Reaction from Africa on Bill Gates' Big Move

Posted by: Steve Hamm on June 26

This is the week of Bill Gates’ move from full-time Microsoft to most-time Gates Foundation. A lot of people think this is a big thing, and I’m among them. I believe that Bill could end up having a much bigger impact on the world in his role at Gates Foundation even than he had in his decades at Microsoft. He has a chance to rethink and redo the way philanthropy is carried out. But it’s not a done deal. I spoke to Josh Ruxin, an assistant professor at Columbia University and director of the Access Project for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which helps people in Rwanda improve their public health system. He was taking orders from customers in his wife’s restaurant in Kigali when I called him on his cell. He said some Gates Foundation people were supposed to have dinner at the restaurant later. I don’t know if he planned on telling them what he told me, but they should hear it.

First off, Ruxin is very respectful of the Gates Foundation. He says that with its attention to public health it has gotten a lot of things going. But he says that over the years, as the organization has matured, it has become less venturesome and less willing to take risks. "These days they're more likely to take safer bets, like providing funding for the World Health Organization, rather than going out the edge and finding great innovators." He hopes that at least a unit of the Gates Foundation will operate almost like a venture capital firm, seeking and funding health care entrepreneurs all around the world.

Now, with both the Gates and Buffett fortunes under its management, the foundation will be forced to make bigger and bolder bets, Ruxin believes. And he hopes that more money will go into implementation of health programs. Until until now, the foundation has focused primarily on solutions, including drugs and vaccines. "It's true that implementation hasn't worked well, but that's why we have to focus on it," Ruxin says. "What we really need is better global delivery and implementation. We need people with MBAs working on it, rather than MDs."

When Ruxin started the Access Project in 2002 he aimed to address health care delivery problems in 10 African countries, but now he has pulled back essentially to just Rwanda. The organization faced corruption and a shortage of government support in the other countries. The project now operates 70 health centers serving millions of Rwandans. "We have shown that management can have excellent results," says Ruxin, who was earlier a management consultant for Monitor Group.

He's hoping that Gates and Jeff Raikes, the longtime Microsoft executive who will become the foundation's CEO later this summer, will bring the same kind of management discipline to the foundation and its ventures that they brought to Microsoft itself.

Ruxin isn't afraid to ruffle feathers. Check out Doctors Without Orders, a piece he recently published in Democracy Journal that attacks the NGO medical establishment and calls for help from the Gates Foundation.

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