Beyond good intentions: building sustainable health solutions, together

The importance of tackling power dynamics to ensure health for all  

In the world of global health, good intentions don’t always translate into lasting change. At Unlimit Health, we’ve recognised that how we work is just as crucial as what we do. Our journey from an academic research group to a not-for-profit organisation to a catalyst for sustainable health systems that ensure health equity represents a fundamental shift in addressing neglected tropical diseases (NTDs).   

From the beginning, we have aimed to strengthen existing structures, provide the resources and support the development of the capacities required to deliver nationally owned programmes, while avoiding establishing parallel structures. Practically, this means we work directly with our ministry of health (MoH) colleagues, providing support at their request and direction, and do not have our own presence within the countries we support.  Nevertheless, we have been constantly refining our ways of working to truly transform and challenge the remaining barriers to health for all.  

For this reason and those outlined in the previous article, we launched a new strategy and brand last year. The strategy, as well as our new name and brand, have at their core the ambition to end preventable parasitic infections, improve health equity, and support resilient systems that sustain good health, so everyone everywhere can reach their full potential. Crucially, our new identity represented an intentional change towards prioritising and committing to the how of what we do, just as much as the what.  

Our role in supporting locally-led development and health equity  

For decades, global health efforts have been plagued by power imbalances between international stakeholders and local health systems resulting in fragmentation, resource waste and undermining the sustainability of health interventions and programmes. International financing for vertical health programmes has created parallel healthcare delivery structures, undermining the very national health systems they aimed to strengthen. It’s widely acknowledged that the sustainable impact of health interventions can only be built when health system priorities are locally led.  

We believe that as an organisation, and as part of the larger NTD community, we have a responsibility to support the broader agenda of health equity and health systems resilience by being even more responsive to the requirements of our endemic country colleagues. Ultimately, all MoH are responsible for the health of their citizens and delivering programmes according to their own context.  As such, following analysis of the changing development and global health context, in addition to aligning our strategy with the three pillars of the World Health Organization’s (WHO) NTD road map, we put country ownership, partnership, and alignment with country needs, at the heart of our approach. This means supporting practical approaches to domestic resourcing and health systems that deliver programmes in response to population needs. This necessarily involves ‘undoing’ much of the current practices that exist in international development, and we acknowledge that it will take time to see tangible outcomes.  

Committing to the principles of coordination, cooperation, and partnership  

The recent WHO global progress report on NTDs indicates that 89.1 million people affected by schistosomiasis received treatment in 2022. Working in partnership with our MoH colleagues, we supported treatment for schistosomiasis to 40% of all people treated globally, highlighting the strength and impact of these partnerships.  

Our transformation extends beyond our own organisation. We’re proud members of collaborations like the Pediatric Praziquantel Consortium, a public-private partnership working to provide access and delivery of a new paediatric formulation for schistosomiasis. A recent success of the consortium is having this new treatment option included in WHO’s list of prequalified medicines, bringing it one step closer to young patients in need.  

But we’re not stopping at treatment. We’re advocating for and supporting a shift from vertical disease programmes to holistic approaches that integrate NTD efforts with other health services. Imagine a future where a woman receiving cervical cancer screening can also be tested and treated for female genital schistosomiasis (FGS) in the same visit – that’s the kind of integrated, efficient care we’re working towards, together with other members of the new coalition FIG – the FGS Integration Group. 

From disease control to elimination

The WHO’s recommendation to shift from vertical disease programmes to holistic and impact-orientated approaches to elimination also means focusing on more effective coordination between different sectors, including water, sanitation and hygiene (WASH), education, and nutrition, and taking a One Health approach, to tackle the root causes of the infection cycle.   

If future generations are to benefit from disease elimination efforts, there also needs to be sustained delivery of interventions by these different sectors that go beyond treatment and include prevention as well as care for disease symptoms where needed. This requires finding ways to integrate disease-specific interventions with other disease control programmes and other health services within the health system to support efficiency and reduce the burden on health workers.  

Laying the foundations to achieve the end goals

Sustainable Development Goal 3 and the WHO NTD roadmap not only highlight the importance of prioritising these diseases but also that endemic countries must continue to lead and take ownership of ending NTDs. This approach requires engaging new funders and supporting our country partners to mobilise existing domestic resources to target NTDs more effectively. Available domestic resources can be used more effectively to achieve disease elimination and reduce reliance on increasingly uncertain external resources. It’s a different way of working, but it is essential to improving health sustainably and supporting the change we all want to see.  

Transforming global health isn’t just about new medicines or more funding – it’s about reimagining the relationships between international organisations, local health systems, and communities affected by parasitic disease. At Unlimit Health, we’re committed to being part of this change.  

This approach is already having an impact. By prioritising true partnership and country ownership, we’re laying the groundwork for a future where parasitic diseases are a thing of the past and health systems are resilient and equitable.  

Stay tuned to our Re-imaging global health series for the next article, sharing views from our partners, in their own words, on how we are meeting our commitments.