VANGUARD

Bill Gates, co-founder of Microsoft and the second richest person in the world, and his wife, Melinda, annually write letters to reflect on issues that touch on their humanitarian work across the world. This year, they focused on things that surprised them. In the build-up to the launch of the letter, titled, ‘Things We Didn’t See Coming’, Melinda, a co-chair of the Bill and Melinda Gates Foundation, did a teleconference with some African journalists.

2019 Annual Letter:

There are five things in particular that surprised me, last year, about Africa especially, as they relate to women, girls and young people.  The first point is that Africa is getting younger while the rest of the world grows older. This can be either a source of instability or it can be a huge asset.  It all depends on young peoples’ access to education and good health. The second thing about Africa I want to highlight is I’m amazed at how little data we have on the lives and experiences of women and girls in Africa.  Missing data is just harmful because data really should guide all the decisions that we make, and it should inform policy.  So, if we are going to make progress in meaningful ways for women and girls, we have got to collect and analyze data and then act on it.

The third thing about Africa I will say is also surprising is how transformative access to toilets can be for women and girls.  We know better toilets and sanitation helps keep girls in school, they expand women’s economic participation and they protect them against violence.  So, sanitation is crucial when we think about good health and education for everyone across the continent, particularly women and girls.

The fourth surprise is mobile technology.  We are seeing it everywhere at this point.  It’s growing across the continent. It’s really creating new opportunities to fight inequity and lift women up.  Finally, the fifth thing that I will say about Africa is that the rise of nationalism in donor countries could have direct impact on Africa’s most vulnerable communities.  Bill and I have been spending a lot of time talking to donor nations and Africa, everybody sees that Africa is stepping up its efforts on domestic health financing but aid from donor countries is still essential.  So, over the next 18 months, the entire world really needs to recommit to global health as the critical health fund needs to get replenished like the Global Fund while financing health systems, particularly the primary healthcare system, is vital to improving peoples’ lives.  So Bill and I are spending a lot of time on that issue with donor countries.

Nigeria’s leaders and global family planning

Well, I think for Nigeria, it really hangs in the balance.  I mean, there’s this incredible generation coming up that has the chance to transform Nigeria, and that generation has already been born. So, we need to look at the fact that 70 percent of the population is under the age of 30 and this wave of youth, their dynamism, their energy, their potential is one of Nigeria’s greatest untapped natural resources. So, for me, it’s all about how do we invest in the potential of those people?  The reason family planning is so important is that it empowers people and it particularly empowers women.  When the woman understands her body and has access voluntarily to family planning, to contraceptive, she can have the time to space the birth of her children.

Women who have access and are younger also tell us that they stay in school longer.  We know an educated girl transforms society and transforms families and so I think, across Nigeria, really redoubling the efforts to make sure girls and young women are informed about their bodies, there are contraceptives available in the public and private sectors and that they have access to them is vital to moving forward. We know that for every dollar you invest in family planning, it’s a $6 return and so this is really a crucial area for Nigeria to literally tap into the potential of its people in the next decade.

Localising financing of health systems

We are working very closely with governments across Africa and particularly in Nigeria to explain to them why financing their health systems, particularly the primary healthcare system, is vital to improving peoples’ lives.  We know that primary healthcare is where mothers and fathers go first with their children, but it needs to be financed properly because when a mother or a father shows up there, if there is not an educated medical person there, if the supplies aren’t there, if the quality is not there, then he or she has to turn to other places.

So, Nigeria consistently moving money to the states, and then the states moving money out to primary healthcare and collecting the data about how they’re actually doing in primary healthcare is one of the most vital things and one of the things that Bill and I advocate the most when we are in Nigeria or even from afar talking about both the federal and state levels.

When you see other African nations making progress on maternal mortality or child mortality, it’s because they have invested in primary healthcare system.  Quite frankly, Nigeria has a long way to go, particularly in the North and they need to fund it consistently so the medical staff will actually show up there and do a quality job.

Comprehensive sexual and reproductive health rights

What I would say is the largest generation of young people entering their reproductive years and so I have two teenagers, I know this is a real dynamic period of life.  It’s quite critical that people have the information they need to make smart and informed decisions particularly when it comes to their health. An unplanned pregnancy can change everything for a young girl or a couple if they aren’t physically, emotionally or financially ready for a family.  I believe it’s really important to provide young people with age-appropriate accurate culturally relevant information about their reproductive health so that they can safeguard their health and plan for their future.

I have met so many young women across the continent of Africa and they talk about how crushing it is when they have a child too young.  It changes the future of their lives and what they want and hope for.  We need to make sure that they can all survive and thrive.  But it starts, honestly, with good health when they are young and then coaching them and teaching them in culturally appropriate ways about their reproductive health when they are young teenagers.

Developing countries and data

When I first got involved in global health and development, quite honestly, I was shocked to learn how huge the gaps were in the gender data.  Our Foundation is committed to better data across the board, but I was particularly excited about the workaround gender data because that data is what informs and guides the work. So, we don’t have reliable information about how many girls are going to school, how many women are having the chance to earn an income, what their health and their safety looks like and even whether they’re dying of preventable diseases and death.  And, so, we need to invest and collect that data and we need good policies around it. Bill and I have put some money down in this. We announced an initiative back in 2016 around gender data and we brought the partners together.  Countries really need to invest in their own information systems, so they get that gender-disaggregated data.

Most of the national information systems around the world don’t collect data on issues that disproportionately affect women and girls, whether it is data about partner violence, the distribution of money, household labour, demographic information, and education.  So, we have been highlighting that issue because we know data matters because what you measure is what you get done and, quite frankly, if we are going to invest on behalf of women and girls, governments need to know where and how to invest so that the taxpayer money is spent well.  That’s why we are so passionate about making sure data is collected but that it’s disaggregated, and specific information is collected around women and girls.  It is important.