In this module on global health governance, we're discussing the wide range of governance models being used for various organizations and initiatives. In this lesson, we're going to talk about the Global Polio Eradication Initiative, or GPEI, which is one of the most ambitious and wide-reaching global health initiatives in recent years. It has reduced polio cases by 99% and has an annual budget of $1 billion. Let's go back to 1988 when the World Health Assembly voted on a resolution vowing to eradicate polio by 2000. At that time, polio paralyzed more than 1,000 children every day. What's interesting and unusual about this WHA resolution is that it was championed by a civil society organization, Rotary International. Which prioritized polio eradication for their organization and had pledged to raise $120 million to vaccinate children against polio. Once this resolution was approved by the World Health Assembly, the Global Polio Eradication Initiative was created. GPEI was housed at WHO, and its leader reports to the Director General of the World Health Organization. In addition to the WHO, the Initiative also included UNICEF, the US Centers for Disease Control and Rotary International. These groups called themselves the spearheading partners and together they made all decisions about the polio program. The original goal was for polio to be eradicated by 2000. While cases decreased significantly, unfortunately, that milestone was missed and so were the next several. The program was heavily criticized for not achieving its goals and was running out of funding. In 2007, the Bill & Melinda Gates Foundation announced that it would contribute $100 million toward the eradication of polio. At the time, it was believed that polio could be eradicated within five years. Within the next few years, the polio program budget reached a steady state of $1 billion a year. Yet despite the magnitude of this budget, the program was still being governed by the four original spearheading partners. It was an unusual governance dynamic, as the four organizations who were implementing the work and managing the budget were the same organizations charged with overseeing their program. The donors who contributed the funding and the countries where the work was being performed had no formal say in the program's overall governance. Major funders of the polio program, including the United States, the United Kingdom, and the Gates Foundation, pushed for stronger governance and a number of new entities were created. The first is the Polio Oversight Board, which includes leaders from the original four spearheading partners plus the Gates Foundation. This group meets quarterly with the defined goals of providing operational oversight and high level accountability across the GPEI partnership. Unfortunately, this oversight board still has the same governance challenge of the previous mechanism, as the board is only comprised of five organizations who are heavily involved in the day to day execution of the program. The second new entity is the Global Polio Partners Group, called the PPG. The PPG serves as a stakeholder voice for the GPEI and reports the results to the Polio Oversight Board. The addition of this group has expanded the input given to polio decision makers so that a wide range of organizations who are involved in polio, including donor and endemic country governments, can contribute. However, the group is somewhat informal in nature and its recommendations are non-binding. A third group that was established was the Independent Monitoring Board or IMB. While this group is funded out of the GPEI budget, it operates independently and issues regular reports with very candid assessments of GPEI's progress toward eradicating polio and advises on course corrections or changes that the program needs to make. While the IMB has been a big improvement in transparency and independence in the polio governance landscape, its mandate is limited only to certain GPEI activities. And it has no authority to make changes, only provides a bully pulpit for making recommendations. In summary, while these additional governance mechanisms have certainly strengthened and broadened the participation and oversight of the polio program. The governance of GPEI would still benefit from adopting some of the best practices in governance from other organizations in the global health sector. Now let's take a moment to review what we have learned so far.
