“Progress is impossible without change” – our priorities for the year ahead

Change is constantly present in our lives, but we would all be forgiven for feeling overwhelmed by the pace and magnitude of change over the past few years. At SCI Foundation, however, we have tried to stay mindful of the fact that, in the words of George Bernard Shaw, “progress is impossible without change”; we are therefore committed to using this period of turbulence to catalyse progress towards our mission and goals.

Two decades of work on schistosomiasis

Being open to change, and the benefits it brings, is more relevant than ever for SCI Foundation. This year marks 20 years since our establishment as the Schistosomiasis Control Initiative within Imperial College London, and the context in which we operate in 2022 is markedly different to that which led to our existence.

At that time, the prevalence of schistosomiasis and other parasitic worm infections represented a constant heavy toll on the lives and livelihoods of hundreds of millions of people globally, and most endemic countries lacked the medicines and the strategies to address the problem.

Today, thanks to strong, country-led programmes, and the availability of donated medication resulting in over 500m children being treated for parasitic worm infections in 2020 alone, the burden of disease has reduced substantially. However, these achievements, although substantial, are fragile and can be overturned without sustained external support.

The changing landscape of NTDs and international development

Our work has been affected by major changes both within the neglected tropical diseases (NTDs) community, and in the broader context of international development. As I highlighted last year, a new 10-year road map on NTDs represents a significant change in approach, away from disease control programmes centred around treatment coverage, towards a strong focus on disease elimination efforts, led by endemic country governments and based on cross-cutting approaches and resilient domestic health systems.

The overall context of international aid, in which low- and middle-income countries have been traditionally perceived as passive recipients, continues to change rapidly. The negative consequences of this approach to aid, and its link to colonial power structures and political agendas, is now being recognised. Non-governmental organisations like ours are also recognising our own roles and responsibilities in improving equity, inclusion and transparency. This responsibility means being willing, and able, to make significant and sometimes uncomfortable changes where needed.

A seismic change has also taken place within the international development funding landscape, resulting from both negative (pandemic-induced real and perceived financial constraints) and potentially positive shifts in the mindset of large aid funders, away from vertical programme funding and towards system strengthening. While this change in particular has led to uncertainty and discomfort as it challenges established models of operation for charitable organisations like ours, it is ultimately crucial to bring about the sort of paradigm shifts that will be needed to make real progress towards elimination of disease and improve equity.

These changes will have a significant impact on our work in the years to come.

Putting equity first

We are proud to have been part of supporting the ongoing delivery of medicines against schistosomiasis and soil-transmitted helminth infections, but our ultimate goal remains the elimination of disease and the reduction in the need for indefinite control efforts and the resources these require. Later this year, we will be publishing our new five-year organisational strategy, and while there is much in our current strategy that is still valid and will remain in place, our focus will be shifting away from relatively narrow disease-control objectives to one aimed at improving health equity through disease elimination. This will include a stronger focus on improving access to healthcare services, as well as health promotion, to ensure no one is left behind.

Making change systematic

We have always seen our role working in true partnership with Ministries of Health in support of the development of national health systems that are able deliver based on the needs of their populations. Treatment for parasitic worm infections is and will continue to be a strong feature of our work, building on both its importance and its cost-effective nature. However, we will also accelerate our existing efforts to ensure that this is delivered as part of an overall package of services to strengthen health systems and improve their resilience, alongside a stronger focus on primary disease prevention and a One Health approach. As I mentioned last year, these aspects of systems strengthening, country ownership and cross-cutting actions are fundamental to achieving the targets of the NTD road map. This will also mean reviewing and adjusting our own organisational systems and ways of working.

What’s in a name?

Part of the change process will include reflecting on whether our current identity – our name, our brand and the way we communicate – reflects who we are and who we want to be as an organisation. While some changes have been made over the years, we are cognisant that our identity still reflects a reality of two decades ago, and new ways of working may require more fundamental changes to how we are seen publicly.

I am certain that 2022 will continue the trend of the past few years, bringing more change and unpredictability to the world at large and to our own work. Nonetheless, I and the SCI Foundation team are ready not only to embrace the consequences, but to actively bring them about.

Dr Wendy Harrison, CEO, SCI Foundation