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The difficulties of "scaling up" are felt not only in developing countries, which have to figure out how to effectively use large new inflows of aid. On the spending side, a doubling of expenditures by the world's largest foundation is not easily accommodated, either. The New York Times reports on the ways in which the Bill & Melinda Gates Foundation is facing management, human resources and accountability quandaries as it ramps up outlays to include the additional $1.5 billion to be provided each year by Warren Buffett.

"It's like having a second child," said Dr. Helene D. Gayle, who left the foundation this year to become president of CARE USA, the international relief group. "It's not just twice the amount of work; rather, things change in vastly different ways."

If the experiences of other large funders in the development community are a guide, the biggest challenge will be to keep the institutional eye on the quality of projects while pressures intensify to move the money out the door on time. One way the Foundation could maintain attention to quality and impact is by making sure that public statements focus on what has been accomplished by funded projects -- backed up by credible evidence to support the assertions -- rather than on the number of dollars spent.

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.