Reflections from our CEO on our new strategy: elimination is not the end

It isn’t easy to decide on a new direction for an organization. It’s an opportunity to take a broader view of what we are doing and why.

This allows us to “zoom out” of our daily focus and see the important opportunities that can make a lasting impact. It also helps us to avoid ignoring threats that may undermine our success.

The larger picture

An example from my life illustrates this.

My daughter, who was four years old at the time, was diagnosed with Type 1 diabetes three years ago. She became totally dependent on insulin. Our UK health service provides her with free access to highly advanced technology that monitors and regulates her insulin levels.

We reviewed the local healthcare services in case an emergency occurred when we visited relatives in Arusha Ta,nzania. We soon realized that there was no diabetes care or insulin available at any of the local health facilities and that even Dar es Salaam could not guarantee a reliable supply. The reality of mothers with diabetic children in this region deeply moved me.

I almost forgot about my training in public health and thought for a second that I could bring enough insulin with me to supply Arusha. I knew that diabetes was a chronic disease and that a robust system would be needed to not only provide a reliable supply of insulin but also to train and support families and individuals to deal with its complications. Even though it would be nice to bring a single supply of insulin, this would not make a significant difference in terms of the health care situation for the people living there.

This moment, even after a career in public healthcare, brought to life the inequity in health experienced by many.

It made me think about the work that we do.

We work in global healthcare because we want to “do something worthwhile.” It is easy to forget the fact that the way we deliver something could end up contributing to the problem. The strategic shifts that we were making became more important as we realized how we needed to change our work.

What does it mean to us in terms of practicality?

It is not the first change we have made to our strategy. Our previous system, which was originally designed as a disease control initiative focusing on specific interventions, took a more holistic approach. It included a broader primary preventive and care element alongside our mainstay – mass treatment for parasitic infections.

Now, we see that the shift was not enough. We now see that this shift did not go far enough.

What will we do differently?

We are proud of the achievements we have made to date. This includes supporting one billion treatments for parasitic infections. A milestone was achieved on our 20th anniversary last year. Our new strategy will be based on the goal of ending parasitic infections that are preventable and improving health equity.

In practice, it means that we build on our legacy and expand our work to encompass other important aspects, such as improving the quality of programs and their impact and supporting cross-sectoral collaboration. It is also important to shift the power imbalance that undermines country ownership and health system resilience and further embeds inequality.

We will not view interventions as the starting place. Still, rather, we will respond to the needs of our colleagues in endemic countries to support local health systems to deliver programs that are tailored to their context.

It may seem obvious, but these steps represent a major departure from how we have been operating up to now. We must be careful that as a partner organization based outside the countries we support, the way we work does not create structures, power dynamics, or systems that are detrimental to the goals we all share.

Our organization has always been committed to not having offices in any country, mainly because it wanted to avoid the possibility of parallel structures being set up. We need to modify our processes and work methods to challenge and transform the remaining barriers that prevent health systems’ resilience, ownership by countries, and health equity. We must consider the why as well as the how we work.

In order to achieve this, we will not only need to engage new funders but also support our country partners in mobilizing their resources. This is a totally different way of working, but it’s essential for the change we are trying to achieve.

Zooming in – Why We Do What We Do

In 2002, we were established as the Schistosomiasis Control Initiative. At that time, our name reflected exactly what we did. The disease control field has changed from Control to Elimination. And global health in general – moving from programme-driven assistance to strengthening health systems. My opinion is that our work and the broader NTD Community must be directed towards supporting the broader agenda of Health Equity and Health Systems Resilience by being responsive to the requirements of Ministry of Health Clients who are ultimately responsible for the health of citizens, not just their NTD Status.

Our new name, Unlimited health, is based on this new Why of Health without Limits for All. In our new slogan, we aim to eliminate parasitic diseases collectively.

With our new brand, we are confident that this will enable us to support country-owned solutions that eliminate parasitic infection for good.

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