WORKING GROUP ON INVESTMENT FOR IMPACT IN THE CONTROL OF NEGLECTED TROPICAL DISEASES (IfI) Terms of Reference Mission: Generating evidence for investment and impact in the prevention, control, elimination and eradication of Neglected Tropical Diseases 1. Preamble Investments in NTD control have increased in recent years, including increase in national budget, commitments from community of partners and in-kind donations of medicines by the pharmaceutical industry. An integrated portfolio of interventions is delivering better value for money than ever before. However, sustained investment remains insufficient to achieve the targets for eradication, elimination and control laid out in WHO s Roadmap. In its 2012 NTD Report, WHO expressed its commitment to assist Member States in undertaking the necessary analysis and making appropriate forecasts of investments needed for implementation. Given the changing economic and political landscape, greater focus may need to be placed on domestic funding. Investment needs and the financing mix will change as countries move through the last mile of elimination to post-elimination surveillance. The World Health Assembly resolution of 2013 urges Member States to expand implementation by "ensuring that resources match national requirements and flow in a sustainable manner as a result of thorough planning and costing of prevention and control activities and detailed analysis of associated expenditures". There is considerable evidence of the association between NTDs and poor health outcomes, lower educational performance and higher levels of poverty. However, there is more limited evidence of the impact of NTD control in contributing to human development. The Sixth meeting of the Strategic and Technical Advisory Group (STAG) on Neglected Tropical Diseases (NTDs) in 2013 discussed the need for the Department of Neglected Tropical Diseases to ready itself for the post-2015 development agenda (post-millenium Development Goals), including but not limited to Universal Health Coverage, and concluded that economic and other evidence demonstrating the multisectoral impact of NTD control should be given high priority within the evolving STAG architecture. It was suggested that Task Force on Enhanced Measurement of the impact and outcomes of Preventive Chemotherapy and control of NTDs (EMPaCT) should continue its work under a new Working Group (WG), going beyond the epidemiological impact of interventions targeting diseases amenable to preventive chemotherapy. This document defines the terms of reference of this WG, named Investment for Impact in accordance with its primary objectives. 2. WG objectives The mid- and long-term objectives of the WG are to assist WHO and its Member States: (a) to optimize the level of investment in NTD control by endemic countries or regions and their partners in development, better leveraging the resources already available and diversifying or increasing them as necessary; (b) to demonstrate the impact of those investments beyond epidemiological impact and across development sectors, such as education, water and sanitation, transport, agriculture and veterinary public health; (c) to monitor and evaluate the contribution of NTD control to the post-2015 (post-mdg) agenda with a special focus on access, financial protection and achieving universal health coverage; Shorter-term objectives may be articulated, as required. For example: 1
(x) to inform the forthcoming WHO report on Investing to overcome the global impact of neglected tropical diseases, to be published end 2014 and Disease Control Priorities Project 3rd edition in 2015. 3. WG activities WG Participants (as defined in 5.1 below) are expected to: (a) identify gaps and opportunities in gathering the evidence needed to monitor investments and evaluate impact, in collaboration where relevant with the WHO NTD M&E Working Group; (b) provide support to WHO and its Member States in the generation and application of such evidence; (c) improve collaboration and coordination among WG Participants and, as required, the broader range of stakeholders involved in related initiatives; (d) flag emerging issues of strategic importance for WHO, its Member States, and NTD champions; (e) assess and synthesize the available evidence and draw conclusions on specific questions put to the WG by STAG. 4. Nature of the WG The WG reports to the STAG. The WG is a flexible organisational structure established by the STAG and administered by WHO. The WG will provide the Participants with the opportunity to discuss matters which fall within these Terms of Reference and, where appropriate, to formulate proposals and recommendations to be adopted through a consensus-based approach and made public. Such proposals, recommendations and working plans do not commit the participating governments, organisations, institutions, agencies and associations in any way, but constitute a reference for guidelines, official policy or other action, as appropriate, under the responsibility, and according to the prerogative, mandate and internal rules and procedures of each such participating governments, organisations, institutions, agencies and associations. 5. WG Collaborating Parties and Structure 5.1 Collaborating Parties: The WG is open to the following collaborating parties involved in activities that may influence investments for impact in NTD control, including but not limited to impact evaluation, health economics, health financing, international development, poverty alleviation, public policy and public finance. The WG aims at ensuring appropriate regional representation, especially from developing countries where NTDs are endemic. Participants (a) (b) (c) (d) (e) Intergovernmental organizations and institutions, such as the World Health Organization and the World Bank; Governmental institutions and agencies; Universities and other academic institutions; WHO Collaborating Centres; International non-governmental organizations; Invited experts The WG may invite individual experts, with outstanding experience, to participate in meetings of the WG, 2
for the purpose of sharing information and/or advising the Participants on matters within the sphere of their competence. Invited experts will not, however, be considered as Participants. They will be considered as Temporary Advisers and, as such, will need to sign a declaration of interest before attending any formal meetings so that conflicts of interest can be announced before the start of these meetings. Observers The WG may furthermore invite organisations, institutions, agencies and associations who do not meet the criteria for participation, but are involved in activities which are relevant to all or part of the goal and objectives of the WG to attend all or certain designated meetings of the WG, as observers. Observers will not be considered as Participants. Upon invitation of the Chairperson, they may, however, make a statement to present their views or positions on the issue under consideration. 