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Diplomacy in Action

Case Study: U.S.-Middle East Partnership for Breast Cancer Awareness and Research

June 16, 2009


Background Information

Partnership Name: U.S.-Middle East Partnership for Breast Cancer Awareness and Research

Partnership Type: Programmatic/ Development Objective
PPP Life Cycle Phase for Learning: Scoping
Bureau or Post: Office of the Middle East Partnership Initiative in the Bureau of Near Eastern Affairs
State Department Strategic Goal: Investing in People/ Governing Justly and Democratically
Major Partners: USAID, Susan G. Komen for the Cure, and the University of Texas M.D. Anderson Cancer Center, Saudi Cancer Society (Saudi Arabia), King Fahad Medical City (Riyadh, Saudi Arabia), King Hussein Cancer Center (Amman, Jordan), King Hussein Cancer Foundation (Jordan), Health Authority of Abu Dhabi (UAE), and the Dubai Chamber of Commerce (UAE)
Resource Contributions: $4.5 million
Dates of Partnership: Announced June 2006
Problem/Challenge Statement: Breast cancer is the most common cause of cancer-related deaths among women, and in the Middle East awareness needs to be raised significantly and screening made more available to earlier and better detect the cancer, thereby improving a woman’s chance of survival.

Worldwide, breast cancer is the most common cause of cancer-related deaths among women. Dr. Ahmed Mubarak Al Mazrouei, director general of the Health Authority Abu Dhabi, estimates as many as 75 percent of all breast cancer cases in Abu Dhabi are still diagnosed and treated at a very late stage, compared to 30 percent in the U.S. and Europe. The U.S.-Middle East Partnership for Breast Cancer Awareness and Research partnership is the first major regional collaborative effort to help countries in the Middle East fight breast cancer through improved awareness, clinical resources, and world-class research.

“The women of the Middle East have shown remarkable energy and determination in the fight against breast cancer as they've built this powerful coalition to save the lives of their mothers, sisters and friends,” said Nancy G. Brinker, founder of Susan G. Komen for the Cure®. “The investment of the Middle East Partnership Initiative has helped accelerate their progress, creating a growing international partnership of medical professionals, government officials and civil society to empower women.”

In 2006, Middle East Partnership Initiative representatives were meeting with women in a socially conservative province of Saudi Arabia to investigate opportunities for working together. The Saudi women identified breast cancer awareness and the need for better education and screenings as a priority issue. Following the needs assessment, MEPI staff recognized a number of US companies and organizations that not only improved breast cancer awareness and survival rates in the US, but that would be ideal for partnership. From the beginning MEPI considered it ethically important to have a medical component so that women whose awareness was raised could get screenings and treatments as needed. The partnership began with a call to Nancy Brinker, founder of Susan G. Komen for the Cure. Komen came on as a partner, despite the fact that it was not yet operating in the Middle East and had not yet started to comprehensively train NGOs in other countries around their operational and community-impact models.
Together, MEPI and Komen worked on a framework and announced the goals of the partnership in June 2006. After initiating partnership with Johns Hopkins Medicine in U.A.E., M. D. Anderson Cancer Center was brought in as the primary medical partner for Jordan and Saudi Arabia. Following this, the partners entered into detailed negotiations with several countries. While the US embassies in the three countries chosen for the program (UAE, Jordan, and Saudi Arabia) were not formal signatories to the partnership, they did work closely with MEPI.

MEPI contributed $4.5 million to the implementing partner, ICF International. In turn ICF brought together different groups, managed all communication and reporting, and tracked and matched needs with resources for partners. MEPI retained approval over any strategic decisions made by ICF. Once an action plan was finalized, ICF reached out to regional partners to help them categorize their needs and “wish lists” and then approached U.S. partners to match needs with resources. The Statement of Work with ICF states objectives and indicators, on which they report to State on a quarterly basis. Although ICF is a for profit company, their agreement with State explicitly states that they will not make a profit with this project.

Each additional partner has contributed significant in-kind resources or direct cost-share.

