Operating Principles

We are committed to reinventing what a nonprofit organization working internationally looks like. We adhere to a set of principles designed to optimize our effectiveness in helping people in low and middle income countries, while making efficient use of the donor money supporting our work.


We focus on opportunities for achieving sustainable systemic change.

We focus on projects that will be sustainable on a large scale, and this means the change must be able to continue in the future without dependence on public sector financial support.

Scale and cost effectiveness are of overriding importance.

It is relatively easy to achieve change in a neighborhood or district, but much more challenging to achieve beneficial change for a country or large region. We are wary of pilot projects too expensive to be replicated on a large scale. In order to help as many people as possible, cost-effectiveness must be built into any strategy from the start.

We concentrate on barriers to progress that can be minimized in the near-term.

Some barriers cannot be influenced by anything we might offer externally, such as traditional practices inhibiting access through clinics to needed medicines or family planning. Other barriers, however, can be overcome with relatively modest financial inputs and careful planning, such as the market availability of needed high quality, off-patent, affordable products beneficial to health.

Our work is organized around a scientific evidence base.

We work in collaboration with the School of Public Health at the University of California, Berkeley, which provides the health and economic data describing the needs and a variety of opportunities for improving health in the developing world. We apply sound academic findings in selected subject areas where we are well positioned to make a difference.

Where a product is involved, prices for the poor must not contain costs in the U.S. or Europe.

The values of currencies of developing countries in relation to the value of the dollar and Euro means that many people cannot afford to buy health products coming from the US or Europe. But local products or high quality generic pharmaceutical products from manufacturing companies in India, China, or Egypt, for example, can be affordable for large numbers of people.

We are committed to staying administratively compact.

In much of our work, we are able to be flexible in terms of engaging participants in specific projects, creating “dissolving teams” who work together as long as it takes to complete a task. Our financial reporting, by contrast, is formal and conventional.