It appears that the Gates Foundation works under certain contstraints, dictated of course by the elite family which runs it. For example, they appear to strongly respect intellectual property and corporate profits, as you might expect from a Microsoft founder. (This may take the form of ensuring that companies like Monsanto benefit from aid.)

There was an informed article in The Nation which touched upon the undemocratic vision the Gates Foundation allegedly has; people affected by poverty do struggle to fix their own problems in a self-governing way. Elite benefactors like Gates or Soros may conceivably help to strengthen the systems which make it hard to self-govern, along with whatever benefits they accomplish.

http://www.thenation.com/article/gates-foundation-and-africa...

(Incidentally, I don't see why Gates is considered a particularly predatory businessman. He just happened to be the one who succeeded, as usually happens; and other businesspeople don't like an entity with the resulting market power. He might be a much nicer guy than many of his competitors, for all I know.)