As the ACTION Global Health Advocacy Partnership marks its 20th anniversary, it’s more than a milestone; it’s a moment to reflect on a journey fueled by our collective, relentless dedication to achieving true health equity. Founded in response to a grave need in the fight against tuberculosis (TB), ACTION emerged as a coalition of passionate advocates determined to address TB as a disease deeply intertwined with poverty. Since 2004, the ACTION Partnership has expanded both in size and scope and now has 14 Partners across five continents. The origins of ACTION are a testament to the power of collective action, proving that together, a handful of committed people can drive change even in the most neglected global health areas.
The Spark of an Idea: From Individual Efforts to a United Partnership
Twenty years ago, Nelson Mandela called on the global health community to prioritize TB in the fight to end the HIV/AIDS epidemic. His appeal at the 2004 International AIDS Conference in Bangkok, Thailand, captured global attention and highlighted the long overlooked connection between HIV/AIDS and TB. TB had killed 1.6 billion people worldwide in 2004 alone, and it remains the leading cause of death in people with AIDS.
Among the audience that day were the founding members of ACTION, representing organizations from France, India, and the United States. Dr. Bobby John, an ACTION founding member and head of Æquitas Consulting in Delhi, India, reflected on the moment: “We created ACTION to ensure that diseases of poverty, like TB, receive the attention and resources they deserve from governments and global health institutions.”
That same year, leaders from locally rooted organizations and NGOs, including RESULTS Educational Fund (REF, U.S.), Global Health Advocates (GHA, France), and Æquitas Consulting (India) gathered in Washington, D.C. to discuss how to unite their efforts to address TB and other diseases of poverty that had been largely neglected in global efforts to address health inequities. They were buoyed by REF’s success in the U.S.—REF had recently mobilized U.S. leadership to secure the first U.S. congressional appropriation for TB and mobilized around the idea of a formal global fund to fight AIDS, TB, and malaria. “At our first planning meeting,” said John, “we spent 14–15 days together in a room, dreaming of things beyond the room.”
Out of these planning meetings came the decision to create a new partnership—Advocacy to Control TB Internationally (ACTION). ACTION would be made up of independent organizations that have a shared commitment to fighting diseases of poverty and health inequities and a strong belief in the power of collaboration.
At the heart of ACTION lies a powerful guiding principle: cause before brand. From the very beginning, this ethos has united the Partnership and allowed it to transcend typical organizational boundaries. Partners came to the table committed not to self-promotion but to the urgent cause of ending TB and tackling global health inequities. This spirit remains a cornerstone of ACTION’s work and is a source of pride and inspiration for those involved. As John shared, “When we started, there was an understanding—spoken or not—that we were all here for the same purpose. The cause was non-negotiable.”
Partners, Persistence, and Progress
ACTION realized the unique value of having organizations working in both donor and implementing countries. Organizations in high-income countries could swiftly mobilize key stakeholders to unlock significant funding for TB, while organizations in impacted countries could amplify the on-the-ground needs of TB affected communities and their countries’ health care systems. For example, when a World Bank loan of nearly $1B for India’s National TB program was stuck in the funding pipeline, John flagged the concern for Joanne Carter, Executive Director of REF and founding member of ACTION, who was able to connect with the World Bank president in Washington, D.C. about it. “Within 24 hours, this high-level intervention moved the funding forward, which significantly expanded the TB diagnostic capacity across India,” said John. Patrick Bertrand, Executive Director of GHA and another founding member of ACTION, added that the example demonstrated that “ACTION’s strength lay in its ability to connect the right people at the right time and align international pressure with on-the-ground needs. In leveraging our relationships across various levels of decision-making, ACTION facilitated a funding breakthrough for TB in India that no single organization could have achieved on its own.”
One of the earliest evolutions in ACTION’s partnership was to prioritize adding organizations based in Africa, starting with Kenya with the addition of KANCO in 2007. “It was paramount that our Partnership was inclusive and diverse, and a true representation of the countries most impacted by TB and other diseases,” said John. Before joining KANCO as its Executive Director, Allan Ragi was a long-serving leader in Kenya’s Ministry of Health where he spent years managing health programs in some of Kenya’s most affected regions. His work soon expanded to HIV management and he built trusted relationships with communities and leaders. It was during this period that a chance conversation with ACTION co-founder Bertrand changed his perspective on TB advocacy. Patrick’s simple yet probing question—“Why aren’t you working on TB?”—highlighted a critical gap in TB advocacy efforts in Kenya. Inspired by this conversation, Allan invited Patrick to an HIV network meeting, and from that discussion emerged a renewed focus on TB by health advocates and the Ministry of Health, contributing to a 67% increase in funding for TB programs in Kenya.
