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Real Collaboration

Real Collaboration: What It Takes for Global Health to Succeed

Mark L. Rosenberg
Elisabeth S. Hayes
Margaret H. McIntyre
Nancy Neill
With a preface by William H. Foege
Copyright Date: 2010
Edition: 1
Pages: 280
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  • Book Info
    Real Collaboration
    Book Description:

    Essential reading for those who work in global health, this practical handbook focuses on what might be the most important lesson of the last fifty years: that collaboration is the best way to make health resources count for disadvantaged people around the world. Designed as a learning resource to catalyze fresh thinking,Real Collaborationdraws from case studies of teams struggling to combat smallpox, river blindness, polio, and other health threats. In honest appraisals, participants share their missteps as well as their successes. Based on these stories, as well as on analyses of many other enterprises, this accessible, engaging book distills the critical factors that can increase the likelihood of success for those who are launching or managing a new partnership. • Features a solutions-oriented approach • Covers leadership skills, management approaches and lessons from experienced project teams • Information is clearly presented in graphics, sidebars, checklists, and other useful features • Supplementary teaching aids including a DVD and additional online resources

    eISBN: 978-0-520-94555-5
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-x)
    Daniel M. Fox, Carmen Hooker Odom and Samuel L. Milbank

    The Milbank Memorial Fund is an endowed operating foundation that works to improve health by helping decision makers in the public and private sectors acquire and use the best available evidence to inform policy for health care and population health. The Fund has engaged in nonpartisan analysis, study, research, and communication about significant issues in health policy about significant issues in health policy since its inception in 1905.

    This is the twentieth book of the series of California/Milbank Books on Health and the Public. The publishing partnership between the Fund and the University of California Press encourages the synthesis and...

    (pp. xi-xiv)
    William H. Foege
    (pp. xv-xviii)
  6. Chapter 1 INTRODUCTION: Why Collaboration Matters and Why It Happens Too Rarely
    (pp. 1-14)

    In the mid-1980s several organizations involved in global health wrestled with how to get a stalled immunization effort back on track. They formed the Task Force for Child Survival, a partnership that quickly reinvigorated the effort and allowed the organizations to reach the goal.¹ The partnership had another impact: it provided a stunning example of what partnerships could achieve through real collaboration. Briefly, this is how the story of the Task Force unfolded.

    In 1974 member states of the World Health Organization (WHO) had passed a resolution to bring vaccines to children across the globe. At the Alma Ata Conference...


      (pp. 17-30)

      In 2003 two of our authors, Mark Rosenberg and Margaret McIntyre, experienced firsthand the impact external forces can have on a partnership. They were working on a drug-resistant TB effort in Peru with the Partnership Against Resistant Tuberculosis: A Network for Equity and Resource Sharing (PARTNERS) TB Control Program.¹ Rosenberg recounts the effort:

      It was a very compelling project—showing the feasibility of scaling up the treatment of multi-drug-resistant TB (MDR-TB) to all of Peru and creating an approach to be used across the world. We had great resources: Partners in Health initially supplied the medical staff, Socios en Salud...

      (pp. 31-51)

      Once in a rare while, global health reaches a critical threshold in technology or strategy for controlling a disease/threat. Smallpox during the middle of the twentieth century is a good example: a vaccine had been developed in 1796, but it was the technological advances in the 1950s for delivering the vaccine—a bifurcated needle and a freeze-dried process—that made mass vaccinations practical. With these advances global health had both a product and a way to deliver it, and the modern story of smallpox eradication efforts began.

      With smallpox still raging in sixty-three developing countries, scarring more than ten million...

      (pp. 52-66)

      In chapters 2 and 3 we’ve described two challenges to developing real collaboration—the diverse landscape of global health and the nature of the disease or threat. The third major area consists of the cultural and social challenges of working with a diverse group of human beings.

      The formative period of the Mectizan Donation Program illustrates how easy it is for cultural issues to get in the way of close collaboration.

