Introduction to GEAR

The WHO 2030 NTD Roadmap targets twelve diseases for elimination or eradication (E&E). To be successful in this next decade, the neglected tropical diseases (NTD) community will need to take a proactive and critical look at past experiences (both successes and failures), improve learning across the diseases and programs and build tools to help identify weaknesses to build stronger programs. The GEAR process and associated tools have been designed to facilitate this critical thinking and reinforce continuous learning to support all twelve NTD E&E programs included in the WHO Roadmap as well as other disease E&E programs to stay on track to achieve their goals.

The GEAR process was designed by a small team from Global Institute for Disease Elimination (GLIDE) and Bridges to Development. The work began with the development of a ‘white paper’ which reviewed what has and has not worked for other disease elimination and eradication efforts and identified seven key risks to disease E&E programs. These findings were analyzed and put forward as a potential tool to review and identify opportunities to strengthen programs. This concept was presented at the Coalition for Operational Research on NTDs (COR-NTD) Annual Meeting (October 2020). During this meeting, onchocerciasis was suggested as the first disease to pilot the GEAR evaluation.

The GEAR process provides the framework and tools needed to support teams to solicit and analyze feedback from across the broad community of stakeholders involved in a disease E&E program through surveys, focus groups and interviews. With the help of a disease expert group and an independent advisory group, the findings from the review process, including the identification of strengths and risks to the program reaching E&E goals, are shared back to the disease community to take forward for strategic improvement and increased impact.

Ultimately, the purpose of the GEAR process is to improve and increase the efficiency and effectiveness of disease elimination and eradication efforts through applying an independent review and evaluation framework.

The GEAR Pilot with Onchocerciasis

From June 2021 to May 2022, the project team designed and tested the GEAR process and tools with the onchocerciasis community. During that collaborative effort, the team developed and carried out:

• a survey questionnaire covering several facets of disease elimination

• and a series of interview protocols for key informant and focus group interviews;

• an independent review process drawing on an independent advisory group and engagement with a representative group of subject matter experts at various stages of the process

• a synthesis of early learning and tools for the GEAR process for use in other elimination and eradication efforts.

The Global Elimination and Eradication Acceleration Review (GEAR) was a collaboration between Bridges to Development and The Global Institute for Disease Elimination (GLIDE)