Elsevier

Surgery

Volume 165, Issue 2, February 2019, Pages 273-280
Surgery

The Bill & Melinda Gates Foundation: An opportunity to lead innovation in global surgery

https://doi.org/10.1016/j.surg.2018.08.002Get rights and content

ABSTRACT

Background

The Bill and Melinda Gates Foundation has made unparalleled contributions to global health and human development by bringing together generous funding, strategic partnerships, and innovative leadership. For the last twenty years, the Gates Foundation has supported the expansion of programs that directly address the fundamental barriers to the advancement of marginalized communities around the globe, with a transformative focus on innovations to combat communicable diseases and to ensure maternal and child health. Despite the wide spectrum of programs, the Gates Foundation has not, as of yet, explicitly supported the development of surgical care.

Methods

This article explores the pivotal role that the Gates Foundation could play in advancing the emerging global surgery agenda. First, we demonstrate the importance of the Gates Foundation’s contributions by reviewing its history, growth, and evolution as a pioneering supporter of global health and human development. Recognizing the Foundation’s use of metrics and data in strategic planning and action, we align the priorities of the Foundation with the growing recognition of surgical care as a critical component of efforts to ensure universal health care.

Results

To promote healthy lives and well-being for all, development of quality and affordable capacity for surgery, obstetrics and anesthesia is more important than ever. We present the unique opportunity for the Gates Foundation to bring its transformative vision and programing to the effort to ensure equitable, timely, and quality surgical care around the world.

Introduction

The Bill and Melinda Gates Foundation has redefined global health funding, becoming the first major private fund dedicated to worldwide health and development projects and a strong, incredibly generous, and important advocate for improving measurement of health and development outcomes and impact. Over the last 20 years, the Gates Foundation has remained firmly grounded in the principle that “all lives have equal value”1 and has primarily and resolutely sought to assist people around the world in reaching their full human potential. This focus on human development has led the Gates Foundation to support innovative programs that leverage advancements in science, technology, health, agriculture, and education to the benefit of the most neglected populations around the world. The combination of expansive resources, a vast network of forward-thinking partners, and a focus on data analytics has made the Gates Foundation a powerful leader in the global health arena. The Gates Foundation values efficiency and high-impact, results-driven projects and has pushed development actors with its ambitious yet achievable goals, which aim to eradicate disease and improve the lives of people worldwide.

This paper reviews the history, organizational structure, and primary areas of grant-making of the Bill & Melinda Gates Foundation in global health, with a special focus on efforts related to global surgery. We describe the leading role of this foundation in funding global health and development and guiding global health policy. Then, we discuss the need for greater funding and innovation in global surgery and propose pioneering ways for the Gates Foundation to invest further in dramatically advancing global surgery to help prevent mortality from surgically treatable diseases.

Section snippets

History

The philanthropic work of Bill and Melinda Gates began in 1997 as the Gates Library Foundation, which was established with the mission to bring personal computers and Internet access to libraries in low-resource communities in the United States. That same year, Bill Gates took a trip to India, where his vision for a world without polio was born. The Gates family quickly recognized the fundamental importance of investing in the health of the communities they sought to transform through

Governance and organizational structure

The Foundation is based in Seattle, Washington, where it employs more than 1,200 staff members. The Foundation is led by an executive team composed of CEO Dr. Susan Desmond-Hellmann, CFO Jim Bromley, Co-Chair William H. Gates Sr. and trustees Bill and Melinda Gates and Warren Buffett. This team shapes the vision and strategic direction of the foundation and coordinates efforts among its various components. The organization is structured into five programs: Global Health, Global Development,

Finance and Grant-Making

From its inception through 2016, the Gates Foundation has made humanitarian investments and contributions totaling more than $41.3 billion.5 The key targets of the funding of the Gates Foundation have been in the development and deployment of vaccines; the prevention and treatment of malnutrition and infectious diseases, such as HIV/AIDS, malaria, tuberculosis, acute diarrheal and respiratory illnesses, and tropical parasitic diseases; and the expansion of reproductive, maternal, newborn and

Role in global health

As described earlier, the Gates Foundation has emerged as the leading investor in novel areas of global health and human development that prioritize poor and marginalized populations around the world. It models a dedicated, thoughtful, and impactful commitment to global health by advancing the delivery and policy agenda through ambitious but attainable outcome goals, by its malleability to shift as the issues evolve, and by leveraging partnerships for effective global health advocacy.

The

Role in global surgery

To date the Gates Foundation has not explicitly focused on surgical care or the development of surgical systems. Most initiatives funded by the Gates Foundation that touch on surgical disease have been “vertical” or limited to specific disease processes similar to the early vaccine initiatives. Prominent examples of supported vertical programs that include surgical care are the provision of eye care for trachoma14 (a leading cause of preventable blindness) and male circumcision for HIV/AIDS

Case for the engagement of global surgery

Momentum to incorporate essential surgery into universal health coverage continues to grow. Dr. Jim Kim, the president of the World Bank, stated that “surgery is an indivisible, indispensable part of health care.”20 We also believe, along with Bill and Melinda Gates, that all lives have equal value and that where you are born should not determine access to lifesaving surgical interventions like potentially lifesaving Cesarean sections. The burden of surgical disease is vast but still

Innovations to “bend the curve”

To urgently reach more people, faster, better, more affordably, and more sustainably in the next 5 years, we also propose that the Gates Foundation harness its track record in innovations to increase access and quality of surgery. To drive the next wave of disruptions, the global community needs increased investments to fully understand the problems and bottlenecks, to conduct user-centered design and new design thinking, and to test and prototype novel solutions at facilities in low-resource

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