The Gates Foundation’s last 20 years: Planning for sustainability matters

Among last spring’s many unprecedented announcements in global health, the one that stood out as the most encouraging was Bill Gates’ commitment to giving away virtually all his wealth — more than $200 billion — with the aim of sunsetting the Gates Foundation by 2045. In making this announcement, Gates stated that his intention was to “put the world on a path to ending preventable deaths.” It’s critical, therefore, that in strategizing for the next 20 years, the Gates Foundation also considers how its impact can be sustained beyond this period of external investment.

When development programs started in the 1950s and 1960s, it was not intended that these would continue forever. Indeed, in presenting the case to the U.S. Congress for the creation of USAID, then-President John F. Kennedy suggested that the 1960s would be a decade “when many less-developed nations make the transition into self-sustained growth.” With hindsight, the notion of a decade of development was hugely optimistic. In addition, the phasing out of development assistance programs has been undermined by the fact that they are rarely designed with long-term sustainability in mind, and may be captured by parties who have vested interests in sustaining the status quo.

As Gates and his foundation contemplate the next two decades, what do they need to do to plan for sustainability? We are learning more every day, but after years of studying programmatic transitions (the process through which an externally supported public health program is transferred to local recipients for implementation and funding), we offer four key lessons.