Disease Eradication in the 21st Century: Implications for Global Health

13. Managing Neglected Tropical Disease Partnerships

13 Managing Neglected Tropical Disease Partnerships Andy Wright Abstract A key ingredient for success of eradication and elimination initiatives is the formation of an effective partnership among all participating parties. This chapter examines the mechanisms required to manage the partnerships and the delivery of the interventions needed to achieve the eradication and/or elimination goals. Such mechanisms include technical and programmatic leadership; implementation guidelines; supply of diagnostics , drugs, or vaccines; technical and programmatic review; monitoring of progress; evaluation of impact, budgeting and cost management; management of data; safety monitoring and reporting; and inventory management and distribution of drugs and vaccines. Introduction The formation of an effective partnership among all participating parties is a key ingredient for success of eradication and elimination initiatives. The concept of partnerships was discussed at an expert colloquium held at the Carter Center (Dentzer 2008), at which Tachi Yamada, from the Bill & Melinda Gates Foundation, stated: “The largest success of the past decade has been the formation of partnerships between private industry, between government, between affected nations and not-for-profit organizations such as ours” (Dentzer 2008:2). GlaxoSmithKline has participated for more than a decade in the global partnership to eliminate lymphatic filariasis (LF), donating albendazole to reach several hundreds of millions of people in 50 countries. This chapter builds on the GlaxoSmithKline experience and examines the principles of managing a neglected tropical disease (NTD) elimination initiative in partnership with multiple countries to achieve a common goal. 176 A. Wright Background Effective partnerships are essential for successful eradication and elimination initiatives and may involve: • national governments of individual countries, as represented by the ministries of health, education, finance, and transportation; • United Nations organizations (WHO, World Bank, and others); • international donors (bilateral agencies, foundations, and private individuals); • the pharmaceutical industry, which contributes financial donations and supplies drugs and vaccines; • nongovernmental organizations (NGOs), which focus on implementation and patient care; • civil society (patient care); and • research institutions and universities, which supply scientific and programmatic support. Each of these diverse partners brings unique strengths and capabilities to bear on the global challenge of disease elimination or eradication. Every effort should be made to ensure those strengths are used optimally. Published reviews describing the achievements of the partnerships and the lessons that have subsequently been learned are available for onchocerciasis (Thylfors et al. 2008) and leprosy (Braber 2004). Mechanisms Needed to Implement the Partnerships To achieve the goals of elimination, a range of mechanisms are required for both the partnerships and the initiatives: a governance structure and forum, de- fined roles and responsibilities for each partner, shared strategic plan, advocacy and fund raising, and coordination and communication. These are discussed elsewhere and will thus not be repeated here (see, e.g., Stoever, this volume). For a partnership and NTD program to operate effectively, however, specific mechanisms are needed and will be discussed in turn below: • lead technical and programmatic authority, • implementation guidelines, • diagnostic supply, • drug or vaccine supply, • technical and programmatic review, • monitoring progress, • evaluation of impact, • budgeting and cost management, • data management, Managing Neglected Tropical Disease Partnerships 177 • safety monitoring and reporting, and • inventory management and distribution. Lead Technical and Programmatic Authority Because of the nature of NTD elimination programs, a coordinated approach is required across all countries engaged in the effort. For most of the initiatives listed in Table 13.1, WHO fulfills this role. It establishes guidelines for implementation, monitoring, and evaluation and appoints regional and technical groups to guide program implementation and strategy. Implementation Guidelines Each NTD program has published guidelines, specifically developed for county program managers, on how to implement an intervention. For many disease programs, delineation of these guidelines is carried out by the WHO as part of its normative function. For example, for the LF elimination program, WHO published a program manager’s manual (WHO 2000a) that sets out the methodology on how to plan and implement the interventions, including: • mapping disease prevalence, • baseline surveys, • training, • mass drug administration, • social mobilization, • midterm evaluations, • stopping of mass drug administration, and • surveillance after mass drug administration. More recently, with the emergence of integrated control of NTDs,WHO has published guidelines on preventive chemotherapy for NTD control (WHO 2006c). For trachoma, the International Trachoma Initiative (ITI) has published detailed guidelines for the implementation of the comprehensive SAFE strategy Table 13.1 Current elimination programs that target neglected tropical diseases. Leprosy Global Alliance for the Elimination of Leprosy http...