On World Health Day, Who’s Funding Work Toward a Healthier World for All?

Ghana, Africa. ROMEDIA/shutterstock

The World Health Organization (WHO) has celebrated World Health Day on April 7 for more than five decades. Each time, it’s put a year-long spotlight on a particular priority or area of concern. Last year was the year of the nurse and midwife. The year before, the focus was on universal health coverage. 

In the continuing aftermath of a global pandemic that drew sharp lines between the haves and the have-nots, it’s no surprise that the campaign this year amplifies the idea of eliminating health inequities. The deeply held goal of building a fairer, healthier world for everyone aligns with WHO’s organizing principle: that the highest health standards should be available to all as a basic human right, regardless of gender, religion, or economic and social status.

While governments have the greatest influence on protecting the health of their citizens, philanthropy can play an important role in driving equal access to quality health services. 

As an expected rise in global poverty rates threatens hard-won social development gains and pushes greater numbers of vulnerable populations into poverty, here are some funders backing low-income countries now, so that when the world builds back, it builds back fairly.  

Righting mitigation inequities 

In some ways, COVID-19 was an equal opportunity destroyer. High- and low-income countries alike struggled to slow transmission, sustain food security and keep economic engines running. 

But vulnerable populations worldwide assumed the greatest health risks, particularly women, who were often on the front lines in healthcare settings, supply chains and public-facing businesses.

High-income groups were in a position to follow guidelines on slowing transmission by working virtually in spaces that allowed for social distancing. The vulnerable were left on the wrong side of the digital divide and often without simple means to resist the virus, like running water for hand washing. 

Access to interventions

Disparities in medical interventions are particularly acute, and essential to the world’s ability to build back in an equitable way. 

When the world was searching for ventilators, only 0.14% were available per 100,000 Africans across 54 countries, compared to nearly 9% for the same number of upper-middle-income citizens. West Africa had the lowest number of ICU beds available in the world, with a ratio of 1.1 to 100,000 people. But the disparities are most glaring on developing and distributing vaccines. At the current rate, the U.S. is on pace to vaccinate 75% of its population by July. Brazil will reach the mark in 10 months. South Africa won’t pass the gate for 10 years. 

Several major institutions made treatment and vaccine equity their priority from the start. The Bill & Melinda Gates Foundation stands out, investing a total of $1.7 billion toward the global response, mostly for health equity.   

In March, the Bill & Melinda Gates Foundation provided $50 million in seed funding to the COVID-19 Therapeutics Accelerator, which has attracted investments totaling nearly $300 million from co-founder Wellcome, and partners including Mastercard, the U.K. government and Alwaleed Philanthropies. Among its goals is providing the most marginalized with access to testing, treatments and vaccines through the Access to COVID-19 Tools (ACT) Accelerator. 

On vaccines, Gates made early commitments totaling $156 million to Gavi’s COVAX Advance Market Commitment to ensure jabs are affordable and accessible in 92 low- and middle-income countries. As multiple vaccines cleared approval, the foundation upped its equity response. In early December, it committed an additional $250 million to speed delivery to “the majority of human beings that live in low- and middle-income nations.” The foundation projects that, as things stand, these nations will only be able to cover 20% of their populations.  

The investments were part of a newly allocated round of funding totaling more than $680 million, which includes $47.5 million toward country and regional responses to rising cases in Africa and South Asia. Gates has also made up to $750 million available for at-risk financing from its Strategic Investment Fund for manufacturing, treatments and diagnostics in the same geographies. 

In 2021, its focus is zeroing in on equitable, timely and scalable delivery of proven interventions. 

As covered in Inside Philanthropy, the world’s largest philanthropic health research funder, Wellcome Trust, is working to turn research into resiliency for vulnerable populations. 

As the pandemic spread, Wellcome quickly activated its research networks, committing significant resources to treatment and vaccine research and development—and expanding the capacity to scale and deliver them equitably.

