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[afro-nets] a challenging environment for niche NGOs

Target Tuberculosis Closes

Wendy A Darby, ex-CEO Target TB; Jeffrey W. Mecaskey, Advisor

Target Tuberculosis (2003-2015).  Following a period of growth and development 
in supporting critical efforts to improve the health of poor and disadvantaged 
people in Africa and Asia, Target Tuberculosis (TTB) has closed.  

With meticulous attention to detail, and the understanding of its creditors, 
TTB achieved a solvent wind up.  It is donating the modest fund conserved in 
the wind up to TB Alert as well as a number of our partners in the field. But 
this is of little consolation for the front line partners in Africa and Asia, 
where prospects for other sources support are extremely limited. 

Despite efforts to frame tuberculosis control as an entry point for larger 
health equity or link it with other related health system strengthening, 
poverty alleviation and, of course, HIV/AID, there is an increasing gap in the 
tuberculosis funding necessary for control.  Where other previously neglected 
conditions such as the trachoma, schistosomiasis and intestinal helminths 
control found succour as "neglected tropical diseases" with major new funding 
and a new lease on life, financing for tuberculosis control's brief resurgence 
came with the emergence of the HIV/AIDS global pandemic, but failed to 
stabilise.  Perhaps because the prominence of TB transmission in the Global 
North declined, the decline in support for efforts in the Global South hit TTB 
particularly hard.

Two other changes in the "market" also played a key role in TTB's demise, and 
continue to threaten niche organisations.  On one hand, there is a general 
tendency that public as well as statutory donor support is increasing to the 
larger charities and NGOs.  For example, DFID is keen to manage their "risks" 
and "transaction costs" by working through larger grants and contracts with 
larger organisation. The proportion of charitable funding "captured" by the 
largest charities-the top one percent--now amounts to 69.8 percent of all 
charitable giving up from 48.7 percent in 2006. ( 
accessed 20150707) 

The second change came with a misguided effort by statutory and philanthropic 
donors to achieve Value for Money by reducing funding for the vital overheads 
necessary to cover fiduciary risk management, programme quality assurance and 
public accountability.  While this has affected the larger as well as smaller 
charities, it been particularly disruptive for those in a niche.  There is hope 
that an effort by the initiative of BOND, MANGO and others to define what 
constitutes a "living wage" in terms of overhead coverage will influence the 
donor community.  Still it is sobering to note that 2013 there were 
approximately 5,000 fewer charities in operation in the UK than in 2006.

Despite the sorrow of loss, TTB left a legacy of innovation and impact in the 
global effort to eliminate tuberculosis.  TTB was an early advocate of 
integrating TB control into larger primary health care including early advocacy 
for Community Directly Observed Therapy (Community DOTS).  TTB took an early 
approach to an integrated systems strengthening approach to its support of 
Tuberculosis control in African and Asia.    And TTB's work with partners in 
Africa and Asia delivered programmes that demonstrated how effective TB case 
identification, treatment completion and transmission interruption could be 
achieved in some of the world's most vulnerable communities.  



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Jeffrey W. Mecaskey
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