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

Deciding a new strategic direction for an organisation is a daunting task. But it’s also an exciting opportunity to step back and take a wider view, not only on what we’re doing, but why we do what we do.

It’s an opportunity to ‘zoom out’ of our daily focus on our nearest tasks and goals, so that we can see important opportunities to make a more lasting impact. This also prevents us from overlooking the threats that could undermine our success.

The bigger picture

A story from my own life helps to illustrate this.

Three years ago, my then four-year-old daughter was diagnosed Type 1 diabetes, making her totally dependent on insulin. Fortunately, our health service in the UK provides her with highly advanced technology that monitors and adjusts her insulin levels, free of charge.

When travelling as a family to visit relatives in Arusha, Tanzania, we reviewed the healthcare services available in the area in case of an emergency. We quickly realised that no diabetic care or insulin was available in any local health facilities, and even supply from Dar es Salaam was unreliable. The reality faced by mothers of diabetic children living in this area hit me profoundly.

I forgot all my public health training and for a moment considered trying to bring with me enough insulin to supply the Arusha area. I of course knew that diabetes is a lifelong disease that needs a robust system in place not only for a guaranteed supply of insulin, but also to train and support individuals and families to cope with the complications of the disease. Bringing a one-off supply of insulin with me, however worthwhile, would do very little to change the healthcare reality for those living in the area.

Even after a long career in public health, this moment brought the depth of health inequity experienced by so many to a very personal level.

This made me reflect on the work we do as an organisation.

Most of us who work in global health do so because we want to ‘do something worthwhile’. It’s easy to forget that the way in which we deliver this something may end up being part of the problem. How we needed to change the way we work became even more central to the strategic shifts we are making.

What does this mean in practical terms for us as an organisation?

This is not the first time we implement a significant shift in our strategy. Having been set up as a disease-control initiative focused on very specific interventions, our previous strategy took a more comprehensive approach and incorporated broader primary prevention and care elements alongside our mainstay of mass treatment of parasitic infections.

We now see that this shift did not go far enough. The targets and goals set out under the Sustainable Development Agenda, and by the World Health Organization (WHO) – on universal health coverage, ending poverty, tackling inequalities, and eliminating diseases – require a much more radical shift not only in the interventions we support but also in the way we deliver that support.

How does this change what we will be doing?

We can be proud of our achievements to date, which include supporting the delivery of one billion treatments against parasitic infections, a milestone reached on our 20^th anniversary last year. Our new strategy will have at its core the ambition to end preventable parasitic infections and to improve health equity, and ultimately to contribute to resilient systems that sustain good health, so everyone everywhere can reach their full potential.

In practice, this means building on our existing legacy and broadening our work to include other crucial aspects such as improving programme quality and impact and supporting cross sectoral collaboration. Importantly, it also means shifting the power balance that currently undermines country ownership and health systems resilience and further embeds inequalities.

Instead of viewing interventions as the starting point, we will be responsive to the requirements of our endemic country colleagues to support local health systems that deliver programmes according to their own context.

These may seem like obvious steps, but they represent a significant departure from the way in which we have operated until now. As a partner organisation headquartered outside of the countries whose efforts we support, we must ensure that the way we operate does not result in structures, systems and power dynamics that undermine what we are all trying to achieve.

Not having country-based offices has been a key principle for our organisation from the start, precisely to avoid the risk of setting up parallel structures. But we need to further modify our processes and ways of working to truly transform and challenge the remaining barriers to health systems resilience, country ownership and health equity. The how of what we do matters just as much as the what.

This approach will require not only engaging new funders, but also supporting our country partners to mobilise their own resources. This will be a completely different way of working, but we believe it is essential to support the change we want to see.

Zooming out – why we do what we do

We were founded in 2002 as the Schistosomiasis Control Initiative; at that time, this name very much reflected what we did. But things have changed, both in the disease control space – from control to elimination; and in global health more generally – from programme-driven aid to health systems strengthening. Our work, and that of the broader NTD community, can, and in my opinion, must also be directed to support the broader agenda of health equity and health systems resilience by being responsive to the requirements of our Ministry of Health clients who ultimately have the responsibility for the health of their citizens not only their NTD status.

This new why of health without limits for all is at the core of our new name: Unlimit Health. Our aim, to end parasitic diseases together, is reflected in our new strapline.

Together with our new strategy, we believe this new brand will allow us to support country-owned solutions that eliminate parasitic infections for good.

Watch strategy video: