By Jeffrey C. Walker and Ellen Agler, CEO of the End Fund
To accomplish the big bets in health that Bill and Melinda Gates detail in their annual letter we need to:
• Learn from successful, cause-focused collaborations such as polio, neglected tropical disease, and malaria initiatives and apply those learning points to the new goals;
• Focus on strengthening country-level health systems for sustainable improvements;
• Empower local communities and country-level leaders even more than we do today and work as solid partners with them to accomplish our shared goals; and
• Use philanthropy to support innovation and transition funding, while including in program designs a path to reducing reliance on philanthropy.
Yesterday, Bill and Melinda Gates released their foundation's annual letter. This letter has evolved over the past six years from a missive about the foundation's work to a manifesto laying out a vision for the future of global health, development, education, and activist philanthropy. This year, they put a stake in the ground, boldly listing their "big bets" on what is possible to achieve between now and 2030.
If we take a closer look at the global health goals outlined, they are broadly in line with the priorities forming around the post-2015 global development agenda and consistent with what many of us in the global health community believe to be urgent, important and achievable goals. As the letter points out, we have the capacity to halve the number of children who die before the age of 5, cut by two-thirds the number of women who die in childbirth, bring an end to polio and other neglected tropical diseases (guinea worm, river blindness, blinding trachoma, and elephantiasis), create the tools and plan needed to end malaria, and bring HIV to a tipping point where more people are receiving treatment than the number of new cases. But this list is only a beginning. It is the "what," but not necessarily the "how."
From our experience as Vice Chair of the UN Secretary General's Office for Health Finance and Malaria, working to dramatically reduce health related deaths and strengthen health systems in the developing world, and as CEO of the END Fund, scaling up treatment globally for the neglected diseases listed in the letter, we see the most effective way to reach these goals is to put authentic, humble, and proactive cause-based collaboration at the center of how we work.
We've seen this work well in the case of malaria where a global collaborative came together, agreed on common goals, and together has reduced the number of malaria deaths from 900,000 to less than 400,000 in the last eight years. A consortium of organizations dedicated to ending mother-to-child transmission of HIV, called Born Free Africa, has exemplified collaborative action over the past five years and cut transmissions from 350,000 to 200,000, and the rate continues to plummet. At the END Fund, we've built a platform for engaging philanthropists to end the scourge of neglected tropical diseases and have seen how effective collaboration can help strengthen a broad range of organizations working in the field and result in tens of millions of additional people being treated for these devastating diseases each year. Neglected tropical disease control has been on the forefront of collaborative action, as exemplified by coalitions such as Uniting to Combat NTDs, the International Coalition for Trachoma Control, and the Global Alliance for the Elimination of Lymphatic Filariasis.
Effective partnerships will indeed look more like jazz bands working in ensembles rather than single, gifted soloists on their own. Collaboration in global health is certainly not a new idea, but one that in practice often requires modification of our existing habits of work and communication, humility about the role of one individual or organization in a broader agenda, and the willingness to put the cause or the alliance before individual global health heroes and organizations. It's about lowering ours egos for a higher goal.
The Gates annual letter is an opening for all of us to have a broader discussion on the implications of these "big bet" goals. We need to take seriously how to keep collaborative action at the forefront of our work and have ongoing, thoughtful discussions many of these key questions:
• How can we ensure that single disease eradication efforts being promoted do not become vertical, siloed efforts, but are used as a lever to more broadly strengthen health systems? As we have seen most recently from the Ebola crisis, much of the solution to these health goals lies in having more capacity, tools, infrastructure, and trained personnel across health systems, all the way from specialized, tertiary care facilities down to the most remote community-based health posts.
• How can we ensure that local, community-based organizations have key roles and voices in this work? What is the best way to build healthy collaborations based on communication and goal-setting involving those most affected by these diseases? As we have seen from our work with community health workers, often the key to the success of many of these health initiatives involves support, education, and financing mechanisms to ensure the success of frontline health workers.
• And what is the role of philanthropy in addressing these big causes of our day? We believe that philanthropy can fund innovations and create sustainable models to address these large issues, but is not a permanent solution. We do need increased private philanthropic investment and collaboration among donors across all the areas listed in this letter, but how do we ensure that private philanthropy is used to jumpstart programs, prove models and tackle discreet problems and that sustainability beyond philanthropy is at the forefront of any philanthropic investment in global health?
The annual letter ends with a call for action to become global citizens and join globalcitizens.org. We'd like to interpret this call to action as not only signing up for an online, digital activism platform, but as the first step in engaging in with these goals and contemplating what it means for each of us as individuals to be a global citizen. How would you define what it means to be a global citizen? Who gets to be a global citizen? We would hope to see a world where rural villagers in Malawi or Bangladesh, global health and development experts in London and Washington, business leaders in Hong Kong and São Paulo, and young students all over the world have equal chance to participate as global citizens, collaboratively and mindfully contributing to creating a healthier, more prosperous world.
We look forward to an ongoing discussion on these issues and hearing your thoughts.