The challenge of sustaining effectiveness over time: the case of the global network to stop tuberculosis

Abstract

Where once global health decisions were largely the domain of national governments and the World Health Organization, today networks of international organizations, governments, private philanthropies and other entities are actively shaping public policy. However, there is still limited understanding of how global networks form, how they create institutions, how they promote and sustain collective action, and how they adapt to changes in the policy environment. Understanding these processes is crucial to understanding their effectiveness: whether and how global networks influence policy and public health outcomes. This study seeks to address these gaps through the examination of the global network to stop tuberculosis (TB) and the factors influencing its effectiveness over time. Drawing from ∼ 200 document sources and 16 interviews with key informants, we trace the development of the Global Partnership to Stop TB and its work over the past decade. We find that having a centralized core group and a strategic brand helped the network to coalesce around a primary intervention strategy, directly observed treatment short course. This strategy was created before the network was formalized, and helped bring in donors, ministries of health and other organizations committed to fighting TB-growing the network. Adaptations to this strategy, the creation of a consensus-based Global Plan, and the creation of a variety of participatory venues for discussion, helped to expand and sustain the network. Presently, however, tensions have become more apparent within the network as it struggles with changing internal political dynamics and the evolution of the disease. While centralization and stability helped to launch and grow the network, the institutionalization of governance and strategy may have constrained adaptation. Institutionalization and centralization may, therefore, facilitate short-term success for networks, but may end up complicating longer-term effectiveness.

Keywords: Global health policy; governance; networks; policy adoption; policy analysis; tuberculosis.

Figure 1

Structure of the WHO TB Department WHO (2012c)

Figure 2

Revised Structure of the Stop TB Partnership from the Global Plan 2011–2015 (2010)

Figure 3

Total Global Funding for TB from 2002 to 2013 (Total TB Funding data are from the annual WHO Global TB Control Reports, data missing for 2003–2005)

Figure 4

Number of Countries Adopting the DOTS Policy from 1995–2007 (Policy adoption data come from the annual WHO Global TB Control Reports, data missing for 1996)

Figure 5

Drug Susceptible and Drug-Resistant TB Case Detection and Treatment Success 1995–2013 (Case detection and treatment success data come from the annual WHO Global TB Control Reports)