2007-12-17 13:19:08.0 Dom: I recently spoke with two residents of Malawi about faith-based aid programs operating in their country. They said that the best ones were those who came in asking questions rather than acting as if they had all the answers. How much of the problem with the Gates Foundation's implementation do you think stems from a Western attitude that 'we know what you need.'


2007-12-17 13:20:15.0 Charles Piller: I believe that the GAtes folks are working in good faith and with determination to help. It's hard to do well in these complex issues. But describing weaknesses is not meant as an attack on their motives.

2007-12-17 13:20:22.0 pcharles: Much of your story seemed to imply that many of the problems that you described were a result of the activities of the Gates Foundation. My take on this has been that the Gates Foundation have made remarkable progress despite the problems that you describe.

2007-12-17 13:21:38.0 Charles Piller: No question. The Gates Foundation does important work. And their learn from their mistakes, as they often have said. In my talks with them, they emphasized that they are building new programs when they see a way they can help. Not everyone sees the progress the way they do, however.

2007-12-17 13:21:51.0 Administrator2: How do you think other (currently in existence or future) charities can benefit from the experiences of the Gates Foundation?

2007-12-17 13:22:22.0 pcharles: Mr. Pillar- your statements here are in rather striking contrast to an article entitled "...victims of the Gates Foundation..."

2007-12-17 13:22:57.0 Charles Piller: Other charities already take their lead from Gates. And some have chosen different approaches, such as the Clinton Foundation. My guess is that everything Gates does is studied carefully for ideas by other charities.

2007-12-17 13:23:10.0 Stephen: You missed a real opportunity in this story. You could have evaluated the Gates Foundation as a catalyst to perhaps creating a new energy behind tacking global health issues and maybe, just maybe achieving the millenium development goals. You could have said that and then talked about the UK's announcement about the Internatinal Health Partnership and similiar new initiatives that are aimed at addressing health system strengthening. And then, watched it to see if it actually developed or is just a hot air.... that is where the debate is now.

2007-12-17 13:24:09.0 Stephen: Instead, you blamed Gates for pouring billions into Africa but not paying for a $35 valve.....

2007-12-17 13:24:57.0 Charles Piller: To be sure, the story left out much of the debate. But I think we covered some of the key issues clearly. And many health experts with experience in Africa share concerns about hte directions taken by large donors, of course.

2007-12-17 13:26:15.0 Charles Piller: The Gates foundation is indeed a catalyst--all the more reason to look closely at what it is doing, in order to help provide information that will increase its influence in the most favorable and successful ways. At least that's what we hope will result from the debate stimulated by the story.

2007-12-17 13:27:10.0 Sarah: But your article doesn't offer a helpful discussion of how to move forward to address these issues--you seem a bit myopically focused on taking Gates to task. I agree with stephen that this seems like a missed opportunity. You have a voice that most of us don't have, and it's disheartening to see reporters like you miss an opportunity to constructively advance such an important debate.

2007-12-17 13:27:12.0 Jane: Is there a charity or foundation that is, in your opinion, doing it "right" and filling in those gaps that you identified?

2007-12-17 13:28:16.0 Stephen: What you brought to the forefront is the need for a holistic approach to health care in Africa. But Gates had to start somewhere and unfortunately, you bashed them

2007-12-17 13:28:26.0 Charles Piller: Well, there are many that have tried a comprehensive approach. Three mentioned in my stories are worth a look: Doctors without Borders, Partners in Health and the Clinton Foundation. Irish Aid, an arm of the Irish government, is also giving funds in very creative ways.

2007-12-17 13:29:19.0 Chris: I imagine that if you examined any one of them closely with the approach you used with GF, you would find that despite the good each of them does, people are still dying from causes they do not address

2007-12-17 13:29:36.0 Administrator2: What is the most important constructive change that could be made in foundations like the Gates' in order to improve the work they are doing?

2007-12-17 13:29:59.0 Chris: Isn't that inherent in the nature of our world, with so many interrelated causes impacting people?

2007-12-17 13:30:06.0 Charles Piller: Thanks for the comment about "bashing" Gates. This story was written to point out some observations of our research, not as an attack on the Foundation. Much praise has rightfully been received by them as well.

2007-12-17 13:31:36.0 Charles Piller: Partners in Health has an interesting perspective--that the "limits" in what can be done in Africa are artificial. Some of their programs have demonstrated that the weaknesses in health aid programs are not inherent, but a matter of design.