5.2 General Guidance The WG will be guided by the STAG. The Secretariat (see 5.5) will develop guiding principles and a practical mechanism to ensure the effective operation of the WG. The STAG will review the reports and proposals presented to it by the WG (see 5.3) and, where appropriate, will recommend all or part of their content for endorsement in light of the WG goals and objectives. The STAG will perform its responsibilities on the basis of its own terms of reference. The STAG will biennially nominate a WG Chairperson to act for a two-year term. 5.3 Management Unit of the WG The Management Unit shall be comprised of the WG Chairperson and the WHO Secretariat. The responsibilities of the Management Unit will consist of the following: (a) development and coordination of reports and proposals of relevant collaborating parties for review by the STAG; (c) review and acceptance of applications for participation as experts or observers in the WG meetings; (d) identification of the need for invited experts (as described above) to support the achievement of the WG's objectives; (e) identification of the need for the establishment of semi-formal networks (see 5.4) to address and advise the WG and the STAG on specific issues relevant to the WG's goal and objectives (for confirmation by the STAG); and (f) submission of proposals for nomination of candidates for WG Chairperson to the STAG. The Management Unit will operate by consensus, and will meet (virtually) at least once a year, in addition to usual meetings of the WG. 5.4 Networks As noted above, the WG may support the establishment of semi-formal networks to address specific issues relating to the WG's goals and objectives. Networks will be managed by a Focal Point, that is the WG Chairperson or, depending on the workload and competencies involved, any other WG Participant as selected by the Management Unit. 3
These networks are semi-formal in the sense that they are coordinated by a WG Participant but may comprise members from outside the WG. Only the network Focal Point is formally recognized as a WG Participant. Other network members may be invited to WG meetings as Invited Experts or Observers. Networks may be formed around sectors, disciplines, topics or working modalities, as deemed appropriate by the WG Chairperson and as allowed by the expertise and convening power of individual WG Participants. In the interest of generating evidence for an integrated NTD portfolio, networks will not be formed around individual diseases. Possible sectoral networks have been discussed at two meetings on Measurement of Enhanced Outcomes and Impact of Preventive Chemotherapy, convened by WHO in September 2011 and April 2012: (a) Health (b) Socio-economics / poverty reduction (c) Education (d) Water, sanitation and hygiene (WaSH) In extending the work beyond the Preventive Chemotherapy diseases, one might also add: (e) Agriculture and animal health Disciplinary networks were discussed at the STAG in April 2013: (a) Impact evaluation (b) Health economics, including economic evaluation (cost, cost-benefit, cost-effectiveness) (c) Health financing, including planning and budgeting, health accounts, health insurance (d) Public policy and finance A topical network might, for example, focus on the post-2015 agenda, Universal Health Coverage, climate change or vector control. A modal network might, for example, focus on pairing the explicit needs of disease-endemic countries for evidence generation with a global network of students, as proposed by the EMPaCT Task Force of the Monitoring and Evaluation Working Group. 5.5 Secretariat support for the WG Subject to the availability of sufficient human and financial resources for this purpose, secretariat support for the WG will be provided by WHO, though its NTD Department at the Organization's headquarters in Geneva. In this connection, WHO will, among other things,: (a) coordinate the organization of the meetings of the WG (b) organise a central repository of information and documents relevant to the WG; (c) maintain a database of participants activities relevant to the WG; (d) inform the participants of activities, ongoing, or planned; (e) prepare and distribute draft agendas, meeting reports, progress reports, and overviews of implementation, etc; (f) receive and inform the STAG of notices of termination; and (g) take the necessary measures to ensure the confidentiality and protection of materials and information that are provided to WHO with the request to keep them protected from unauthorized access. WG documents and other output will be issued by WHO and will be disseminated with appropriate disclaimers, including that the content does not necessarily reflect the views or stated policy of the participating organizations, agencies and institutions (including WHO, providing the secretariat support for the WG), as well as a clarification of the nature of the proposals/recommendations put forward in such WG documents. 6. Budget and financing 4
6.1 Budget ceiling The annual budget of the working group will not exceed US$ 100,000. This is to cover travel expenses for up to a maximum of 10 people ($3000 each for air travel and 4 days of per diem at US$400) and $4,000 in miscellaneous meeting costs, for no more than two meetings per year, and usually one. Some cost and human resource efficiencies are expected, as expertise that had previously been pulled into multiple fora will now circle around one group. To the extent possible, travel expenses will be reduced by organizing meetings directly before or after other major meetings. 6.2 Financing of and fundraising for the WG Secretariat support will be provided in accordance with the terms of reference of existing WHO staff members. Each Participant, Observer, and other invited expert will, in principle, be responsible for meeting its own expenses in relation to the WG (including, but not limited to, travel and subsistence for the attendance of meetings and country-focused initiatives). Subject to the availability of funds, WHO (as a provider of secretariat support) may, in consultation and agreement with the WG Chairperson, decide to support the participation of certain developing country Participants and/or of invited experts. WHO may raise funds from other sources to support the work of the WG, in accordance with WHO's established policies and principles. 7. Applications Applications to become a Participant or Observer will be submitted to WHO for presentation to the Management Unit and the STAG, in accordance with the procedure described above. 8. Termination Any participant, observer, and invited expert may decide to terminate their involvement in the WG by providing written notice to WHO as the WG secretariat. WHO shall remove the organization, agency or institution or individual in question from the list of participants, observers, or experts, as appropriate, and inform the STAG accordingly. In addition, it should be noted that: (a) the involvement of observers and invited experts extends only for as long as they are invited by the STAG; and that (b) the involvement of any Participant shall terminate (on a voluntary basis or by consensus of the STAG), if and when this Participant ceases to meet the criteria set forth in the first paragraph of section 5.1 above or no longer subscribes to the goal and objectives of the WG as described above. 9. Amendments These Terms of Reference may by modified by consensus at a STAG meeting. 5