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Organizations like the Gates Foundation often bypass national governments and nationally-established health systems in order to push forward their own governance principles on health and healthcare. This often de-stabilizes local, on-going initiatives and de-legitimizes public healthcare efforts. Not to mention, the Foundation often prioritizes treating "the symptoms" with technical interventions, rather than building a resilient, holistic system to prevent diseases and health issues from arising in the future.

Some sources on the legitimacy and efficacy of their workings (within global health):

Doyle, C., & Patel, P. (2008). Civil society organisations and global health initiatives: problems of legitimacy. Social Science & Medicine, 66(9), 1928-1938.

Pfeiffer, J. (2003). International NGOs and primary health care in Mozambique: the need for a new model of collaboration. Social Science & Medicine, 56(4), 725-738.

Storeng, K. T. (2014). The GAVI Alliance and the 'Gates approach' to health system strengthening. Global Public Health, 9(8), 865-879.