Abstract:
While private foundations have long been active in global health, the meteoric rise of Bill and Melinda Gates Foundation (BMGF) in the last two decades is unprecedented. With its growing financial and non-financial influence, BMGF is poised to become one of the largest funders of the World Health Organization (WHO), challenging the dominance of traditional bilateral and multilateral donors. This shift raises important questions about how other donors respond to the Foundation's presence. This paper addresses the question: 'How does the presence of private foundations such as BMGF influence the funding allocation of other bilateral and multilateral donors within global health?'. Using a mixed methods design, I analyse 314,107 unique health projects across 143 countries and 21 years, coupled with qualitative interviews with former BMGF staff and global health experts. The study reveals a 'crowding-in' effect, where bilateral and multilateral donors increase their funding for the same disease areas within the same countries in response to BMGF. The crowding-in effect is strongest in the year immediately following BMGF's involvement, with a slight decline over time. I identify three key strategies by BMGF that drive this effect: (1) its substantial funding volume and strategic engagement at the country level, which influences other donors to follow suit, (2) its 'multi-channel' funding approach, which amplifies its influence across various organizations, and (3) its role on governance boards, enabling BMGF to shape funding priorities beyond its direct contributions. These insights contribute to broader debates on the role of philanthropies and the evolving architecture of global health financing. They underscore the need for better empirics and clearer frameworks to govern the interactions between private foundations and traditional donors.
