New Delhi, May 11: Health researchers have questioned the funding decisions and priorities of the Bill and Melinda Gates Foundation’s multibillion-dollar effort to improve global health.

The Gates Foundation, the world’s largest philanthropic initiative set up by software czar Bill Gates and his wife Melinda, has committed nearly $10 billion (Rs 49,290 crore) over the past decade to organisations worldwide.

It supports projects to make treatment for HIV, malaria, TB and other diseases available and to deliver vaccines against life-threatening infections. It also funds research aimed at introducing innovations in medicine.

But two groups of researchers have said that the Gates Foundation is focusing on technology-based solutions, such as vaccines and drugs, and not investing enough to promote simpler, proven alternatives to tackle the health problems of the poor.

The researchers have acknowledged the foundation’s role in dramatically increasing resources available for global health. But, in papers published in the medical journal Lancet, they said that much of the foundation’s grants go to western institutions and limited funds are available to build capacity for improving healthcare in developing countries.

David McCoy and his colleagues from the University College, London, have cautioned that the foundation, through its influence on health policy networks and think tanks, may be indirectly undermining the decision-making capacity of health ministries in the developing countries.

The UK group analysed the flow of grants worth $8.95 billion (Rs 44,115 crore) from the foundation between 1998 and 2007.

McCoy’s analysis has shown that 40 per cent of the foundation’s grants so far have gone to international or supranational organisations such as the World Health Organisation or the Global Alliance for Vaccines, an agency that promotes vaccines for children.

About 49 per cent went to US-based organisations, 8 per cent to Europe, and 3 per cent to the developing countries.

“This is not an attack on the foundation. It is an assessment of funding and the foundation’s influence on decisions involving global health,” McCoy told The Telegraph.

The foundation’s high focus on technology-based solutions may steer policy makers away from other possible solutions such as access to drinking water, sanitation and hygiene, the paper has suggested.

“By emphasising technological solutions, the social, economic and political determinants (factors) of health can get swept under the carpet,” said McCoy, a medical doctor who has specialised in public health.

The foundation has said it welcomes the Lancet paper. “We try to be very thoughtful about how to target our resources, and we constantly seek out feedback from outside experts and stakeholders,” it said in an email to this newspaper.

“In the end, we use our best judgement to determine where our funding can achieve the greatest reductions in health inequity around the world.”

A commentary in the Lancet said that while vaccines and drugs would be useful against childhood diarrhoea and pneumonia, there exist proven measures such as breast-feeding, oral rehydration or zinc supplementation (in diarrhoea).

“There are many such health interventions that we know work but are not fully used. Research is needed on how to improve coverage of these interventions,” Robert Black from the Johns Hopkins Bloomberg School of Public Health in the US, the lead author of the commentary, told this newspaper.

“Inexplicably, such research that could lead to rapid improvements in child survival and mortality reduction... has received only a few per cent of the grant funding from the Gates Foundation,” Black and his co-authors from Brazil, Croatia, India, South Africa and the UK wrote.

They also said the limited direct funding from the foundation to institutions in the developing countries is “arguably the most unfortunate imbalance in its research portfolio”.

“The foundation has transformed the landscape of health. Its efforts need to be applauded,” said Maharaj Kishan Bhan, India’s biotechnology secretary and a co-author.

“But solutions to the health problems of developing countries are likely to emerge through local institutions, and funds need to be invested to build local research capacity.”