The potential polio dividend Innovative governance in global polio eradication efforts: Towards the effective transition of polio-related knowledge and processes Stephen A. Matlin,* Michaela Told, Ilona Kickbusch and Julianne Piper Global Health Centre, Graduate Institute of International and Development Studies, Geneva *s.matlin@imperial.ac.uk The polio transition A window of opportunity to multiply the impact of the world’s 30-year investment of > US$15 billion in the Global Polio Eradication Initiative (GPEI), to advance global health goals including health equity, preventing and responding to pandemics and achieving universal health coverage.1 The global health community can preserve the strengths and learn from the weaknesses of governance mechanisms behind the legacy of polio eradication. The relevance of the polio legacy to precision global health is discussed in this presentation, with particular emphasis on issues of access, accountability and ownership. The potential polio dividend Global public good Disease eradicated in human beings for only the second time in history Polio assets can benefit other national and global health objectives and initiatives Sustainable Development Agenda 2030: In addition to SDG3 (ensuring healthy lives), the GPEI is relevant to effective partnership and cross-sectoral collaboration - cornerstones of the contemporary development paradigm. Global Health Security: Polio eradication assets are credited for their effective deployment in response to the Ebola outbreak in Nigeria. Globally, polio surveillance and containment capacities remain a crucial feature of global health security infrastructure Stronger Health Systems: Polio-funded services and staff extend well beyond the scope of combatting a single disease; where they operate, they provide essential primary healthcare services that could be translated into the foundation of health system strengthening The cash dividend gained by donors when no longer funding GPEI Translating Global legacy Future disease eradication programmes? Other global health initiatives GPEI National legacy Country Health Systems Universal Health Coverage Transitioning >90% of GPEI resources are at the country level. Polio assets include: Skilled personnel Community reach Cold chains Surveillance systems Lab facilities Rapid response systems Process of transitioning “country driven” - BUT heavily dependent on bilateral and multilateral partners End of GPEI support in transitioning Tapering off GAVI support Polio assets need linkages to other programmes Reaping the potential polio dividend requires: Moving the polio assets out of the polio silo Adapting the polio lessons regarding access, accountability and ownership Paving stones on the pathway to precision global health Accountability The evolution of accountability mechanisms such as the Polio Oversight Board and the Independent Monitoring Board has played a critical role in the polio story. They serve as potential pathways to build innovative accountability mechanisms for wider health and development agendas; but also to adapt based on lessons learned e.g. in terms of the need for joint ownership and representation. Ownership The goal of eradication has been unifying and created collective ownership – the GPEI has sustained impressive levels of financial and political commitment, which do not necessarily translate to transition processes as easily. The collaborative and cross-sectoral partnership element of polio is highly relevant to the SDG agenda, in creating an ownership and momentum that transcends north-south, public-private divisions. This ownership, driven by the public good of eradication, now needs to extend to wider public goods of health security and UHC. Partnership involving collective action by multiple actors will be central – and requires collective governance and accountability mechanisms. Accountability Ownership Access Access The drive, vision and adaptability of the global governance of the initiative has led to the programme's ability to reach inaccessible and underserved areas to an unprecedented extent. To achieve UHC, the world's most vulnerable and remote populations will need to be connected to health systems - polio offers a number of proven approaches which have been effective in ensuring all children are reached with specific interventions.  Quotes from interviewees in the project Ownership: “There’s a huge lesson to be learned in how you bring together coalitions of partners – public, private, communities etc. – Bringing all of these entities together for one goal and maintaining them together for 30 years” (Interviewee 18)  “There are absolutely no safety nets on how to transition GPEI assets and activities to routine immunisation.… The question becomes who’s responsible, and who finances it? ” (Interviewee 10) Accountability: “To have true resilience evolve is no different than the whole system we have built to eradicate polio. You cannot take away any one part of it without making the system much weaker.” (Interviewee 21) Access: “If you really mean universal health coverage, you know there is 10-20% of the population worldwide which doesn’t get anything, but they get polio drops. So if we can build on that, then that’s something very interesting.” (Interviewee 21) “One of the great difficulties of all the health systems in the world is reaching people equitably. And you have a real good set of examples from polio of how that could be done… It’s a great example of how polio can contribute to a broader strengthening of health systems.” (Interviewee 5) Acknowledgements We thank the Bill and Melinda Gates Foundation for supporting this work. References 1. For publications of the Global Health Centre related to this work, see: Polio eradication: overcoming the final barriers and ensuring a lasting legacy for health systems. http://graduateinstitute.ch/ghp/polio