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

14. Group Report: Elements of Good Governance in Disease Eradication Initiatives

14 Group Report: Elements of Good Governance in Disease Eradication Initiatives Kari Stoever, Chris Maher, R. Bruce Aylward, Julie Jacobson, Ali Jaffer Mohamed, T. Jacob John, Robert S. Scott, and Andy Wright Abstract This chapter identifies five key elements required to launch, execute, and manage a global eradication initiative, taking into consideration time, resources, and technical expertise in the context of the 21st century. The five elements include conducting a landscape analysis, obtaining the necessary commitments from a diverse group of stakeholders, constructing a framework to support the program, monitoring and managing the collaboration process, and incorporating research into the core operations of the program. Regardless of the type of organizational arrangement, there is a fundamental need to understand the changing dynamics of a program, both as a function of the evolution of the eradication program and the environment within which a global eradication effort operates. Recommendations in this chapter were informed by the lessons learned from the Global Polio Eradication Initiative, the Global Alliance to Eliminate Lymphatic Filariasis, and, to a lesser extent, the Guinea Worm Eradication Program and the groundwork being established around measles eradication. Introduction In the 21st century, before organizational arrangements are established, disease eradication programs will be subject to a series of prerequisite steps, such as meeting feasibility criteria and establishing a business case, to garner sufficient political will. A core group of stakeholders will need to champion the formative work and establish the initial mechanisms for collaboration. However, to broaden support and manage the collaboration process in a multicultural and nonhierarchical environment, a series of sequential steps are required to co-opt 192 K. Stoever et al. new constituents. Once sufficient buy-in has been achieved, structural arrangements should be identified to assist in facilitating work so that it can adapt to new data and embrace new technologies to achieve even more. The ultimate goal of any structural arrangement is to reduce bureaucracy and simplify work toward a common goal. To identify, organize, and activate a diverse group of actors (agencies, stakeholders, individuals, and groups) in support of a global eradication effort, we subdivided the main question into two areas. The first addresses the precursors that would inform on the types of organizational arrangements to support a global, large-scale, and multiyear program. The second builds on these initial requirements and extrapolates from them the essential elements required to execute and manage a global eradication program. We constructed a multidimensional framework that can be applied to any disease eradication or elimination initiative. Components of the framework include functional areas and governance issues that address accountability, leadership, monitoring, and risk management. The framework focuses on the global organizational arrangements but is scalable and can be applied toward regional programs or smaller-scale global eradication efforts for diseases such as yaws. The Critical Role of Scanning the Environment and Conducting a Stakeholder Analysis Once the technical feasibility and investment case has been established to eradicate a disease, a thorough scan of the environment needs to be conducted. The scan enables decision makers to understand the external environment and the interconnections of its various sectors as well as to translate this understanding into the planning and decision-making processes (Fahey et al. 1981). Basic components of the analysis include: • assessment of political will at the global, regional, and national levels, • financing trends in global health, • general economic trends, • assessment of perceptions and demand for eradication programs, and • a list of actors required to launch and support the program. Once the key components of the analysis have been completed, the data needs to be analyzed and presented in a SWOT analysis1 framework; critical gaps should be identified, and a decision made to move to the initial strategic planning phase. The strategic plan will focus on the launch phase of the eradication 1 SWOT analysis is a strategic planning method used to evaluate the strengths, weaknesses, opportunities , and threats involved in a project. Elements of Good Governance in Disease Eradication Initiatives 193 program and on obtaining the necessary commitments from key stakeholders in support of a resolution. The identification of key actors is a critical step in understanding how you create buy-in and from whom it must be obtained to align the various actors within the organizational framework. Each actor in the system is grouped into core functional areas: • national governments, • interested parties (e.g., national governments, UN agencies, technical...