  • Susan G. Komen for the Cure contributed significant in-kind resources through the creation of training modules expressly for the partnership. Entitled “Course for the Cure™,” these modules were designed by Boston Consulting Group in a contract worth roughly $1.2 million. For in-country implementation, Komen turned to the Institute of International Education and arranged to have local partners pay for the course. In legal terms, Komen contracts with IIE, which, in turn, enters into MOU agreements or subcontracts with local groups that then pay IIE. By January of 2009, 250 women and men had completed the course in Saudi Arabia, UAE and Jordan. As an additional contribution, Komen has made their staff available to advise local partners, speak and participate in program-related conferences, and help organize meetings.
  • M. D. Anderson Cancer Center has donated in-kind resources through allowing oncology faculty to travel to conduct medical assessments, speak at conferences, share educational on-line resources, and arrange and host observerships for regional doctors and health professionals at M. D. Anderson.
  • King Fahad Medical City and Saudi Cancer Society have covered virtually all program-related costs to host research conferences and visits by M. D. Anderson and U.S. medical faculty, coordinate advocacy programming, and host partnership events.
  • The Health Authority of Abu Dhabi paid for the translation of the Course for the Cure text into Arabic and the costs of participation in the program.
  • King Hussein Cancer Center and King Hussein Cancer Foundation have contributed cost-share for educational workshops for medical professionals, implemented the Course for the Cure in three cities, and contributed staff time to the coordination of partnership events.

All partners sign a Statement of Principles, which is a non-binding declaration of shared intentions and clarifies each partner’s role, responsibilities, and commitments to the larger partnership. This statement is ICF-led and was introduced after the first year to prevent future misunderstandings. The Statement does not stipulate a dispute mechanism, and any disputes are settled informally.


The UAE program launched in October 2006, in Jordan in March 2007, and in Saudi Arabia in October 2007. That same month, the First Lady announced that the program would next extend to Morocco, West Bank, and Egypt. As USAID operates in all of the three new countries, MEPI approached the development agency for potential partnership. The USAID Egypt Mission has committed to funding the program in Egypt. MEPI is funding the Morocco and West Bank programs, but USAID in West Bank has said that if a small pilot is successful that they could help branch out. There is also an effort to leverage other US government agencies’ expertise.

MEPI estimates that 25,000 community beneficiaries have been reached through the partnership. More than 2,500 advocates have directly participated in the Partnership’s advocacy and medical capacity-building and consultative activities. And other countries and regions are taking notice. Although the partnership had formal launches in only three countries, its work has now grown to engage more than 140 different organizations in 15 countries in the Middle East and North Africa.

A Latin American partnership was created using lessons learned from MEPI and its Middle East partnership. ICF shared the US-Middle East Partnership’s logo, communications templates, and techniques on how to present partners. This shared knowledge helped the Latin American program get set up quickly move at a much quicker pace than those in the Middle East.

That is not to say all is smooth or settled with the Middle East partnership. MEPI would like to shift the financial model to one that is more sustainable by approaching the private sector to help with implementation costs. The current program is funded through the end of 2009.

Key Take-Aways:

  • Country-specific needs assessments are essential in identifying local issues to be addressed though regional partnerships. Needs may be classified before partners are found.
  • In large initiatives with many partners covering multiple countries or regions, a statement of principles or other unifying document among partners can outline shared intentions and projected resource contributions. A statement of principles is less formal that a Memorandum of Understanding or Agreement (MoU or MoA) and is therefore less challenging to put together.
  • The Foreign Assistance Act provides authority to any government agency implementing foreign assistance funds carrying out the purposes of that Act to enter into grant with any entity to carry out a foreign assistance program. State Department grant regulations and Grant Policy Directives provide specific requirements for federal assistance awards to commercial firms, to ensure that no profit is made on a project undertaken with foreign assistance funds. Accordingly, NEA has entered into awards with ICF, among other commercial entities, after scrutiny of an allowable and approved budget.
  • Recognize the strengths and weaknesses of all potential public and private partners and seek out those that can best enhance the initiative’s objectives. Once partnered, divide responsibilities accordingly.
  • Think about financial sustainability from an early point and work with private and public sector partners to devise ways to continue initiatives beyond the life of existing funding. Do not wait until the latter part of a partnership to address sustainability.

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