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

12. Governance Models for Eradication Initiatives

12 Governance Models for Eradication Initiatives Kari Stoever Abstract Eradication initiatives are trans-organizational systems (i.e., partnerships, alliances, or coalitions) that enable, and are reliant upon, the joint decisions and actions of participating organizations, each of which maintains its individual identity and goals. Trans-organizational systems are multicultural, nonhierarchal structures that service a megacommunity in the collective pursuit of public goods. Governance models for trans-organizational systems require higher levels of coordination, cooperation, and collaboration than traditional organizations because of the independence, diversity, and number of actors and extended timeframes involved. Applying management science and best practice, five critical success factors are identified for good governance: institutional mapping, leadership and skills, nontraditional decision-making processes, organizational culture, and the mobilization and alignment of financial resources. This perspective is applied to eradication initiatives and used to inform resource mobilization and aid frameworks. Introduction Agonize or organize.—Harry A. Fagan Broadly defined, organizations are systems of coordinated action among individuals with different interests, preferences, and knowledge (March and Simon 1958). In the context of an organization or network of organizations, as in an eradication initiative, governance refers to the tools that organizations employ to influence an individual’s contribution toward a goal. Governance often invokes concepts of power, authority, and formal lines of reporting. However, effective governance requires skilled leaders to motivate, persuade, and inspire (Kotter 2001). To catalyze and coordinate collective action in a network of decentralized yet interdependent groups, innovation and flexibility are required. The manner by which tasks and people are specialized and divided, and authority is distributed is referred to as structure (Brandach 1996). Organizations 160 K. Stoever are structures of human relationships designed to achieve goals through work (Roberts 2004). A trans-organizational system is an “organization of organizations able to make decisions and perform tasks on behalf of member organizations , while the member organizations maintain their separate identities and goals” (Roberts 2004). A trans-organizational system bridges specialist identities and accountabilities of member organizations to produce a new knowledge base. The following characteristics are typical of a trans-organizational system (Cummings and Worley 1996): • They tend to be under-organized. • Relationships among organizations are loosely coupled. • Leadership and power are dispersed among autonomous organizations, rather than hierarchically centralized. • Commitment and membership are tenuous because member organizations attempt to maintain their autonomy while jointly performing. • Knowledge management is a core function. Although the concept of a trans-organizational system has been widely utilized for global health initiatives, they are more commonly referred to as partnerships , alliances, or coalitions. The concept of the megacommunity is a valuable tool for eradication initiatives . Defined as “the means in which organizations and people deliberately join together around a compelling issue of mutual importance, following a set of practices and principles that make it easier for them to achieve results” (Gerencser et al. 2008), it is useful in thinking through the structure, management , and evolving needs of an eradication initiative. Establishing a megacommunity (Figure 12.1) requires a fundamental shift in thinking as work must be organized across multisector and multinational boundaries. Eradication initiatives require high levels of coordination, cooperation, and collaboration. Because of the diversity and number of actors in the system, the time required to reach the goal (multidecade), and the volatile global environment in which they operate, eradication initiatives require the development of processes to formalize and support the strategy of working together. In addition , while accountability among the interdependent organizations is highly diffuse, it requires active monitoring and management. Much can be learned from the private sector. The failure rate of private sector alliances has been estimated to be as high as 70%, with most of this failure attributed to an over-emphasis on defining the plan and minimizing conflict (Hughes and Weiss 2007). Understanding and defining how organizations work together, make decisions, allocate resources and cultivate mutual trust must be identified in the formative stages of an initiative and revisited, at a minimum, on an annual basis. To develop the good working relationships within an alliance, Hughes and Weiss (2007) identify four key areas that can be applied to an eradication initiative: Governance Models for Eradication Initiatives 161 1. Peg metrics to progress:Augment “ends” metrics with “means” metrics to assess factors that affect the alliance’s performance (e.g., information sharing and new idea development). 2. Leverage differences: The fundamental principle of organizing diverse actors...