In their 2017 annual letter (HTML or 18 pages, PDF), Bill and Melinda Gates reflect on improvements in global health and development and their foundation's efforts to build an ecosystem of partners for that effort.
Addressed to Warren Buffett, who in 2006 pledged about $31 billion in Berkshire Hathaway stock to the Gates Foundation, doubling its resources, the letter focuses less on how the foundation is doing and more on "how the world is doing — and how we see our role," highlighting, among other things, a decline in childhood mortality globally; an increase in vaccination rates and the foundation's part in creating GAVI, the Vaccine Alliance; the expansion of women' access to contraceptives and the Gates-supported Family Planning 2020 partnership; and a drop in the number of people living in extreme poverty.
The Gateses also acknowledge ongoing challenges in the letter, including the lack of progress in preventing newborn deaths and malnutrition; the need to accelerate improvements in women's empowerment and access to contraceptives, which are directly linked to anti-poverty outcomes; and the difficulty of eradicating not only polio but also malaria, tuberculosis, and HIV/AIDS. To that end, the letter states, the Gates Foundation has been using Buffett's gift "to build an ecosystem of partners that shares its genius to improve lives and end disease."
"This ecosystem," Bill Gates writes in the letter, "includes a global database on disease that helps countries spend their money where it matters most. It directs scientific capacity toward research that will make an impact in the lives of the poor. It recruits scientists to global health and gets experts in other fields to apply their findings to infectious disease. Building this ecosystem is one of the most important things we've done — because we’re going to need every bit of this capacity to solve the next challenges."