Billions to Give, Yet Feeling Thwarted by That Last Mile

When you speak to just about anybody working in global development and global health, the last mile of aid is often referred to as the Holy Grail of their work. From vaccine and health care delivery to microfinance and food insecurity, plenty of funders are fighting to cross the finish line here. Now the Gates Foundation is thinking more about last mile delivery.

Through its grant programs, the Gates Foundation has worked in Africa since the late 1990s. In 2012, the foundation established offices in Addis Ababa, Ethiopia; Johannesburg, South Africa and Abuja, Nigeria. From there, Gates grew its African presence to include full-time consultants in Kenya, Tanzania, Zambia, Senegal, Burkina Faso, Ghana, and more recently, the Democratic Republic of Congo.

Related: Gates Foundation: Grants for Global Development

Over the past decade or so, the foundation has awarded thousands of grants to benefit a large number of African nations in a variety of global health and development fields including vaccine delivery, maternal and child health, food insecurity, agriculture, and water sanitation and hygiene. Those grants have led to much progress in the foundation’s fields of interest, but not as much impact as the foundation had hoped. 

According to Dr. Ayo Ajayi, the director of the Bill and Melinda Gates Foundation's Africa Team, the foundation didn’t see an impact that was “...commensurate with the level of effort that had been put into it.” After evaluating its work in Africa, the foundation discovered the roadblock impeding meaningful progress in its global health and development work—the last mile.

The Gates Foundation says it underestimated what it took to get its innovations and resources to the places that often needed them the most—in other words, there was a significant delivery gap problem in the foundation’s work, and now it wants to plug the holes.

Very few details are available regarding the foundation's plans to embark on its more focused last-mile journey; those specifics will likely develop over time. For now, Gates is developing more local partnerships with the public and private sectors in its regions of focus.

It's big news that Gates is joining the ranks of organizations working harder to close the last mile delivery gap, given that it’s the largest foundation in the world. But the last mile delivery focus is hardly new in the global health and development space. For example, Pfizer is working on last mile vaccine delivery; the Greenbaum Foundation is a big supporter of Last Mile Health which trains and stations health care workers in remote villages in Liberia; and the UPS Foundation is deeply involved in providing last mile aid in disaster areas.

Related: Pfizer Gives Big to Help Bridge the Last Mile Vaccine Gap

It’s nice to see that the Gates Foundation is paying more attention to this issue. It’s pretty safe to assume that we can all expect to see significant progress in last mile delivery now that this mega-funder is on board.