By Sandi Doughton

The storyline sounds familiar: The world's richest man is taking on diseases of the poor, and demanding results for his money.

But this time, the entrepreneur is Mexico's Carlos Slim Helú, who in 2010 knocked Bill Gates off the top of Forbes magazine's billionaires list.

As did Gates, Slim is discovering that making a difference to peoples' health is much trickier than turning a profit in telecom, banking, construction or any of the more than 200 businesses in his empire.

The fledgling Carlos Slim Health Institute has pulled back from its original, ambitious goal of targeting all of Latin America, a representative said at the Consortium of Universities for Global Health meeting in Seattle this week.

"Now, we're working largely in Mexico and Central America," said Victoria Márquez-Mees.

It's not clear how much Slim is devoting to health projects, but he has pledged a total of $6 billion for all three of his foundations, including ones targeting education and economic development. Forbes estimated his net worth at $53.5 billion, compared to $53 billion for Gates and $47 billion for Warren Buffett.

Among Slim's health priorities are improving maternal and child health, reducing the burden of chronic diseases and bringing innovation to primary health care, Márquez-Mees said. As a man who made much of his money in telecommunications, Slim is pushing the use of wireless and mobile technology to bring health care to remote areas.

STR/AFP/GETTY IMAGES

Spanish Health Minister Trinidad Jimenez (left), Bill Gates, Carlos Slim and Inter-American Development Bank president Alberto Moreno (right), in Mexico for the Mesoamerica Health 2015 Initiative.

The institute is also funding genomic research on diabetes, cancer and kidney disease, focusing exclusively on Latin Americans.

The question of who will benefit is one that the institute asks about every proposal, Márquez-Mees said.

Education is a major focus to promote healthy lifestyles.

"We're trying to get away from doctors and help people understand how they can take of their health without the use of a doctor," she said.

But efforts to boost medical education have run into problems with a system that focuses more on memorization than hands-on experience. A scholarship program for graduate students yielded no qualified candidates, Márquez-Mees said.

"Something is missing," she said. "There's a mismatch between the needs and programs."

Slim and the Gates Foundation, along with the government of Spain, are contributing equally to a 5-year, $150 million project called the Mesoamerica Health 2015 Initiative. The eight nations that have signed up to participate are also kicking in about $100 million of their own funds, said Jaime Sepulveda of the Gates Foundation.

The program is just getting started, but will focus on the poorest 20 percent of people, with the goal of reducing inequities in health and health care. Unlike many Gates initiatives that emphasize a single disease or vaccine, the approach will incorporate health systems, vaccination, nutrition, and other efforts to improve maternal and child health.

"We have to move from the vertical approach to something that is much more integrated," said Sepulveda, former director of Mexico's National Institutes of Health.

But Mesoamerica Health 2015 faced a rocky road inside the tech-oriented Gates Foundation. Sources say Bill Gates wanted to kill the program, and singled it out for criticism in a widely-circulated memo soon after he came on board full-time at the foundation.

Perhaps it survived because, as Sepulveda said at the conference, it offers the potential for "quick wins."

"We need to have this good news," he said.

Sandi Doughton writes about science and global health for the Seattle Times.