      Africans had lived with what they called “river blindness” for generations when merck & Co. made a key discovery in 1987. Bill Foege, senior adviser for the Bill &...


    • [PART TWO: Introduction]
      (pp. 67-68)

      With such complex challenges facing global health initiatives, we knew it was impossible to try to devise a simple formula for achieving real collaboration. At the same time, partnerships clearly need some kind of guidance. We asked ourselves how we could frame the lessons learned from the partnerships we were examining in a useful way.

      To prepare for the meeting of our advisory group, we developed materials around a theme of “Last Mile” collaboration—stressing the importance of collaborating in a way that takes the project all the way to impact, whether that is in terms of saving lives or...

      (pp. 69-84)

      In a book about climbing the world’s second-highest mountain, K2 in the Himalayas, photographer Jim Curran describes the experience of seeing the peak from base camp: “There it was, unequivocal, real, present, impassive and quite monumentally huge. A great triangle that hung like a gigantic backdrop to the silent amphitheatre of Concordia. It, too, was draped in snow and its wintery vastness looked utterly impregnable, yet with a beauty and simplicity of form and balance that gave it a certain lightness that I had not expected from the many photos I had seen taken from this spot.”¹ Curran’s description reminded...

    • Chapter 6 THE FIRST MILE
      (pp. 85-107)

      Chapter 5 described the photographer Jim Curran’s awe at the colossal peak of K2 rising before him when he arrived at base camp. After this initial surge of exuberance, he and his fellow climbers settled down to the more mundane tasks of a base amp—acclimating themselves, agreeing on roles, and preparing for the climb.

      As we completed our research and analysis for this book, we concluded that the First Mile of a collaborative partnership involves similar tasks, and it’s the experience of working together on these tasks that helps the team lay the foundation for trust and close collaboration...

    • Chapter 7 THE JOURNEY: Discipline and Flexibility in Management
      (pp. 108-126)

      Jim Curran, the photographer who joined a group of climbers on K2, describes what it felt like to leave base camp and begin his journey up the mountain: “Would so many people moving up and down the mountain work out for good or bad? If harmony and co-operation prevailed, there could be a formidable collection of strong climbers breaking and maintaining trail which, after the bad weather, would be a more than normally arduous business higher up. But rivalry and discord could create a modern day Tower of Babel and the whole random collection of men and women striving for...

    • Chapter 8 THE JOURNEY: Complementary Leadership Roles
      (pp. 127-142)

      Photographer Jim Curran’s mountain-climbing team began to run into serious problems in their journey up the treacherous slopes of K2. Unfortunately, their leader was unable to guide them through these difficulties.

      “[His reluctance] was almost a matter of principle with him,” Curran says, “for he always believed that leadership was unnecessary, just a word on a piece of paper to satisfy bureaucracy. But the fact was he didn’t enjoy it and, because of that, wasn’t very good at it.”¹

      This attitude strikes a familiar chord in global health projects, where partners often focus on the intervention itself and pay little...

    • Chapter 9 THE LAST MILE
      (pp. 143-156)

      The mountain climbers we’ve been following up the slopes of K2 struggled as the weather turned dangerous. Without strong leadership they had never become a real team, and conflicts began to surface. Photographer Jim Curran describes their state of mind:

      Our attempts on the North-West ridge had fizzled out with the knowledge that we had not even managed a summit bid. Given the weather and the weakened team, we have had no reason to reproach ourselves, let alone blame anyone, but by now no-one was particularly happy with themselves, or with others. It was 8th July and after six and...

      (pp. 157-175)

      Dramatic forces have swept through global health since the mid-1980s, shattering the architecture that had given shape to the field, multiplying the number of participating organizations, and increasing the expectation that recipient countries should participate in decision making. In this new environment individuals from every sector have voiced a need for working together more effectively and shared with us their lessons learned for achieving real collaboration. A pivotal force for ensuring these lessons are applied is the donor community—the global agencies, bilaterals, multilaterals, NGOs, foundations, and private-sector organizations that have made a commitment to global health. They have the...

