PRE VENTING NEGLEC TED TROPIC AL DISEASES OF POVERT Y JUNE 2014 Working in Partnership 88851 A Successful Public-Private Partnership Model The control of onchocerciasis (river Africa implements directly, in this and using this to develop an indicative blindness) is widely acknowledged case through the APOC Secretariat budget to implement the multi- to be one of the major public in Ouagadougou, Burkina Faso. year plan. To aid financial planning, health achievements of recent As the implementing agency of a detailed budget is prepared on a decades in Africa. Lessons from the APOC, WHO is responsible for two-year basis and provided to the implementation of the Onchocerciasis developing procedures to implement Committee of Sponsoring Agencies Control Programme (OCP) led to a community-directed treatment with (CSA) for the next step in the budget stronger partnership approach in the ivermectin (CDTi), approving funding process. The biennial Plan of Action African Programme for Onchocerciasis to countries, maintaining surveillance and Budget is subject to scrutiny by Control (APOC). and ensuring monitoring and the CSA, and a final version, agreed on A key contributor to the success of evaluation. The implementing agency by the CSA and the APOC Secretariat, APOC is the diversity and depth of supports governments directly in this is presented for formal approval to its public-private partnership, which role, aided by a group of 15 NGDOs the Joint Action Forum (JAF). The JAF has brought together communities, operating nationally, regionally and comprises Ministers of Health of policymakers and health workers in internationally. 20 participating governments as endemic countries, UN organizations, The APOC Secretariat is also well as representatives of more multilateral and bilateral agencies, responsible for initiating the budget than 20 contributing development donors, private foundations, and process; taking the lead in preparing partners, co-sponsoring agencies non-governmental development a multi-year Plan of Action for APOC and 15 NGDOs. organizations (NGDOs) to successfully deliver preventative medication Figure 1: Contributions by APOC Development Partners to the donated by Merck & Co., Inc. The Africa Regional Trust Fund for River Blindness, 1995 to present program, which serves and facilitates this partnership, has helped the Kuwait 3.5 governments of 20 endemic countries Other: Switzerland 5.0 Australia to sustain the periodic ivermectin Saudi Arabia 5.0 Other 22.9 Caritasverband treatment that controls river blindness. Nigeria 5.1 World Bank Champalimaud Found 45.0 Finland Belgium 5.6 The World Health Organization (WHO) Germany Luxembourg 6.6 Gulbenkian Found serves as the implementing agency, Ireland France 8.4 working with countries and NGDOs Japan Kitasato Institute while the World Bank, working with United Kingdom United States of America Mitosath 44.2 20.5 other development partners, is the Norway OFID program’s fiscal agent. Netherlands Poland 20.6 Africa Portugal Development The WHO APOC Sabin Vaccine Inst. Canada Bank 22.0 28.4 Sightsavers Secretariat: Playing Total US$263.8 million MERCK Slovenia Including 25.0 UNDP Many Roles • 20 bilateral partners WHO • civil society partners APOC is one of the few programs www.who.int/apocs In nominal US dollars (millions) that the WHO Regional Office for Centralized Financial ensures that the pooled trust committed support of multiple Management: The Role fund has an adequate amount to development partners. The APOC of the World Bank and cover the scheduled withdrawal Trust Fund is supported entirely requests from the WHO, reports through voluntary contributions other Development to the APOC governing bodies on from development partners that Partners the flow of funds for the program, have been formally admitted as For over 40 years, the World Bank and helps ensure that these flows contributors to the Program. Both has played a key role as the fiscal respond to the approved multi- the World Bank and WHO are also agent for OCP and then for APOC. In year Plan of Action and Budget. contributors to the trust fund. Overall, managing the APOC 32 development partners have The World Bank Trust Fund, the World contributed to the effort and the OCP Channeling all also plays a role, Bank’s experience and APOC Trust Funds have managed in collaboration with fiscal contributions into with the other more than US$1.2 billion in support governance has of river blindness control over the last APOC partners, helped to channel a single trust fund 40 years. in resource the contributions of has enabled APOC to mobilization— The World Bank and WHO make no more than 30 donors leading a charges on the Trust Fund; all services including national select priorities on partnership effort are supported directly by the World governments, the basis of overall to identify income Bank budget. The World Bank does multilateral and pledges of not levy any overhead on the income development needs—a practical income for the to the Trust Fund and therefore 100 organizations, duration of the percent of the contributions enter bilateral example of financial Plan of Action the fund. In fact, the held funds development harmonization. and Budget. typically augment, pending transfer partners, Throughout the to WHO, as the World Bank Treasury foundations, duration of the invests the funds prudently as individuals, and the private sector. OCP and APOC Trust Funds, both permitted by donors, as part of its The multidonor trust fund serves as a programs have benefited from the overall management responsibility. central funding mechanism through which multiple donors can co- finance international development Figure 2. Total Mectizan Shipped from 1998 to 2013 projects. Channeling all contributions 800 into a single trust fund has enabled APOC to select priorities on the basis 700 Number of Mectizan Tables Shipped (Millions) of overall needs—a practical example 600 of financial harmonization. 