Bill & Melinda Gates Foundation

My First Return to Africa as CEO of the Gates Foundation

August 12, 2014

I recently came back from a trip that had a lot of meaning for me, both professionally and personally – my first return to Africa as CEO of the Gates Foundation. 

I emphasize the “return” nature of this visit because Africa has such a special place in my career and in my heart. My husband Nick and I had worked as caregivers, medical faculty, and researchers in Uganda earlier in our careers. 

Uganda wasn’t on the agenda this time, but Bill Gates and I did have the chance to see two nearby countries – Ethiopia and Tanzania.

In my first couple of months at the foundation, I’ve heard a lot about the remarkable work that our grantees and partners are doing in East Africa – but there’s nothing like seeing it firsthand. 

Nothing, in other words, like going out in the mud and rain to plant teff with Ethiopia’s Agricultural Transformation Agency, a Gates Foundation partner that has pioneered extraordinary breakthroughs in agricultural productivity, with a particular focus on smallholder farmers.

Or like visiting a Purchase for Progress (P4P) site and talking with the farmers who are the focus of this UN World Food Program initiative, which is leveraging its purchasing power to support agricultural and market development. Bill and I asked one woman where the money goes when she sells her crops. 

She said it goes to her husband – a common phenomenon in a continent where women do much of the agricultural work, but receive relatively little financial gain from their efforts.  Addressing gender inequalities is one of the main issues within the Agricultural Transformation Agency’s special-initiatives focus.

Again, it’s one thing to talk about this disparity back at our offices in Seattle; it’s another to see the reality in person, in all its imperfection and complexity. After all, there was real progress here – this female farmer was obtaining access to markets, and going to co-ops. Yet her checks were still going to her spouse, not to her. 

Only by actually being there could I have seen these factors converge. Of course, our grantees and partners are there every day, living amid all the convergence and complexity. 

That’s what makes their work so important – they see things up close that we can’t see from afar. They make connections that might not even occur to us. In order for us to achieve our foundation’s missions, we depend on this experience and expertise. 

As a physician, my favorite part of the entire trip was a visit to one of the approximately 16,000 health posts the Ethiopian government has established to improve access to care in rural areas. 

One of our grantees there is L10K, short for “last ten kilometers.” The organization’s name refers to its focus on ensuring that health care gets all the way to the ultimate destination – into homes, such as the hut where I visited with a new mother who was talking about her baby as chickens roosted overhead.

As I mentioned in my short interview on Bill’s website, this woman had given birth only 45 days before, and she and her child were doing just fine. She attributed her good fortune to the work of a Health Development Army volunteer, a member of the local community who – together with her Health Extension Worker partners – was committed to making sure new moms were getting the health information they needed.  The access to prenatal care and the focus on ensuring safe childbirth now turned to other issues such as routine vaccination and family planning.

This is how progress actually happens: with grantees and partners capable of translating good intentions into concrete realities. Such work requires deep practicality, an understanding of local circumstances, and an ability to reach the people who are in greatest need. 

This is what I saw in Africa this time around. I can’t wait to return again. 

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