Gates is doing his philanthropy in almost exactly the way Rockefeller did. Large top-down programs designed to attack problems that require high startup capital; things that social entrepreneurship (Kiva, microfinance type ideas) are structurally ill-equipped to do.

They also seem to be attempting to learn from the failures of such models in the past, especially in Africa.

I think he's doing the best he can, but he's not innovating enough in philanthropy. We're caught in a top-down/bottom-up dichotomy in attempting large-scale change that he's been unable to break.

So the one thing I'd do differently is invest a significant amount in funding innovation in philanthropic models themselves. It is clear that the spectrum between Kiva/Grameen type thinking on the one hand, and Gates/Rockefeller thinking on the other, simply does not cover some of the more difficult challenges today.

He's also dangerously amplifying a broken model of development. What's the end-game when you put developing countries on the trajectory of increasing standards of living, better healthcare etc.? Developed countries obviously. What starts with vaccines ends with consumerism, vapid self-absorption, entitlement and obesity.

He has the opportunity and leverage to steer things differently in major ways for "developing" economies, but it will take creativity and innovation to do that, and he's not really pushing on that front.

But push comes to shove, I think its a good thing that he's not doing the Kiva/microfinance type approach (at least not in any huge way that I know of). There is still a reason to deploy capital in more massive ways.