30. Reinventing donor co-ordination to beat neglected tropical diseases

UK Department for International Development (DFID), United States Agency for International Development (USAID) and Bill & Melinda Gates Foundation

Neglected tropical diseases disproportionately impact the extremely poor, preventing their escape from poverty

Neglected tropical diseases (NTDs) are a diverse group of diseases that threaten 1.5 billion people worldwide and thrive in conditions of extreme poverty. While NTDs account for about 170 000 deaths a year, they contribute more significantly to blindness, severe disfigurement, disability, stigma and discrimination - often making it impossible for those affected to escape poverty. By keeping children out of school and adults out of work, and excluding the diseased from society, NTDs deprive families, communities and nations from reaching their social and economic potential. These diseases persist despite proven, low-cost solutions for prevention and treatment.

In 2012, a coalition of pharmaceutical companies, donors, countries and non-governmental organisations signed the London Declaration on Neglected Tropical Diseases. This ambitious commitment spurred a dramatic increase in political momentum and raised awareness of these diseases. Partners nevertheless faced a huge challenge: success hinged on rapidly reaching 1.5 billion people with high-quality, sustainable treatment. This meant not simply investing more but investing smarter.

The Bill & Melinda Gates Foundation (Gates Foundation), the United States Agency for International Development (USAID) and the UK Department for International Development (DFID) took this challenge as an opportunity to redefine partnership among donors.

Improving donor co-ordination to achieve a common goal by building on individual strengths and leveraging synergies

The collaboration among the Gates Foundation, USAID and DFID stemmed from a desire to avoid replicating efforts on NTDs. However, it soon became clear that simply avoiding duplication would be a missed opportunity. By working in partnership, the three organisations could pinpoint the most urgent challenges and maximise the impact of their collective investment.

The group initially agreed on the most pressing priorities and the focus of each donor’s activities. This co-ordination of individual priorities and funding then evolved into a working relationship between partners around a shared goal. By leveraging their individual strengths, partners have been able to sustain and bolster efforts to eliminate NTDs in countries where they are endemic. Over time, a level of trust and understanding developed that allowed partners to work jointly to achieve more with their investments.

The new approach supported the 2013 launch of Nigeria’s national plan for NTDs. DFID and USAID carried out a joint scoping visit and established complementary programmes. Other funders, including the Gates Foundation, the Children’s Investment Fund Foundation and other private funders, made additional contributions to complement USAID and DFID anchor funding.

The partners’ first major joint venture was the Coalition for Operational Research on NTDs (COR-NTD).1 This coalition of researchers, programme implementers and country stakeholders seeks to identify and tackle the key research questions needed to optimise progress to the elimination of NTDs. By pooling operational challenges and leveraging synergies across research, COR-NTD has made rapid progress on technical issues and has made national NTD programmes more effective.

The partnership, in addition to closing gaps in research and knowledge, has continued to evolve and expand its portfolio, exploring ways to accelerate delivery of NTD treatments. The Gates Foundation, USAID and DFID, as core members of the cross-sectoral partnership catalysed by the London Declaration, work together to facilitate collaboration on NTDs and to seek strategic opportunities to advance global progress.

Investing in relationships, building trust and enhancing communication make for effective partnership

The success of this partnership offers two critical lessons:

  • Nothing is more important than investing in relationships. From the beginning, regular communication and a willingness by all parties to invest in the relationship built deep levels of trust and laid the groundwork for effective co-operation. In particular, frank, honest dialogue enabled resources to be deployed rapidly and effectively. For example, when political circumstances required a donor to withdraw from a country partners quickly engaged the END Fund to fill the gap through private philanthropic donations.

  • Starting with a small group with clear goals can lay the groundwork for greater successes. Very few donors support efforts to eliminate NTDs. Launching the partnership with a small, core group facilitated communication and quickly built trusting relationships. Strengthening and aligning the core group made it easy to welcome new partners and sustain co-ordination, an important factor in accelerating progress on NTDs on many fronts.

The Expanded Special Project for Elimination of NTDs (ESPEN) - a World Health Organization (WHO) Regional Office for Africa (AFRO) programme offering technical and fundraising support to African countries on NTDs - was launched in May 2016 with seed funding from USAID, DFID and the Gates Foundation. ESPEN is building crucially important capacity to eliminate NTDs in countries with limited resources that might otherwise be unable to fund and run NTD programmes.

What next?

While incredible progress has been made, the 2020 targets set out in the London Declaration and WHO Roadmap2 will not be reached. Ongoing co-operation will be essential to reducing the global burden of NTDs.

One billion people received NTD treatment in 2016 but 500 million people are still out of reach. The Gates Foundation, USAID and DFID are committed to fostering stronger relationships among donors - as well as among all those working to eliminate NTDs - to ensure that no one anywhere is disabled, disfigured, trapped in poverty or dies from diseases that can easily be prevented or treated.

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