Everything I've read indicates Gates takes his philanthropy very, very seriously and is having a real impact on improving people's lives. I'm sure his foundations are not perfect and have problems, but I also believe they are a net benefit to the world.
Interesting to contrast with someone like Steve Jobs. His company arguably produced much better products impacting (shockingly) many more people, but he didn't give a dime to charity (as far as I know). Could have long philosophical arguments about who had the more positive impact on humanity overall.