    • Chapter 11 CONCLUSION: The Purpose of Real Collaboration
      (pp. 176-178)

      Throughout this book we’ve described an exceptional kind of partnership—the kind that becomes an integrated team and then goes on to achieve far more than anyone anticipated. Like author Jim Collins in his bookGood to Great in the Social Sectorsand Jon Katzenbach and Douglas Smith inThe Wisdom of Teams,we’re talking about excellence and the rewards it brings.¹ We chose this focus because the rewards of dramatically improving human lives are worth the difficulties. We can think of no better way to close this book than to return to the inspiring words of Stephen Lewis, the...


    • The First Mile Toolkit
      (pp. 179-196)

      As a participant in a newly launched global health project, you are about to begin the exciting yet sometimes daunting First Mile. As pointed out in Chapter 5, the First Mile of a partnership is characterized by optimism and a sense of possibility, but it can also be intimidating. To make the task a little less overwhelming, we have provided you with a toolkit.

      In the following pages are tools that can help the partners accomplish the important tasks of this stage:

      Choose the right membership

      Develop a shared goal

      Select the appropriate structure

      Shape a strategy

      Clarify organizational roles...

    • The Journey: Management Toolkit
      (pp. 197-210)

      The Journey of a global health partnership will present many challenges—logistical, technical, financial, personal, or social in nature. Chapter 7 includes examples of partnerships that have faced such challenges and emerged even stronger than before. One of the central lessons learned from their experiences is that global health teams need to apply greater management discipline to their efforts. This “Journey: Management Toolkit” provides tools to do so and addresses the following:

      Research and planning. Partnerships must apply discipline in research and planning to combat the unexpected but inevitable twists and turns in the journey using a flexible approach. Effective...

    • The Journey: Leadership Toolkit
      (pp. 211-221)

      As mentioned in Chapter 8, fulfillment of several leadership roles is extremely important in global health partnerships. The most successful partnerships fill the needed leadership roles not through a single, strong individual but through complementary leadership in both internal (team) roles and external roles. Over the life of a partnership, roles assume lesser and greater importance, and one role may actually be played by several people as needed. These tools help partnerships clarify the responsibilities for each of these roles, so the person(s) assuming the role can develop an action agenda.

      Whether a partnership is formally chartered or remains informal,...

    • The Last Mile Toolkit
      (pp. 222-232)

      With the goal in sight and the imminent dissolution of the partnership just around the corner, several important exercises will enable a smooth transition and increase the likelihood of program sustainability once the partnership leaves it in the hands of local stakeholders.

      In partnerships focused on intervention, a change in approach to surveillance is often needed in the Last Mile as the number of cases declines. While increasing capabilities to conduct surveillance earlier in a partnership typically lead to detection of a greater number of cases, the number of cases detected drops as a partnership nears its goal. At this...

    • The Donor Toolkit
      (pp. 233-242)

      A pivotal force for ensuring that the lessons of collaboration are applied is the donor community—the global agencies, bilaterals, multilaterals, NGOs, foundations, and private-sector organizations that have made a commitment to global health. In every successful partnership we profiled, donors played a highly supportive role in providing strategic guidance, supporting local area infrastructure, and/or encouraging collaboration between members of a partnership. The following tools are examples of additional ways donors can support collaboration.

      The heart of close collaboration is the partner group itself the individuals who arrive with different perspectives to try to reach a single goal. Whether they...

  10. Appendix 1. Coalitions and Collaboration in Global Health: A Dialogue Hosted by the Task Force for Global Health (formerly the Task Force for Child Survival and Development)
    (pp. 243-244)
  11. Appendix 2. Coalitions and Collaboration in Global Health: A Symposium for Global Health Leaders
    (pp. 245-248)
    (pp. 249-252)
  13. INDEX
    (pp. 253-262)