Learning and growing

While the foundation was doing great work, to achieve our mission we needed to evolve. To my pleasant surprise, I found that Bill, Melinda, and other leaders were more than prepared to engage and experiment. While initially unsure that the foundation could add meaningful direct value in beneficiary countries rather than working through large intermediaries, we started to test some grants. My first big one was a $40 million initiative to support the growth of independent development policy think tanks in countries across Africa, Asia, and Latin America. Other teams started to trial and expand similar work, from new agricultural initiatives in India and Ethiopia to tobacco prevention programs in Southeast Asia and West Africa.

Once Bill formally left Microsoft in 2008 and Melinda's time freed up as well, they both started traveling more extensively to countries where our work was focused. This allowed them to get deeper exposure to the work and to meet and learn from local leaders.

Soon after, they asked me to take on an expanded role to turn our HIV prevention programs in China and India into full-fledged offices that dealt with a range of issues and to explore establishing a presence in Africa. Those initial steps led to establishing offices in Abuja, Addis Ababa, and Johannesburg in addition to Beijing and Delhi. In all, we have more than 230 employees outside of the United States, the majority of whom are nationals of their respective regions.

Meanwhile, we were steadily becoming more aligned with the MDGs, deepening our traditional set of partnerships both with US, European and Japanese aid agencies and multilaterals like the World Bank, World Health Organization, and Food and Agriculture Organization. Often in partnership, we also became more intentional about ensuring our grants support people and institutions closer to affected communities. While most of these were in the service delivery and advocacy space, this also included research and development, one of our largest areas of investment.

For example, we launched our Grand Challenges program in 2003 to incentivize work on 14 major scientific challenges that, if solved, could significantly reduce global health inequity.

Initially, we made a series of very large grants that went almost exclusively to established institutions in high-income countries. To broaden that, we launched a new program called Grand Challenges Explorations in 2008 that conducted more intentional outreach to low- and middle-income countries. We also launched funding partnerships with USAID and Canada, and regional initiatives in Africa, China, and India. Today, most of our Grand Challenges funding goes to researchers in low- and middle- income countries.

Of course, there needs to be a balance. Even as we steadily increase investments in low- and middle-income countries via universities, companies, and research networks, the fact remains that a significant proportion of global technical expertise and capacity remains in the Global North and, thus, so does much of our grantmaking. However, we are fully committed to getting smarter and more systematic about making sure that resources intended to benefit lower-income countries work to strengthen regional and domestic capacity to drive and sustain that impact.