THE BIG-AID DEBATE
Last month's cover story ("Gatekeepers"), Dayo Olopade's critique of the Bill and Melinda Gates Foundation and "big aid," resonated with Reason's Tim Cavanaugh, who writes, "During my brief stay at the L.A. Times, the paper devoted vast resources to a Pulitzer-fishing trip attempting to find the Gates Foundation's sordid underbelly, and failed. But Olopade makes a fresh point: That the Foundation's biggest weakness may be its traditional, grant-based approach to do-gooderism, which mostly ignores microlending, 'social entrepreneurship' and other market-oriented approaches to charity."
Alkesh Wadhwani, deputy director of Avahan, the India AIDS Initiative at the Gates Foundation, was concerned about the portrayal of his program and its accomplishments. "The article says that HIV incidence in India has remained virtually unchanged. This is untrue," he writes. "According to Indian government estimates, the number of people living with HIV/AIDS has declined 13 percent since 2004. There are other inaccuracies, too; for example you suggest we opened, then closed, thousands of HIV treatment clinics. We have never funded such clinics, as we concentrate on prevention in the program, not treatment. It's too early to fully assess Avahan's impact, but we're seeing encouraging signs. For example, surveys conducted in Avahan's target areas suggest that a large proportion of those most at risk of contracting HIV have received HIV prevention services (between 68 percent and 87 percent), and condom use too has increased."
Dayo Olopade responds: I critiqued Gates' Avahan program for spending $338 million to prevent HIV/AIDS in India while leaving infection rates "virtually unchanged." Indian government data shows a 13 percent decline in HIV prevalence between 2004 and 2008, while data from the National Institutes of Health and UNICEF show a stable trend. Initial misreporting from UNAIDS in India also accounts for some of the drop.
Nevertheless, the article concerned itself with the question of sustainability in global development practices. In that sense, Avahan -- which has yet to create a model for the Indian government to adopt -- has indeed fallen short of expectations. While some of the other initiatives sponsored by Gates have better track records, the fact remains that the foundation's model favors funding development work in perpetuity rather than encouraging more sustainable private enterprise. However, as I report in my article, this philanthropic habit appears to be changing.
Responding to Mark Schmitt's column ("Uncertainly Wrong"), reader and small-business owner Patrick Murowsky writes that Democrats' reforms have caused economic uncertainty: "I wish you could sit with me and look through our QuickBooks file so you can see how we barely kept our head above water from March through August, panicking when our health-care provider indicated that our premiums were going up by 37 percent for the third and fourth quarters."
But Steve Benen at The Washington Monthly found Schmitt's argument convincing. "The Republican pitch: we'd be better off if only Democrats hadn't created so much uncertainty, is wildly, almost shockingly, wrong, but it has a certain rhetorical appeal," Benen writes. "Businesses might start hiring and expanding, the argument goes, but they're holding back because of uncertainty over taxes, regulations, health care costs, etc. If only Democrats would govern the way Republicans want them to, the GOP insists, businesses would feel more confident and the economy would get back on track. ... Is there any evidence to support this? Not even a little. Republicans create more uncertainty, not less, by fighting tooth and nail to prevent Democrats from governing."