Bill Gates: The Measurement of Hope

SEATTLE – The lives of the world’s poorest people have improved more rapidly in the last 15 years than ever before, yet I am optimistic that we will do even better in the next 15 years. After all, human knowledge is increasing. We can see this concretely in the development and declining costs of new medicines like HIV drugs, and in the creation of new seeds that allow poor farmers to be more productive. Once such tools are invented, they are never un-invented – they just improve.

Skeptics point out that we have a hard time delivering new tools to the people who need them. This is where innovation in the measurement of governmental and philanthropic performance is making a big difference. That process – setting clear goals, picking the right approach, and then measuring results to get feedback and refine the approach continually –helps us to deliver tools and services to everybody who will benefit.

Innovation to reduce the delivery bottleneck is critical. Following the path of the steam engine long ago, progress is not “doomed to be rare and erratic.” We can, in fact, make it commonplace.

Though I am an optimist, I am not blind to the problems that we face, or to the challenges that we must overcome to accelerate progress in the next 15 years. The two that worry me the most are the possibility that we will be unable to raise the funds needed to pay for health and development projects, and that we will fail to align around clear goals to help the poorest.

The good news is that many developing countries have growing economies that allow them to devote more resources to helping their poorest people. India, for example, is becoming less dependent on aid, and eventually will not need it.

Some countries, like the United Kingdom, Norway, Sweden, South Korea, and Australia, are increasing their foreign-aid budgets; others, even traditionally generous donors like Japan and the Netherlands, have reduced theirs. The direction of many countries, including the United States, France, Germany, and Canada, is unclear.

Still, aid is critical. It helps people in the poorest countries to meet their basic needs. It funds innovation in the creation of new tools and services, and in their delivery. Unfortunately, aid budgets are threatened by fiscal weakness in almost all of the advanced countries. Unless voters hear about the positive impact that their generosity is having, they will inevitably focus on issues closer to home.

A single story, true or not, about a small amount of aid being misused can often cloud the entire field. Imagine how you would feel about investing if every article you read were only about stocks that did poorly, with no reporting on the big successes.

Historically, aid was discussed largely in terms of the total amount of money invested. But now that we are measuring indicators like child mortality more precisely, people are able to see the impact that aid has in stark terms – that it means the difference between, say, giving people access to HIV treatment and letting them die. When framed this way, aid has a better chance of becoming a priority.

But will the world align around a clear set of goals in the next 15 years? The United Nations is starting to map out new goals for the years following the 2015 expiration of the current Millennium Development Goals. As with the MDGs, the next set of goals could help to align groups doing the work, remind voters what their generosity supports, and allow us to see where we are making progress in delivering solutions to the poor.

The MDGs’ success means that there is a lot of interest in expanding them to include a broader set of issues. But many of the potential new goals lack unanimous support, and adding a lot of new goals – or goals that are not easily measurable – may sap momentum.
The MDGs were coherent because they focused on helping the poorest people in the world. The groups that needed to work together to attain them were easy to identify, and they could be held accountable for cooperation and progress. When the UN reaches agreement on other important goals like mitigating climate change, it should consider whether a different set of actors and a separate process might be best for those efforts.

The progress that the world has made in helping the poorest in the last 15 years is the kind of good-news story that happens one life at a time, so it often does not have the same visibility as a big setback, such as the outbreak of a new epidemic. From time to time, we should step back and celebrate the achievements that come with having the right goals, the necessary political will, generous aid, and innovation in tools and their delivery. Doing so has certainly deepened my commitment to this work.


Bill Gates is Co-Chair of the Bill & Melinda Gates Foundation.

Bill Gates: The Optimist’s Timeline

SEATTLE – Usually, “optimism” and “realism” are used to describe two different outlooks on life. But I believe that a realistic appraisal of the human condition compels an optimistic worldview. I am particularly optimistic about the potential for technological innovation to improve the lives of the poorest people in the world. That is why I do the work that I do.

Even so, there is one area of technology and global development where reality has tempered my optimism: the idea that cellphones would revolutionize life in developing countries. A decade ago, many people believed that the proliferation of mobile devices in Africa would mean a short leap to digital empowerment. It didn’t. Digital empowerment is a long and ongoing process, and the mere existence of cellular technology does not immediately change how poor people meet their basic needs.
But now, after years of investments, digital empowerment is underway, owing to a confluence of factors, including growing network coverage, more capable devices, and an expanding catalogue of applications. As more people obtain access to better and cheaper digital technology, an inflection point is eventually reached, at which the benefits of providing digitally services like banking and health care clearly outweigh the costs. Companies are then willing to make the investments required to build new systems, and customers are able to accept the transition costs of adopting new behaviors.

Consider the example of M-Pesa, Kenya’s mobile-banking service that allows people to send money via their cellphones. M-Pesa first needed to invest in many brick-and-mortar stores where subscribers could convert the cash they earn into digital money (and back into cash). This real-world infrastructure will be necessary until economies become completely cashless, which will take decades.

Without omnipresent cash points, M-Pesa would be no more convenient than traditional ways of moving money around. At the same time, it was impossible to persuade retail stores to sign on as cash points unless there were enough M-Pesa subscribers to make it profitable for them.

This kind of bootstrapping is exactly what we had to do at Microsoft in the early years of the personal computer. No one wanted a machine unless there was software, and no one would create software unless there were machines. Microsoft convinced both hardware and software companies to bet on future volume by showing how our platform would change the rules.

There have been many successful small-scale pilot programs using cellphones. But examples of large-scale, self-sustaining programs powered by digital technology, like M-Pesa, are harder to find, because the key pieces have not been put into place to enable the required work to advance beyond the limits of controlled experiments.

Digitally-enabled health care, or mHealth, is one area that has been slow to emerge, because it is difficult to build a great platform and then convince everybody in a health system that it is worth using. If some health workers use cellphones to send information to a central database, but others do not see the value, the digital system is incomplete – and thus just as flawed as the current paper system.

The most promising mHealth project that I have seen, called Motech, focuses on maternal and child health in Ghana. Community health workers with phones visit villages and submit digital forms with vital information about newly pregnant women. The system then sends health messages to the expectant mothers, such as weekly reminders about good pre-natal care. The system also sends data to the health ministry, giving policymakers an accurate and detailed picture of health conditions in the country.

Those working on AIDS, tuberculosis, malaria, family planning, nutrition, and other global health issues can use the same platform, so that all parts of a country’s health system are sharing information and responding appropriately in real-time. This is the dream, but it works only if frontline workers are inputting data, health ministries are acting on it, and patients are using the information that they receive on their phones.

I realized that things were taking off when our partners on Motech started talking about burdensome network costs and simplifying the user interface. The application was really being used in the field, and the stickiest challenges were presenting themselves – which meant that the system had proved that it was valuable enough for people to put in the work to solve problems as they arose, instead of just reverting to the old system. This digital approach is now being extended to other regions, including Northern India.

A decade ago, people said that this would happen quickly. It didn’t, because the pieces just were not there. Now they are starting to come into place. It will take a decade to get certain applications into a lot of places, but the momentum will build and we will learn as we go. In the long run, the results will be just as transformative as we hoped, if not more so. Ultimately, when people are truly empowered, they will begin to use digital technology to innovate on their own behalf, building solutions that the established software-development community never considered.


Bill Gates is Co-Chair of the Bill & Melinda Gates Foundation.