Building a Public-Private Partnership with the World Health Organization

The World Health Organization (WHO) and SmithKline Beecham have announced in January 1998, a new collaboration for the global elimination of lymphatic filariasis, also known as elephantiasis. This is one of the largest disease elimination programs ever undertaken and one of the largest public/private collaborations in public health. 120 million people around the world in 73 countries are infected with this devastating disease.

The success of the Global Programme to Eliminate Lymphatic Filariasis hinges upon active partnership with the many public health and related organizations around the world. Alignment of the wide variety of interests represented by these stakeholders is pivotal to the development of an effective and efficient coalition. The WHO, with the collaboration of SmithKline Beecham, has chosen to utilize a fresh approach for building global partnerships and designing global healthcare programs. This initiative begins with a Partners' Forum in October 1998. CWA, Ltd. will design and facilitate this key participatory global event.

The vision of the WHO Lymphatic Filariasis elimination initiative has been catalyzed by an International Task Force for Disease Eradication (ITFDE) which identified Lymphatic Filariasis as one of only six major infectious diseases that are currently considered to be "eradicable" or "potentially eradicable." In May 1997, the World Health Assembly formally called for global elimination of Lymphatic Filariasis. In its assessment of the opportunity, the ITFDE made a key distinction between evidence for scientific feasibility and evidence for sociopolitical feasibility. This distinction recognizes a critical link between technology and social process in achieving eradication. Creating that link is the mission of the Partners' Forum. The systems approach offered through the CogniScope™ is endorsed as the most practical way to build commitment to a plan of action among a global range of stakeholders.

Geneva Partners' Forum Achieves Strong Convergence in Boundary-Spanning Collaboration

The World Health Organization (WHO), in collaboration with SmithKline Beecham, initiated the building an international partnership in support of the Global Programme to Eliminate Lymphatic Filariasis by arranging a Partners' Forum, based upon a systems approach to planning, held October 28-30th, 1998. CWA, Ltd. served as Interactive Management consultants to facilitate this participatory event.

The successful implementation of the Global Programme to Eliminate Lymphatic Filariasis faces many challenges, as divergent viewpoints and concerns from a wide variety of stakeholders emerge. The collaboration of these partners can be seen as a cascade of linkages connecting international agencies, philanthropic organizations, non-government organizations (NGOs), national government agencies, academic research communities, professional healthcare associations, health service oversight bodies, pharmaceuticals suppliers, monitoring and testing system suppliers, primary healthcare providers, public health field workers, training and education programmes, patients, and the media. The full participation of each of these groups during the implementation of the programme will be crucial to the long-term success of such a large public health initiative.

Seventy two representatives from over thirty international organizations participated in the Forum, whose aim was to support efforts to eliminate this highly stigmatizing and devastating disease from 73 endemic countries, where 120 million people are already afflicted with lymphatic filariasis and 1.1 billion are at risk of infection.

The representatives deliberated on over 120 challenges and proposed approaches to the Lymphatic Filariasis (LF) Elimination Programme. This resulted in a call for an unprecedented breadth of inclusiveness and early involvement in collaboration in the launch stage. The intent of these actions is:

• Form a steering committee and elucidate the goals of the programme by mid-1999;
• Encourage the expansion of the programme to include morbidity control as part of an implementation strategy, and
• Secure early involvement of donors to build capacity and launch pilot programmes.
  

The Forum participants emphasized three prerequisites for the launching of the programme:

• Inclusion of the representatives of other key, non-LF, initiatives in the launch activities of the LF programme. This includes a broader definition of stakeholders even in the formation of the steering committee, and the accommodation of non-LF focused goals in strategy and implementation plans.

• While the quest for elimination of LF by 2020 is focused on breaking the transmission of the disease, Forum participants felt that morbidity control for LF patients is critical to engage community leadership in implementation. This provision implies the need to include, in the launch activities, donors and organizations that would consider the support of patient empowerment central to their goals.

• Early support for building the requisite science base to deploy the programme is critical to additional donor support. A proposed resolution of this dilemma is to employ a broader set of disciplinary perspectives, including sociology, psychology, anthropology, and economics, in "telling the LF story." Instead of asking donors to respond to pre-stated programme requirements, Forum participants viewed early collaboration with donors in the formation of strategy and donor risk management as essential.

Broad stakeholder inclusiveness in the development of a strategic plan implies modifying the traditional execution of international public health programmes. This burden is lessened to some extent through the identification of action tracks, which can proceed in parallel. They are designated:

• Partner's Planning and Goals - primarily addressing political will and coordinated implementation;
• Evidence-Based Strategic Modeling - concerned with surveillance capacity building and the support of the science base for justification and risk management for donors;
• Advocacy - concerned with providing center stage for the voice of the community, and multi-disciplinary perspectives in promoting the launch of the programme; and
• Pilot Implementation - addressing not only the improvement of the evidence-base for the disease, but in validating approaches, especially as it concerns compliance with the combination therapy unique to this elimination programme.

The Forum demonstrated a strong convergence of opinion (95%), reaching consensus among an unprecedented variety of perspectives brought to bear on the challenge in just three days. The inclusiveness and comprehensiveness of the Forum sets an important precedent for future collaborative endeavors at the community, national, and global levels. As the Programme to Eliminate Lymphatic Filariasis progresses, its scope will enlarge. First there is the alleviation of human suffering, a significant goal in itself. As the elimination effort continues, however, not only can the world eventually free itself from this devastating disease, but also, as Dr. Bill Foege of Emory University pointed out, many individuals and organizations have learned to cooperate with each other to solve a common problem. The level of boundary-spanning collaboration achieved in order to reach success can serve as a template for additional humanitarian endeavors working for global well being and social and economic development.