AXIS 3—An effective mechanism of coordination for technical support, resource mobilization, and partnership at local and global levels

The Global Roadmap is a compelling country-driven, multi-sectoral strategy that provides the platform for achieving the goal of ending cholera as a public health issue by 2030. Its implementation relies on the capacity and willingness of countries, partners and donors to coordinate and align interventions in cholera hotspots and for outbreak containment.

The GTFCC provides a framework in which this coordination can effectively take place by building upon:

1. 1. Nationally-led cross-sectoral cholera control programs

Multi-sectoral action must be led by national governments of cholera-affected countries, with support from the GTFCC partners. Developing and strengthening multi-sectoral policy frameworks, partnerships, and cross-sectoral coordination mechanisms at different levels of government and across sectors, underpins the process for how countries can progress towards cholera control or elimination.

National Cholera Control Programs must be set up in each country. The National Programs will work at the operational level and should include representation from each of the different ministries, agencies, and partners involved in cholera-control efforts. The structure of the National Program will be tailored to each country’s specific needs and conditions and will ideally operate at two levels (political and technical). Because of its multi-sectoral nature, the National Program should report directly to the government (ideally to the President or Prime Minister) and have its head nominated by the executive branch.

The National Programs will define and implement the national control plans. The GTFCC will support the National Programs via secondment of resources that ensure the technical, strategic, and financial cooperation with the global effort.

2. 2. The GTFCC as a strong coordination platform

The goal of the GTFCC is to support national and inter-country capacities by providing a strong platform for advocacy and communications, fundraising, inter-sectoral coordination, and technical assistance.

The current structure of the GTFCC has served very well the needs of cholera control in the past 25 years. Its revitalization in 2014 has been successful in “creating an important dynamic around cholera and playing a critical role in coordinating partners and activities,” and by (i) ”producing technical guidance; (ii) supporting cholera control activities in countries; and (iii) increasing the visibility of cholera”. Yet the implementation of the Global Roadmap radically changes the scenario with a broader scope, a larger number of players, and a much stronger focus on implementation at the county level—which requires a strengthened governance structure to successfully achieve its goals. A new governance design that leverages the GTFCC role allows the many additional challenges and requirements of the Global Roadmap to be addressed.

In this set up, the GTFCC represents the global technical, administrative, and operational dimension of the Global Roadmap. The GTFCC supports countries in their plans’ development and implementation; it is responsible for advocacy and communication activities; and it provides the administrative and reporting infrastructure for the Global Roadmap. It has three main components:

• The secretariat of the GTFCC (hosted by WHO): The secretariat is responsible for managing all global technical, operational, administrative, and financial dimensions of the strategy. It is headed by a WHO officer and is composed of 5–7 technical members from different sectors, some from partner agencies, and 2–4 administrative/project management staff.
• Technical Working Groups (WGs): The WGs provide the technical/scientific input and are composed of experts from partner agencies and independent members. The members act in their personal capacities and are overseen by an independent head appointed by the secretariat. The WGs are tasked with advising on technical and scientific matters, covering all aspects of cholera control, developing tools and technical guidance, and providing technical expertise to the countries.
• Country Support Group: Representing the operational support for the Global Roadmap, the Country Support group is comprised by: (a) few permanent staff persons seconded by the partner agencies and deployed at country/inter-country level based on needs; and (b) a varying amount of additional resources mobilised according to needs (i.e. outbreaks). The main task of the group is to provide support to the National Cholera Control Programs, complementing local experts and resources, integrating sectors, building capacities, and ensuring the delivery of material resources (e.g. diagnostic, treatment, and WASH supplies).