Before WHO had formally declared COVID-19 a pandemic, Wellcome had already made two major investments totaling $100 million. In early March, it co-seeded the Therapeutics Accelerator with a commitment of $50 million, and invested $50 million in CEPI, the global vaccine research and development group it co-founded. 

All of Wellcome’s COVID work is collaborative across sectors, engaging philanthropy, business, academia, government, world health organizations, and civil society. Today, CEPI has garnered enough support from all sectors to mount a $3.5 billion plan of action.

A focus on Africa

World Health Day equity goals are specifically aimed at low-income countries. A number of philanthropies with long and deep histories in Africa are fighting inequities on a continent that Brookings calls the “last frontier in the fight against extreme poverty.” Though gains had been made in the past decade, Africa is expected to represent nearly 87% of the global poor by 2030. 

The Rockefeller Foundation, a bedrock of public health investments, established its Africa Regional Office in 1966, and directs nearly a third of its resources there. Last April, the foundation committed “at least” $50 million in resources over two years to help its partners in Asia, Africa and the U.S. battle COVID-19. 

In February 2020, the focus turned to Africa when the foundation announced a three-year, billion-dollar pledge to “help end the COVID-19 pandemic in Africa and for us all.” Within four months, it had invested nearly $35 million in African response efforts, with a focus on ensuring equitable access to testing and vaccines, leveraging innovation and data, addressing food insecurity, and scaling renewable energy. 

The Mastercard Foundation has been funding in Africa for more than a decade, and currently works in 29 countries across the continent. Last April, it rallied behind its African partners by launching a COVID-19 Recovery and Resilience Program to meet urgent needs and “double down” on economic recovery. 

In June 2020, the foundation committed $40 million to Africa Centres for Disease Control and Prevention (Africa CDC), an organization that’s working to strengthen Africa’s public health institutions and create partnerships to respond to rising health threats. Its two central aims have now evolved to supporting healthcare workers and first responders, and providing emergency funding for students.

The three focus areas of the Astellas Global Health Foundation, the charitable arm of the Japanese multinational pharma giant from which it draws its name, have all come into play this year: lowering barriers to healthcare, building resilient communities, and providing disaster relief. 

Much of the work is organized around strengthening foundational healthcare systems and infrastructure in six African nations, including Ethiopia, Nigeria and South Sudan. Its partnership with CARE, for example, provides funding to bolster healthcare infrastructure through surveillance, leadership training for women, and access to water for sanitation. For more on its work, read here. 

All told, Bloomberg Philanthropies has invested $2.5 billion in global public health initiatives. Its commitment to health equity lands through its Partnership for Healthy Cities, a collaboration between Bloomberg, the WHO and the global health organization Vital Strategies. Twelve of the network’s 70 cities are in Africa.

Bloomberg’s global response to COVID-19 intentionally complemented Gates’ vaccine work. In March, it launched a $40 million partnership with Healthy Cities principals, Resolve to Save Lives, and the Stavros Niarchos Foundation with the goal of mitigating the spread in Africa and at-risk low- to middle-income countries. 

Current tactics include deploying rapid response teams to prevent and detect infection, training frontline healthcare workers, and developing lab networks. By June, it reported the successful training of nearly 6,000 healthcare workers. 

Quiet giant ELMA Philanthropies primarily works in Africa, through the six foundations under its auspices. ELMA mounted a $137 million response to the loss of life and livelihoods from COVID, working across NGOS, governments and academia.

The Elma Relief Foundation supported interventions through large humanitarian organizations like the International Rescue Committee, while the Elma South African Foundation supported the South African Solidarity Response Fund to help mobilize the government response and civic efforts. It also leveraged its local knowledge through the Elma Community Grants Program, which supports embedded frontline responders in local communities.  

It characterized its initial COVID pledge as a “minimum commitment that it will likely exceed,” so look for its equity work to continue.

A focus on gender 

There’s ample evidence that women have borne the brunt of the pandemic on multiple levels, but especially health. Globally, women comprise the majority of workers in health and social sectors, and at a time when food security was threatened worldwide, 1 in 3 work in agriculture. 

