinforce key messages

As in other aspects of life, there are changing fads and priorities in development and it is difficult to stick to a given agenda under pressure of other pressing needs and changing circumstances. But we all know that to have staying power, important development messages merit repetition and constant reinforcement.

Jim Grant was masterful in his advocacy of a broad array of development agenda – from debt relief to disarmament, gender equity to environment – but he never failed to always bring back his priorities for child survival and development as somehow relevant for whatever development agenda was the topic of the day. As we know from the advertising world, repetition of key messages is essential to reinforce continuing validity and relevance of the message at hand.

Coming from a well-known personality like Bill Gates, repetition and reinforcement of key messages create the sticking power of such messages. Sometimes, use of visuals can leave a lasting impression, as Jim Grant used to do very effectively with ORS packets and salt testing kits. Bill Gates might wish to hone some such messages, possibly with accompanying paraphernalia to make a lasting impact – in support of the worthy causes he champions.

(Draft for discussion at a meeting with Bill Gates in Washington, DC on 9 March 2011)