Artificial intelligence could be the most powerful tool for reducing global inequality in a generation, but only if deliberate choices are made in the next 12 to 18 months, according to the 2026 Goalkeepers Report released today by the Bill & Melinda Gates Foundation.
The report, titled “Make This Matter,” argues that left to the market alone, AI will be designed by and for the world’s richest people. But if built for frontline workers (nurses, farmers, and teachers) it could expand access to solutions, opportunities, and knowledge that have historically been out of reach for billions.
“AI could be a great equalizer or widen the gap. This is not a long-range prediction. It’s a present-tense choice,” the report states.
Bill Gates, Chair of the Gates Foundation, writes in the introduction that nothing in his lifetime has felt like this moment. “I’ve lived through waves of change that felt, in the moment, like the most significant thing happening on earth. Nothing has felt like this,” Gates writes.
Reflecting on a recent meeting with Gaudence Ngendahayo, a community health worker in Mwulire, Rwanda, Gates describes how AI could transform healthcare delivery in the most remote settings. “The phone in a health worker’s hand could help her recognize a dangerous pattern, know when to refer a patient, and anticipate which medicines her patients will need before they run out,” he writes.
The report presents new data from the Institute for Health Metrics and Evaluation at the University of Washington showing that health and opportunity gaps between the richest and poorest people will remain wide unless dramatic action is taken.
By 2045:
- A young adult in sub-Saharan Africa is projected to still have three fewer years of schooling than their peers in high-income countries
- Nearly 900 million people will still be living in extreme poverty, with low-income countries having 330 times more people living in extreme poverty than high-income countries
- More than 3 million children will still die each year from diseases we already know how to prevent
“We’ve made extraordinary progress,” the report notes. “But on current trends, the gaps between rich and poor don’t close they persist for decades.”
The report warns that AI is following a familiar pattern. “Left to the market alone, the most capable tools will be built first for the people and institutions most able to pay for them not necessarily for those who could benefit most. That is how inequity compounds.”
AI is spreading faster than any technology in history ChatGPT reached 100 million monthly active users in two months, compared to nine months for TikTok and two and a half years for Instagram. But with every month that passes, the report warns, the gap grows between those who have access and those who don’t.
The report calls for three fundamental priorities in the next 12 to 18 months:
1. AI tools must work in every language people speak. More than 90% of the data used to train early large language models came from English-language sources. In English, leading AI speech recognition systems make errors less than 6% of the time. In Yoruba, that same system fails more than 60% of the time. A striking example comes from Malawi, where a woman in labor might say her “water has broken” in Chichewa translated directly to English, it sounds like she has “thrown away water.” That mistranslation could mean the difference between timely medical advice and tragedy.
2. Tools must be grounded in local data and built for local realities. An AI tool built for a commercial farmer in Iowa is not ready for a smallholder farmer in Ethiopia. Building AI that works in every setting requires collecting the right local data (health records, farming outcomes, weather trends, student learning patterns) from the places and populations the tools are meant to serve.
3. Invest in people and access. The communities with the most to gain need local AI leaders at every level, policymakers and technologists who shape how AI enters their countries, and doctors, agronomists, teachers, and data scientists who understand these tools deeply enough to evaluate, adapt, and hold them accountable.
The report features four AI tools already making a measurable difference when built for frontline workers:
- Penda Health, Kenya: An AI clinical copilot embedded in digital records has improved diagnostic accuracy by 16 percentage points and reduced treatment errors by 13%. One clinician describes how the tool flagged a potential congenital heart defect in a four-month-old baby that might otherwise have been missed.
- Kiddom Atlas, United States: In early pilots across 21 middle schools, grade 7 students gained the equivalent of six additional months of learning in a single school year. One teacher describes how the tool helped her identify a student struggling with a fourth-grade concept, allowing her to address the root cause.
- Gemini Guided Learning, Sierra Leone: In an eight-week trial across 12 schools, students made the equivalent of up to 1.7 years of typical learning progress. One teacher reports that his pass rate went from around 55-60% to 100%.
- MahaVISTAAR, India: A free AI advisory service built into government infrastructure has reached more than 740,000 farmers, with 70,000 new users signing up monthly. The service costs the government less than 18 cents per farmer.
“AI is moving fast. The market will not wait. The systems being built now will shape who benefits for years to come,” the report concludes. “We still have a choice, AI companies, governments, and philanthropies. We can let AI follow the old pattern, where the people with the most resources benefit first and most. Or we can make a different choice: build it for people everywhere. Let’s make this matter.”
The report includes guest essays from four frontline workers a clinical officer in Nairobi, a teacher in New York City, a teacher in Sierra Leone, and a smallholder farmer in India each describing how AI tools have changed their work and the lives of those they serve.
