Policy Innovations Digital Magazine (2006-2016): Innovations: Micro-donations Can Make a Massive Difference in Global Health

Policy Innovations talks with Bernard Salomé, managing director of the Millennium Foundation, about raising funds for global health through small donations made when people purchase travel.

What is the mission of the Millennium Foundation for Innovative Finance for Health?

The Millennium Foundation works hand-in-hand with UNITAID, an international drug purchase facility created in 2006 that has already achieved remarkable results by lowering the price of medications and treatments for HIV/AIDS, malaria, and tuberculosis in the developing world. UNITAID is funded by a small tax on airline tickets in 12 countries, while 17 countries contribute to it directly from their national budgets.

However, the urgency of the global health situation requires a rapid increase in funding. To achieve this, the Millennium Foundation for Innovative Finance for Health was created in November 2008 to provide more funding for UNITAID and its work on infectious diseases by offering passengers the choice to voluntarily contribute. This new program is called MassiveGood.

The Millennium Foundation also aims to play a leading role in the debate on "innovative finance" and its great potential to bridge the financing gap for health interventions in developing countries.

How did the alliance with the travel industry originate? Will the project expand to other consumer industries?

The travel industry represents close to 10 percent of global GDP and employs nearly 220 million people worldwide. Hundreds of millions of travel services are sold every year and our research has confirmed that the tax that provides the bulk of UNITAID's funding has not distorted the travel market. Moreover, as an industry that brings people together, the travel and tourism industry was the ideal starting point for creating a global movement of citizens determined to address the current inequalities between developed and developing countries.

Since the creation of the Millennium Foundation, the travel and tourism industry has demonstrated a compelling interest in MassiveGood and their involvement has been an invaluable asset. MassiveGood will be applied on air tickets first but the interest expressed by the whole travel and tourism industry may accelerate the expansion of micro-donations to other sectors.

Do travelers have to opt in or out opt out of the MassiveGood fee? How much health benefit does a single donation deliver?

The Millennium Foundation wants passengers to voluntarily opt in to the MassiveGood donation to create a global movement. Partners of the Millennium Foundation have worked hard to make the donation as easy as possible and the end result is that people booking their air tickets are only one click away from donating. No extra personal information is required—giving will be as easy as ticking a box.

Spreading the word about MassiveGood is critical for its success and will require an educational campaign, transparency, and, of course, results. The goal of the Millennium Foundation is for MassiveGood to become a global movement of like-minded citizens who are convinced that small actions on a large scale can have a huge impact for those most in need.

In order to encourage passengers to give to MassiveGood, administrative costs will be kept to a minimum and funds raised will go to cost-effective health interventions. For example, a single donation of $2 can treat two children for malaria. On a large scale, small donations will help the Millennium Foundation negotiate better prices for medicines and offer incentives for increased R&D into new medicines and diagnostic tools.

Air travel is a significant source of emissions. Do you foresee MassiveGood contributions competing for attention with carbon offsets?

The travel industry has been working very hard lately to curb their emissions despite the difficult economic climate. Our position is that MassiveGood and carbon offsets are complementary in the sense that they both make citizens responsible for the world they are living in, and they both intend to make people more active in the change they want to see.

Is there an advantage to relying on private donations versus public funds?

One of the rationales behind innovative financing mechanisms is that they will provide additional funding for development programs. Public funds and governments commitments remain critical if the international community wants to achieve the Millennium Development Goals by 2015. The challenges are so great that limiting development to either private or public funds would make the fight against HIV/AIDS, tuberculosis, and malaria even more difficult that it already is. Predictable and sustainable new funds from private donations will allow countries to quickly scale up their health interventions and accelerate the rate of success against the three pandemics.

How much do you expect to generate annually? How will the money be used on the ground?

MassiveGood will be launched in successive waves from 2010 onward, first deployed in the United States, United Kingdom, Germany, Austria, and Switzerland in early 2010 before being expanded to other countries. After a couple of years, when running at full speed, MassiveGood is expected to raise hundreds of millions of dollars every year. For example, in only three years, UNITAID has raised almost $1 billion through the tax on air tickets. The potential of MassiveGood is compelling.

The Millennium Foundation's main objective is to finance UNITAID which has developed efficient mechanisms to allocate money on the ground. UNITAID works with a wide range of partners in developing countries including the Clinton Foundation, UNICEF, and the World Health Organization.

UNITAID's objective is to use its funds to generate what it calls "healthier markets." The availability of predictable and sustainable funds works as an incentive for pharmaceutical companies to invest in R&D on diseases that disproportionately affect low- and middle-income countries and allows UNITAID to negotiate price cuts for patented drugs. Driving prices down finally makes existing drugs available to the poorest.

Which countries receive aid? Do they have to meet any governance standards?

UNITAID already works with 93 countries, most of them located in Africa and Asia. Funds raised through MassiveGood will also go to low- and middle-income countries where the needs and cost-benefits are the greatest. Being accountable to both donors and recipients, and with a board composed of diverse constituencies, the Millennium Foundation is particularly sensitive to how its funds are used. Transparency and traceability are key for the Millennium Foundation and it will regularly report on these issues.

How does the Millennium Foundation's work tie into anti-poverty programs?

The international community has been working hard to establish standards on aid effectiveness. The Millennium Foundation's intention is to build on the criteria agreed upon in the Paris Declaration on Aid Effectiveness. The objective is not to duplicate actions that are already being led efficiently in developing countries but to back these actions with new funds.

The Millennium Foundation's work will remain focused on raising funds for medications and treatments for infectious diseases, as we believe this will have a considerable spillover effect on anti-poverty measures. More than 4 million people in low- and middle-income countries were receiving HIV antiretroviral therapy at the close of 2008, allowing them to contribute to society and assist general economic development. Yet over 6 million people are in dire need of antiretroviral treatment. MassiveGood has the potential to raise the money needed to help these HIV-positive people rejoin society.