As economic activity ground to a halt, women-owned businesses were more likely to stay closed. Millions of girls may never return to their classrooms. And stillborn and maternal mortality rates, which had dropped steadily between 2000 and 2017, rose by a third as healthcare systems buckled. Outcomes were worse in low- and middle-income countries, according to a report in The Lancet medical journal.

The Bill & Melinda Gates Foundation believes that building back fairer belongs at the policy level, and prioritizes putting women at the center of rebuilding conversations. 

It has entrusted its gender equality work to the U.K.- and U.S.-based nonprofit think tank the Center for Global Development for more than a decade. A recent grant of $1.45 million specifically funds policy work, an investment in compiling data that can be used to drive outcomes with decision makers such as health ministers. Analysis is currently focused on multilateral development banks like the World Bank, and is expected to widen its scope to include bilateral donors and middle-income countries. 

Megan O’Donnell, assistant director and senior policy analyst on gender, Center for Global Development, says that donors and policymakers need to pay close attention to the gendered effects of the pandemic to realize the goals of “of a “fairer, healthier world for everyone,” and to “prioritize addressing them in recovery efforts.” 

“Women have been on the front lines in responding to the COVID-19 pandemic as the majority of the world’s health workforce—and have also borne the brunt of its indirect health effects, whether with regard to mental health, gender-based violence, or disruptions to maternal and reproductive health services.” 

Pharma giant Merck is among the funders working to maintain gains in maternal mortality. Its $550 million Merck for Mothers initiative reaches three low-income countries: India, Kenya and Nigeria. Like Gates, some of its work involves assembling data to drive sound decision-making. But it also funds quality care in India, and works across sectors in Nigeria, the country that’s home to nearly 20% of the world’s maternal deaths. 

Known for its collaborative relationships, the foundation’s global partners include Concept Foundation, the United Nations Foundation, the WHO, Maternity Foundation and the White Ribbon Alliance, which mobilizes its networks to protect reproductive, maternal and newborn health rights. 

Since inception, the organization has reportedly impacted nearly 1 million lives, and invested $16.2 million in public education, community engagement, and grants that delivered skilled care to more than 371,000 mothers. 

A focus on water equity

Water equity is also central to building back fairly and strengthening health systems in the poorest places in the world—and particularly impacts women and girls.

Jack Dorsey’s recent $4.7 million investment in water.org in Africa recognized that the water crisis is a women’s crisis. Women and girls devote a collective 200 million hours a day gathering water for home use instead of going to school or building businesses.

Scarcity also limited COVID mitigation measures as the virus spread, as hand washing isn’t possible without running water. And the 60% of Africans who lack safe water for home basics like cooking and sanitation had little choice but to risk exposure while gathering around public stand posts.

The support from Dorsey’s #StartSmall initiative came in the form of micro-loans that mostly women borrowers will invest in solutions for their homes, like rainwater harvesting tanks or hook-ups to city systems. Water.org has also attracted funding in Sub-Saharan Africa from the Conrad N. Hilton Foundation, long a leader in safe water.

Hilton takes an integrated approach to ensuring assess to high-quality water by investing in in-country systems and governance, building evidence for sound decision making, and advancing proven and promising models. The work centers on creating reliable access to safe sources in six low-income countries: Burkina Faso, Ethiopia, Ghana, Mali, and Niger and Uganda.

As covered previously in Inside Philanthropy, the GE Foundation (GEF) focuses its WASH efforts on water treatment systems. A program that began by working with researchers from the Center for Global Safe WASH at Emory University has evolved to providing kiosks in Rwanda and facilities in Uganda and Cambodia, where its advocacy funding led to collaborations with WHO, UNICEF and the Cambodian government.

A year from now, World Health Day will come around with a new priority to spotlight, but this year’s focus is one that will remain central in global philanthropy for years to come. Health inequities will remain a critical focus in the fight for a fairer world for all—and continue to drive the work of leading philanthropies.