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Privately Funded Health Initiatives Both Welcomed and Questioned

Private donations - and not government funding -- are filling more and more health needs around the world. The latest example is the $750 million pledged by the Bill and Melinda Gates Foundation to vaccinate children in the developing world. But, as welcome as the money is, some development experts are also casting a critical eye at such gifts.

Lincoln Chen -- an expert on international public health and founder of the Global Equity Initiative at Harvard University -- raises this question: Why is it that a wealthy philanthropist or foundation can set the agenda?

Mr. Chen is not so worried by the specific case of the Gates Foundation pledge, calling it a partnership that is bringing together the best of the public and private sectors. But he worries that private donations cannot take the place of sustaining health programs, and that they run the risk of promoting narrow health interests.

Instead of committing funds to childhood immunization, one could easily argue for treatment against childhood pneumonia or diarrhea, which are equally - if not even bigger - killers of children…or childhood malnutrition or micronutrient deficiencies, Mr. Chen points out. So I think there is an argument that the philanthropic concentrations may not be as balanced as they would be if the families themselves were spending the money, or the governments themselves were spending the money in the poorest countries.

Still, governments and individual donors may be able to work together to overcome any problems that accompany private gifts. Both the public and the private sectors have comparative strengths and advantages, Mr. Chen says, and hopefully these partnerships can build on them, providing a whole that is greater than the parts.

He says the $750 million from the Bill and Melinda Gates Foundation will be used to fund core childhood immunizations - against diseases such as measles, tetanus, pertussis and polio. The funds will also be targeted to help countries where there are localized outbreaks of hepatitis and other illnesses.

The money will make a world of difference, he says, because these are external resources that are stimulating and leveraging much larger domestic resources that are not being as efficiently or energetically deployed because of a lack of both overall resources and the political priority and will. Lincoln Chen of Harvard's Global Equity Initiative believes the Gates Foundation gift will stimulate governments and private groups to make immunizations a high priority and then seek deliverable results.