WHO in 2002: Faltering steps towards partnerships

Publisher Website
Google Scholar
Abstract
Defining partnerships Malaria causes about 3000 deaths a day, over 90% of which are in sub-Saharan Africa.3 It is both a disease of poverty and a cause of poverty (fig 1), slowing economic growth by 1.3% per year in endemic areas.3 Roll Back Malaria (RBM) was launched in 1998 as Brundtland's “pathfinder” project,4 bringing together the biggest players in health with the aim of halving the malaria death rate by 2010. View larger version: In this window In a new window Fig 1 Global burden of malaria It has had two major successes. Firstly, it brought together more than 90 multilateral, bilateral, non-governmental, and private organisations. Secondly, it has raised the profile of malaria, particularly through its April 2000 summit in Nigeria.5 Box 1 Public-private partnerships involving WHO2 European Partnership Project on Tobacco Dependence Global Alliance for TB Drug Development Global Alliance to Eliminate Lymphatic Filariasis Global Alliance to Eliminate Leprosy Global Alliance for Vaccines and Immunization Global Elimination of Blinding Trachoma Global Fire Fighting Partnership Global Partnerships for Healthy Aging Global Polio Eradication Initiative Global School Health Initiative Multilateral Initiative on Malaria Medicines for Malaria Venture Partnership for Parasite Control Roll Back Malaria Stop TB UNAIDS/Industry Drug Access Initiative RETURN TO TEXT David Alnwick, Roll Back Malaria's project manager, said that “when RBM was formed, a very deliberate, very considered position was taken to try to avoid a burdensome, cumbersome, formal governance structure.” But Roll Back Malaria recently commissioned Richard Feachem, executive director of the Global Fund, to lead a team in evaluating the alliance, and the team found that the project's loose governance structure made the very concept of partnership unclear. The roles of each partner were undefined, and this “looseness and uncertainty is confusing to the partners themselves; it allows the partners to avoid responsibility and to put blame on others; and it is also confusing to clients at the country level.”6 One damaging aspect of this looseness is that it encouraged WHO to “go it alone” and make decisions without adequate consultation with partners. Rather than being a true alliance, Roll Back Malaria was “a WHO programme with friends.”6 A recurring theme in my interviews with WHO's partners was their fear that WHO was using its new alliances to get back in the driver's seat in international health policy making. “WHO speaks a language of partnership,” said one senior member of a global health agency, “but the reality is of insecurity and control-freakery.” Brundtland rejected this accusation. WHO cannot be criticised in this way, she said, “because we are not just anyone, we are not just any non-governmental organisation, we have a responsibility to all the governments of the world, and not every partner has that.” Alnwick believes that Roll Back Malaria “was WHO plus friends because a lot of the energy and leadership came out of the WHO.” The evaluation concedes that it is easy for WHO to become the whipping boy partly because of this leadership role. “In practice,” it says, “partners yield most of the responsibility for RBM to WHO, and then blame WHO for what goes wrong.”