Today, Allan credits Patrick’s persistence as the catalyst for building KANCO, one of Kenya’s most progressive TB programs, which now connects over 200 organizations and continues to drive impact far beyond Kenya. This experience highlights how persistent, thoughtful advocacy can ignite momentum for change, demonstrating not only the value of partnership but also the importance of challenging one another to be bold and ambitious.
Meeting Challenges with Ingenuity
In the early days of the ACTION Partnership, one of the biggest challenges was the lack of political attention around TB. “At the time,” said Bertrand, “TB was not a priority on many political agendas, especially in regions like Europe and Africa.” While there were notable successes, such as the establishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) and the STOP TB Campaign, “it took years to bring key European donors like France and the EU on board as major contributors.”
To build political support, ACTION organized delegations of Members of Parliament (MPs) and U.S. Congress to countries most impacted by TB, a strategy that Partners continue to use today. Some of the earliest trips included a U.S. congressional delegation to India and a UK parliamentary delegation to Kenya. “These delegations demonstrated to policymakers the value and impact of funding for TB, and how significant the need is in highly impacted countries,” said Bertrand. “These visits turned MPs into champions who, to this day, remain instrumental in generating lasting political will and global support for TB eradication efforts.” Over the years, these relationships have not only endured, but have also provided a steady foundation of support through shifting political climates, making MP and congressional champion building a cornerstone of ACTION’s long-term strategy and advocacy tactics.
During an early Global Fund meeting, a letter of bipartisan U.S. support for the Global Fund was a pivotal asset for ACTION advocates. With a letter signed by Republican and Democratic senators in hand, ACTION’s founders took a bold approach, distributing copies to delegates to send a message that U.S. support for the Global Fund was unwavering. “We stood at the doorway so no one could enter without receiving a copy,” recalled Carter, “because we knew we had to deliver that message directly.”
Another major early hurdle for the ACTION Partnership was navigating the concerns of the TB technical community, who were initially skeptical about non-specialists advocating for TB. Many questioned the role of advocates without medical or academic expertise in influencing policy. “There were difficult discussions about resource allocation and the value community-based programs brought to the table,” said John. ACTION overcame this challenge by consistently demonstrating the unique value advocates bring—bridging the gap between technical expertise and policymakers, amplifying voices from the most affected communities, and driving political action. By working together, the TB technical and advocacy communities discovered they could achieve far more collectively than either could alone. This collaboration remains critical today, and ACTION has invested in building its own knowledge and capacity to engage effectively with technical experts and speak confidently to decision-makers like MPs, ensuring that evidence-based, people-centered solutions are at the forefront of global TB efforts.
As ACTION grew its membership and its advocacy ambitions, it also expanded its focus areas beyond TB. “ACTION saw an opportunity to apply its expertise and experience to other issues such as immunization, early childhood development, and nutrition,” said Carter. “These areas were identified because of their connections to poverty and the broader maternal, newborn, and child health (MNCH) agenda. By addressing these interconnected health challenges, the Partnership could continue supporting those most affected by poverty, ensuring that health issues were not seen in isolation but as part of a broader equity and development framework.”
Over its two-decade history, ACTION has expanded its focus beyond TB, leveraging the power of partnership to address a wide range of global health challenges while staying true to its core principles of equity and accountability. Today, ACTION works across three interconnected pillars: Ending the Epidemics, Healthy Start, and Equitable and Sustainable Systems. These pillars include critical areas such as TB research & development (R&D), global health R&D, primary healthcare, polio, and health system strengthening, ensuring its impact reaches the most marginalized populations. ACTION’s leadership extends to its instrumental role in creating and shaping global health institutions (GHIs) such as the Global Fund, Gavi, the Global Financing Facility (GFF), and the Global Polio Eradication Initiative (GPEI). By making a compelling case for donor investments and advocating for domestic resource mobilization, ACTION has helped channel resources toward building sustainable health systems. At the same time, its advocacy holds governments accountable to their commitments, ensuring these investments translate into real, measurable outcomes.
Looking Back, Moving Forward
Two decades on, ACTION is more than a partnership—it’s a testament to the collective power of advocacy, trust, and determination. What began with a small group of individuals driven by a shared vision has become a global force for change, demonstrating that when people join forces for a cause, the impact can be transformative. Reflecting on her personal journey, Carol Nawina Nyirenda, a lived-experience TB advocate and Executive Director of ACTION Partner CITAMPlus in Zambia, expressed, “…I’m really grateful on behalf of all affected communities to ACTION and TB advocates. I am a grandmother today because of you.”
Over the past 20 years, ACTION Partners are proud to have collectively helped mobilize pledges totaling over $130.21 billion in their markets for initiatives such as the Global Fund, Gavi, GPEI, GFF, N4G, CEPI, and more. They have also shaped policies, driven accountability, and amplified civil society’s voice on the global stage.
Click here to learn more about our 20-year history.
