What Bill and Hillary Clinton’s Controversial Foundation Actually Does

August 27, 2016, 11:00 AM UTC

The Clinton Foundation has come under increasing scrutiny, threatening to become a political albatross weighing down Hillary Clinton’s presidential campaign. With the Associated Press reporting that many private donors to the sprawling philanthropic organization had meetings with Clinton while she was Secretary of State, critics have pounced, accusing Hillary Clinton of influence peddling and major conflicts of interest.

“It is impossible to figure out where the Clinton Foundation ends and the State Department begins,” Republican nominee Donald Trump said at a rally in Austin, Texas on Tuesday night. “It is now abundantly clear that the Clintons set up a business to profit from public office. They sold access and specific actions by, and really for, I guess, the making of large amounts of money.”

The Clinton campaign denied any impropriety. (Hillary Clinton hasn’t served on the foundation’s board since spring of 2015 and did not serve on its board while Secretary of State). Supporters, meanwhile, have argued that the controversy is obscuring the valuable work that the foundation–launched by Bill Clinton– does.

How well respected is the Clinton Foundation? What has it accomplished? Below are some of its major initiatives, and how they’ve been viewed in the philanthropic world.

What Work Does It Do?

Although the foundation has a wide array of initiatives — promoting economic equality for women, boosting entrepreneurship in emerging markets and tackling climate change — it is perhaps best known for its health care initiatives.

It has several separate entities through which it deploys its health programs, including the Clinton Global Initiative (CGI). Established as part of the Foundation in 2005, CGI essentially acts as a launching pad for programs by bringing together a variety of stakeholders, including NGOs, executives, entrepreneurs, politicians, and others, who then commit to various ambitious projects. CGI doesn’t actually implement those projects itself—rather, it says it serves as a “catalyst for action.” For instance, in 2015, as a participant in CGI’s events, the infant and maternal health group Embrace Innovations pledged to bring its innovative Embrace infant warmer (which doesn’t require a fixed electricity source) to 100,000 babies in sub-Saharan Africa and South Asia.

Since 2005, according to CGI, it has spawned initiatives that:

  • Raised $313 million for R&D into new vaccines and medicines;
  • Helped provide better maternal and child survival care to more than 110 million people, and;
  • Provided treatment for more than 36 million people with tropical diseases.

Private firms are also in the mix. Biotech giant Gilead (GILD) and the NAACP joined forces to recruit religious leaders in the African American community to help fight HIV/AIDS, which disproportionately affects blacks in the U.S. Medical tech company Becton Dickinson(BD), which ranked among the 50 companies in Fortune‘s Change the World list this year, has committed to dramatically cutting the price of CD4 immune cell tests for HIV-positive people across 55 countries.

And in 2015, the American Society for Clinical Pathology (ASCP) and a host of other partners pledged to build up a world-class cancer diagnostic and treatment system in sub-Saharan Africa and Haiti, including boosting telemedicine and cloud-based electronic health records systems. The project is currently ongoing.

The Foundation says that another one of its arms, a collaboration with the American Heart Association (AHA) called the Alliance for a Healthier Generation, has helped provide access to healthier meals across more than 31,000 American schools and boosted physical education, the availability of nutritious meals, and extracurricular exercise in poor communities with high obesity rates.

But the Clinton Health Access Initiative (CHAI), which is an independent entity of the Clinton Foundation, may have had the most wide-ranging impact on global public health to date. It has helped negotiate HIV/AIDS therapy price cuts as high as 90%, ensuring access to these treatments for more than 11.5 million people across more than 70 countries, the Foundation says.

Is the Clinton Foundation Respected?

One charity watchdog, Charity Navigator, no longer rates the foundation because its “atypical business model can not be accurately captured in our current rating methodology,” according to the organization. “Our removal of The Clinton Foundation from our site is neither a condemnation nor an endorsement of this charity,” they write. In essence, the various, wide-ranging projects and federated nature of the organization didn’t properly mesh with Charity Navigator’s ranking methods.

The most recent Clinton Foundation rating from another watchdog group, CharityWatch, gives the organization a solid “A.” The group says that the foundation spent 88% of its 2014 outlays directly on programs (rather than overhead) and that it only has to spend $2 to raise $100.

As for the Foundation’s specific claims about the number of people that it has reached through its programs? Those are a bit harder to verify. For instance, the price of HIV/AIDS drugs in Africa has, indeed, dropped significantly since CHAI was launched in 2002, and the World Health Organization (WHO) points out that CHAI and a consortium of other partners helped make sure there was consistent access to these medications.

The watchdog groups that oversee foundations like the Clintons’ charity don’t necessarily have the resources to audit every individual program they run. But the available data indicates that the Clinton Foundation is a top-tier institution in the philanthropic world, according to CharityWatch president Daniel Borochoff, who also says the foreign fundraising criticisms made about the organization could be applied to any number of international charities.

“We can only judge organizations based on their own financial disclosures, corporate governance, and level of transparency,” Borochoff told Fortune in an interview. “And by those accounts, the Clinton Foundation has a strong record. They reveal much more information about themselves than many other charities.”

A CHAI spokesperson insisted that the HIV/AIDS drugs figures are accurate in an email to Fortune.

What Happens to the Foundation if Clinton Is Elected President?

While much of the work done by the foundation and its partners has been praised, there are still enough questions about potential conflicts of interest that it would likely have to change significantly under a Hillary Clinton presidency. And the Clintons have begun to acknowledge that reality.

In an email to his supporters and members of the foundation on Monday, Bill Clinton wrote:

“If she is elected, we will immediately implement the following changes: The Foundation will accept contributions only from U.S. citizens, permanent residents, and U.S.-based independent foundations, whose names we will continue to make public on a quarterly basis. And we will change the official name from the Bill, Hillary & Chelsea Clinton Foundation to the Clinton Foundation. While I will continue to support the work of the Foundation, I will step down from the Board and will no longer raise funds for it.”

But there are still a number of questions about the fate of the Foundation’s programs and fundraising in the event of a Clinton presidency. For instance, CHAI may not be limited by those same donation rules since it’s technically an independent entity with its own board. And on Wednesday, a Clinton Foundation spokesperson told the Wall Street Journal that Chelsea Clinton plans to remain on the board even if her mother wins in November. It’s unclear whether Chelsea would still be involved in fundraising.

Correction: August 27, 3:40 P.M: A previous version of this post stated that the Associated Press reported more than half of private donors to the Foundation met with Clinton while she was Secretary of State. The report actually stated that more than half of Clinton’s meetings with private individuals were with donors to the Foundation.

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