One Door Closes Another Opens: Second Report of the Transition Independent Monitoring Board of the Polio Programme

"Senior global officials of the polio spearheading partners should organise a comprehensive programme of engagement and in-country briefing..."

Created by the Global Polio Eradication Programme (GPEI), the Transition Independent Monitoring Board (TIMB) is tasked with monitoring and guiding the process of polio transition planning. Its role is to monitor progress toward the transition of polio assets - not only the tangible, but also the diverse knowledge and interventions created by countries and the polio programme as it sought to deliver polio vaccine to every child in the world over a 30-year period. After each meeting, the TIMB issues a report; this is its second (see also Related Summaries, below), and it follows the November 2-3 2017 meeting. It provides an analysis of the priorities, plans, risks and opportunities as the eradication of polio appears to be drawing closer.

The opening pages of the report orient the reader to where things are in terms of polio incidence globally and what steps have been taken (and stumbling blocks encountered) in the transition process to date. The TIMB observes that the feel of the discussion at the first TIMB meeting, held in May 2007, "although tentative on concrete commitments, was quite aspirational and tending to lean towards trying to capture the benefits of the full range of the polio transition spectrum." The second TIMB meeting reportedly had a different, more pragmatic tone. "To some extent, this must reflect the growing apprehension about how difficult a task polio transition is beginning to look. It is breathtakingly sweeping and multi-level, involving a complete shift from a well-supported, top-down global enterprise to a country-centred approach that requires local leadership, buy-in, and financing....Other factors are crucially important in determining the pace and scope of polio transition planning. They turn on leadership, the definition of what success looks like, organisational design, the ceding of power, and formal accountability." The TIMB here discusses some challenges in the area of leadership, also exploring the TIMB's role as an independent assessor.

Next, the report examines the risks and challenges associated with certifying the world polio free. Issues related to acute flaccid paralysis (AFP) surveillance are outlined; for example, there is a concern that long-certified countries are simply making the required returns but are not really challenging their own data to explore the risks being faced. It is expected that a Post Certification Strategy will be endorsed at the World Health Assembly in May 2018.

Organisational change is the topic of the report's next chapter. The dissolution of the GPEI requires the component organisations to, for example, agree and communicate their leadership, accountability, and reporting lines for polio essential functions and non-polio aspects of polio transition planning. To look at one such GPEI organisation: Rotary International does see a role for the organisation in polio advocacy in the future, but wish to see how others will be engaged with the Post Certification Strategy before deciding on any involvement. "It is clear that none of the partners yet has an agreed and finalised plan for their organisations. All are at the 'work in progress' stage."

The TIMB looks at country planning and assessment in chapter 4, describing progress since the May 2017 meeting. "On hearing the presentations on country plans at its meeting, the TIMB gained the impression that the development of plans had been driven at the technical level by polio staff, essential immunisation teams and health ministry officials. There seemed to be much less engagement and firm signs of commitment at the political level....Then there are countries that seem to have taken ownership and made a strong national commitment to ensure the availability of national resources (money and personnel). They are intent on continuing to use polio assets (both knowledge gained and infrastructure established) in the last three decades."

At its meeting, the TIMB reviewed the state of relationships between the polio transition planning and other global health programmes where there is potential to review, preserve, or enhance tangible and intangible polio assets by creating synergies. Six examples were discussed: the Measles & Rubella Initiative; essential immunisation; Every Woman Every Child; global health security; Scaling Up Nutrition; and The Global Fund to Fight AIDS, Tuberculosis and Malaria. A chart shows potential for future synergies based on programme components of each that align with GPEI functions or skills, such as community engagement, social mobilisation, and advocacy. Through their contacts in the global health world, TIMB members have listened to the voices of many potential polio transition planning stakeholders. A number of consistent themes emerged, such as: Some of the country polio donors have felt that their voices were not heard loudly enough in the polio eradication programme, and they are concerned that history is repeating itself in polio transition planning.

Following a conclusion that lays out TIMB's concerns about the country planning process and other areas that need to be addressed, the report ends with a list of 18 recommendations for action. For example: "A better defined communication plan should be developed. This should extend beyond reporting on resources and progress, to create awareness about the need for continuous investments by polio free countries until eradication is assured. The goal should be to nurture a social movement around the historic achievement and the collective commitment to a polio free world. It should be adapted to regional and national cultures and situations. It should also include polio champions and polio-affected survivors."

Having recognised that civil society organisations should be a much more prominent part of transition discussions, the TIMB says: "We also intend to initiate a wide range of discussions with non-polio organisations, professional bodies, civil society organisations, and donors prior to and during our next formal meeting."