Anjali Gopalan depends on private donations to run her charity in New Delhi, which provides care for 380 orphans and families whose loved ones were killed or stricken by HIV/AIDS.
She applauds the $200 million that Microsoft Corp. Chairman Bill Gates has provided for HIV/AIDS prevention and education in India, which dwarfs her government's entire budget for the disease. But Gopalan worries that getting support for the long-term care she is providing AIDS victims could soon be more difficult.
"The Gates Foundation focuses on prevention, and that's important," said Gopalan, who has been helped by a foundation started by actor Richard Gere that gets Gates' funding. "But what happens to people" who already have the virus? she asked. "What happens to the children who are orphaned?"
Global philanthropy got a huge boost with billionaire investor Warren E. Buffett's announcement that he is giving the bulk of his wealth -- about $31 billion -- to the Bill & Melinda Gates Foundation. The group, the world's richest charity, devotes 60% of its funds to global health issues such as the development of an AIDS vaccine and eradication of malaria.
Health experts say Gates' -- and Buffett's -- money would go a long way toward saving the lives of millions of sick people and pulling others from Asia to Africa out of poverty. The Gates-Buffett philanthropic partnership, which totals about $60 billion, is 40 times the annual budget of the World Health Organization.
In a ceremony Monday with the Gateses in New York, Buffett, founder of Berkshire Hathaway Inc., said he was fortunate to be born in the United States and believed that he should give back to society. "If I had been born long ago or born in some other country, the wiring I had would not have paid off the way it has."
But even before Buffett made his announcement, experts warned against governments using this new bounty as an excuse to pull back from their responsibilities. Others worry that the growing influence of wealthy philanthropists could focus attention on a few worthy pet projects at the expense of other important programs.
Samantha Bolton, an advisor to a Geneva-based health advocacy group, said she had already seen glimpses of Gates' influence. Two years ago, representatives of the Drugs for Neglected Diseases Initiative approached the European Union about funding for the group's efforts to fight diseases such as sleeping sickness in Africa.
"Just ask Gates," she recalled them saying. "He's taking care of all that."
Bolton said Gates' contributions were vital, particularly in providing large research grants that governments would never be able to afford. But she said the Gates Foundation's massive assistance was leading some governments and public entities to disengage from their traditional roles and responsibilities.
"You can't have the whole world's health agenda decided in Seattle," said Bolton, whose group eventually got a grant from the EU. "Gates stresses this himself. The priorities and policies have to come from the governments. They have to remain involved. If you want to have an impact, you need to have public money."
Buffett's donation has highlighted an important trend. International spending by U.S. foundations, although still a fraction of overall giving, jumped to $2.8 billion in 2004, more than double the amount spent in 1998, according to the Foundation Center, a New York group that tracks philanthropy.
Companies, private foundations and individuals already account for 80% of the assistance flowing from the United States into the developing world, according to the U.S. government.
Some people involved in health and anti-poverty work expressed concern that the Bush administration and other governments are ceding too much control to wealthy individuals and business leaders, who might be driven by their own interests.
Corporate America stands to benefit from stability abroad.
U.S. firms are increasingly global in their operations, depending on foreign markets for customers and production. As they expand, these companies are landing in poor, politically unstable countries where the governments have failed to provide basic services such as healthcare and education.
"Twenty years ago, there wasn't really a pressure on U.S. companies to give outside the U.S.," said Dwight Burlingame, associate director of the Center on Philanthropy at Indiana University. "The tradition was local -- you did it where your headquarters were."
The Gates Foundation has committed $6 billion since its founding in the last decade to global health programs. It has given $1.5 billion to the Global Alliance for Vaccines and Immunization, a public-private partnership that has helped immunize tens of millions of children from diseases such as measles, tuberculosis and diphtheria.
Foundation officials estimate that the vaccines have saved more than 1.7 million lives since 2000. The foundation has poured millions of dollars into research on malaria and AIDS vaccines.