500 In the APOC model, the World 400 Bank as fiscal agent receives, holds, and invests funds from 300 development partners and, on 200 request, transfers these funds to 100 the WHO, which is responsible for implementation. From 0 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 the WHO, funds flow to the participating countries and the Year of Shipment APOC Secretariat. The World Bank 2 PREVENTING NEGLECTED TROPICAL DISEASES OF POVERTY To date, APOC funds have accrued an that the APOC program came into through the Community Directed additional US$9.6 million in income existence largely because of the Treatment with Ivermectin (CDTi) from these investments. donation program. The Mectizan strategy which APOC adopted Donation Program (MDP) was in 1997. APOC, its member Sponsoring Agencies: established in 1987 to oversee countries, and NGDO partners The Evolving Role of Merck’s donation of ivermectin currently reach up to 100 million the UN System and (Mectizan®) for the control of river people annually. Multilateral Partners blindness worldwide. This was The success of ivermectin for river accelerated and expanded when blindness control and elimination WHO and the World Bank had Merck made a can be attributed specific roles in the development groundbreaking to the partnerships of OCP and APOC, as described The success of announcement that developed above. The list of sponsoring in 1987: it would ivermectin for river as a result of the agencies has changed during the donate ivermectin, donation. The development of the programs, completely free of blindness control donation led to reflecting the different needs of the programs as they evolved. At charge, as much donations of other as needed and for and elimination can the beginning there was a clear medicines by other focus on development, with the as long as needed, be attributed to the pharmaceutical health goals seen as contributing for the elimination companies, many to the overall economic and social of river blindness partnerships that of which are now development of communities. as a public health donated through problem in all developed as a result the WHO. Unsurprisingly, the UNDP was a endemic countries. key partner in establishing this of the donation. In addition to development perspective. Similarly, The donation drug donations, Food and Agriculture Organization initiated the use of mass drug pharmaceutical partners also provide (FAO) provided a perspective on administration as a major technical and often additional how treating endemic and much strategy to control and eliminate financial resources to address specific feared diseases that occurred in river blindness. Between 1987 problems encountered on the well-irrigated arable land might and 2013, the ivermectin ground. Merck remains committed contribute to enhanced agriculture provided was enough to to the program, in the hope that by and increased food production. administer more than 1.3 billion 2025, the MDP will have achieved In more recent years, with a focus treatments for river blindness much more than was expected 25 on sustainable national programs, in Africa, Latin America, and years ago. the African Development Bank has Yemen. Since the inception of become an important sponsoring the program, river blindness NGDOs: The Backbone agency. has been virtually eliminated in of the Partnership the Americas. New strategies to The river blindness story is a leading The Mectizan eliminate the disease are being example of the contribution of Donation Program: A implemented in Africa and NGDOs to operational research Groundbreaking Effort Yemen. and improvements in treatment by the Private Sector Ivermectin for river blindness is strategies and policies. The Pharmaceutical industry donations donated to Ministries of Health, partnership between the have made elimination of neglected mostly through NGDOs, and international, multinational, tropical diseases (NTDs) a realistic distributed by country programs government institutions and the goal for poor countries. It is probable and NGDO partners primarily NGDO Coordination Group was the PREVENTING NEGLECTED TROPICAL DISEASES OF POVERTY 3 backbone of APOC’s structure and OCP to adopt the CDTi methodology drug donation programs for specific facilitated progress and scale-up and gave increased credence to the diseases and with the communities of treatment programs. While OCP importance of devolving authority to affected by NTDs. NGDOs offer and APOC provided leadership, the the community. inputs such as financial and technical NGDOs worked with the national support, training and program CDTi was formally adopted by APOC health authorities to advocate for strategy and implementation, in 1997 as its principal strategy. the CDTi methodology and help it operational research, and production Since NGDOs were and remain to evolve. This ensured a sustainable of health education materials and uniquely positioned to work in method to deliver ivermectin and program management manuals. At partnership with communities and also strengthened community health the national and international levels, governments of endemic countries, systems. NGDOs are advocates for disease they spearheaded the scale-up of In 1988, OCP introduced large- control, encouraging other agencies this new strategy. They not only built scale ivermectin treatment to to participate, and ensuring that high the capacity of health workers and supplement aerial spraying. Initially, coverage is achieved and maintained communities to deliver ivermectin in endemic areas, and that all program health workers would visit endemic but also developed CDTi guidelines. components are addressed. communities to treat patients. It NGDOs have supported national and was the NGDOs which began to In the early 1990s, a group of seven international programs to control involve communities in managing NGDOs began to work together and eliminate some of the NTDs the program, with community to support river blindness control. affecting the ‘bottom billion’—the volunteers distributing medicines. Today, more than 50 international poorest and most vulnerable people From 1989, NGDOs independently and national NGDOs work together in the world—for over 20 years. worked with national health services to control or eliminate five priority to initiate mass distribution of NGDOs have continued to work diseases affecting the world’s poorest ivermectin and pioneer community- in partnership with each other, people. NGDOs work worldwide to based strategies. The improvement governments of endemic countries, respond to the challenge of scaling up in coverage and compliance caused international and bilateral agencies, support for these efforts.