Gates Fortune Looms Large as Promise, Paralysis Overwhelm Ethiopia

Gates Fortune Looms Large as Promise, Paralysis Overwhelm Ethiopia

May 24 , 2025. By Desalegn T. Zegeye (MD) ( Desalegn T. Zegeye (MD) is a technical director at the Institute for Healthcare Improvement. He can be reached at zdesalegn@gmail.com )

Bill Gates' pledge to donate nearly all his wealth by 2045 to his established foundation is exceptional in modern philanthropy. Already, the Foundation spends billions of dollars annually, steering global conversations on vaccines, agriculture, and digital finance.

Such a vast new influx of resources promises an even deeper impact, particularly in countries like Ethiopia, which have been key partners for two decades. They have demonstrated that each dollar goes far. Ethiopia presents an urgent need and an immense opportunity, a potential global case study for successful development despite adversity.

Since its creation, the Gates Foundation has dedicated billions toward addressing global problems, from child mortality and chronic hunger to gender inequality and digital exclusion. Gates’ new pledge, paired with political determination, could fundamentally reshape Ethiopia’s development aspiration. Home to over 100 million people, it faces major issues from high unemployment among its young population and disease to recurring droughts and entrenched poverty.

These factors align closely with the Foundation’s mission to ensure everyone leads a healthy and productive life.

Ethiopia already offers evidence of what well-targeted investments can achieve. The country surpassed the Millennium Development Goal (MDGs) for reducing child mortality, proving the effectiveness of strategic and focused efforts.

However, other flagship initiatives have encountered difficulties. The health extension program, initially celebrated for low-cost community healthcare, now struggles with rising non-communicable diseases and rapid urban migration. A lack of climate-resilient seeds and inadequate local research continue to limit farm productivity in agriculture. A national digital-development plan has not yet inspired grassroots innovation or scalable solutions.

I have witnessed firsthand the tension between ambition and reality in development. While working at the Ministry of Health (MoH), I observed the Foundation’s respectful yet rigorous approach. Its staff co-designed ideas with local officials rather than dictating terms. However, short funding cycles and shifting political priorities often slowed sustained success.

Later, as a fellow in the Foundation-supported International Program in Public Health Leadership at the University of Washington, I visited the Foundation's headquarters in Seattle. The environment was bold yet intensely data-driven, focused on dashboardrandomisedsed trials, and quickly translating pilot projects into widely shared and spread solutions. One program officer broke down the Foundation's guiding principle. Preventing newborn hypothermia doesn’t always require expensive incubators. Sometimes, skin-to-skin contact is the most effective intervention.

Simple, cost-effective, and locally appropriate solutions consistently outperform imported technologies. Ethiopia shouinternaliseise this lesson.

The Foundation’s investments are strategically placed in areas often overlooked by larger global funds. Rather than duplicating efforts by entities like Gavi or the Global Fund, it identifies neglected opportunities where solid evidence, effective partnerships, and sustainable business models can transform outcomes.

Examples from other countries show what can be accomplished.

Bosede Afolabi (PhD) combines frontline obstetrics with clinical research to lower maternal deaths in Nigeria. Radhika Batra’s (PhD) initiative, "Every Infant Matters," provides vital but straightforward services to underserved children in India. In Malawi, Lameck Chimango, an engineer, has successfully adapted neonatal equipment to warm babies in rural hospitals, demonstrating innovation with marginal resources.

These individuals are deeply embedded within their communities and not parachuted in as external consultants.

Ethiopia has the potential to develop similar innovators, but clarity and focus are essential. Broad national strategies often fall short as successful change typically emerges from specific individuals addressing clearly defined issues in particular communities. Each initiative should directly answer a fundamental question.

How does this effort reduce health and development burdens in a meaningful way?

Grim statistics press for urgency. Each year, over 8,000 mothers and more than 100,000 newborns die. One-third of Ethiopian children experience stunted growth, and one in 10 suffers from severe malnutrition. Alarmingly, nearly 90pc of 10-year-olds cannot read simple text or perform basic arithmetic, keeping the Human Development Index around 0.5, jeopardising the country's future workforce.

Addressing these issues requires domestic experimentation anchored by clear and measurable goals.

In education, digital tools and artificial intelligence (AI) can assist teachers in identifying learning gaps, but only if officials require evidence that such technologies genuinely enhance student performance. Farmers-led experiments, resilient seed varieties, and climate-smart methods should supersede traditional subsidy approaches. For digital inclusion, policymakers should prioritise frequent piloting, openly published results, and scaling only solutions proven effective.

The Gates Foundation already invests a substantial amount in Ethiopia, expanding vaccine coverage, strengthening primary healthcare, improving cereal production, and exploring mobile money. However, the future of these efforts depends less on additional funding and more on demonstrable results. Its leaders should convincingly show that resources translate directly into meaningful outcomes, or, as an internal memo describes it, “lives saved, suffering prevented, futures transformed.”

This will require quicker feedback loops, transparent monitoring, and political commitment so that successful pilot projects endure leadership changes. Three practices could accelerate this progress.

Solutions can be designed collaboratively with communities, who typically identify and overcome barriers faster than external teams. The authorities should strive to adopt the Gates Foundation’s emphasis on real-time and accessible data tied explicitly to decision-making processes. Dashboards need to clearly indicate whether initiatives like drought-tolerant crops or text-message reminders to pregnant mothers yield measurable results.

Protecting continuity is crucial as frequent political reshuffles often erase institutional memory. Long-term commitments, managed by independent boards, can ensure programs withstand political and financial volatility.

Without these deliberate steps, Ethiopia risks stagnation. The country's economy is fragile, international investment is limited, and donor enthusiasm is waning. Yet, a focused alliance with the Gates Foundation, noted for its rigorous and data-driven methods, provides it a unique opportunity. The Foundation expects Ethiopia not merely to accept funding but to implement essential reforms, swiftly test new ideas, and transparently publish outcomes, whether successes or failures.

Ethiopia can either set an example, demonstrating that disciplined and evidence-based innovation can thrive even in difficult conditions, or risk being surpassed by more agile countries. The moment for decisive action is now, and its leaders should boldly seize this rare opportunity.

PUBLISHED ON May 24,2025 [ VOL 26 , NO 1308]