Big western philanthropic organizations hold enormous power, and arguably none tops the Gates Foundation. A running UN joke is that the Gates are the 194th member state, and that’s hardly an exaggerated representation of their role in development. According to a newly released report from the Organization for Economic Cooperation and Development (OECD), the foundation invested more than $9 billion in health between 2013 and 2015. That is nearly 15 times as much as the second-highest donor, the Buffett Foundation.

At such a size, it’s inevitable that, while their intent may not be political, their stage ends up lending political capital. Modi is not the only leader to benefit. Rwandan president Paul Kagame, as just one other example, has been widely celebrated (including by former president Bill Clinton’s charitable organization) for his achievements in development, despite ongoing reports of human rights violations.

While recognizing questionable leaders helps legitimize their actions, some think there could be a potential upside. Stuart Holliday, former US ambassador to the UN for political affairs, said that while the public recognition afforded to leaders may seem like approval, the intent could be different: Giving global visibility to somebody’s work is also a way to ensure there is higher scrutiny of their actions.

“There are two ways to look at it,” he told Quartz. “In diplomacy, you have carrots and sticks, incentives and disincentives. Are awards an incentive to be integrated in the system of nations?”

Quid pro quo

Giving an award to someone like Modi, or any other controversial leader, also has practical purpose. India gets the most global philanthropic money for health, according to the OECD report. And the Gates Foundation provides more than half it. So staying on India’s good side is essential to make sure its money is spent the way they intend.

Mo Ibrahim’s foundation,  for instance, which works in Africa, gives out an annual award specifically to the continent’s leaders.

“Philanthropy is a lever, and the enormous thing it is pressing on is either the public sector or the capital market,” Berman said. But, as with Modi, that can mean being placed in an awkward position. “What gets complicated is that global development involves policy, and policy can lead to politics.”

The choice to work with a certain country on a certain project can be an ethical question that philanthropists have to confront, and answer with transparency. They must be clear about the reasons why they are making those choices. “You have to make a decision. Can you legitimately focus on one part of what they do, without looking at everything that they do?” Berman asked.

It is a question that applies the other way around, too: Is it ethical to accept money from organizations or people independently from their actions or political positions?

Johnathan Marks, who directs the bioethics program at Penn State, warns specifically against this. In his book, The Perils of Partnership, he notes that the belief that partnership between private corporations and public bodies is a good, efficient system to achieve public interest goals should face scrutiny.

“The drive to reach common ground with industry in public health,” he writes, “can undermine rather than promote the common good.” He provides an example: Say you are a public official in charge of a community that doesn’t have a playground, and the fast-food chain that’s promoting bad eating habits in the very same community wants to finance one, would you take the money?

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