The Rockefeller Foundation’s Disease Surveillance Networks (DSN) Initiative was launched in 2007 under the new Strategy framework of the Foundation with the objectives of: Improving human resources for disease surveillance in developing countries, thus bolstering national capacity to monitor, report, and respond to outbreaks;  Supporting regional networks to promote collaboration in disease surveillance and response across countries; and  Building bridges between regional and global monitoring efforts. In August 2009-2010 an independent external evaluation of the DSN Initiative was undertaken in three parts: in Asia, Africa, and at a global level. This report presents the results of the Global Evaluation which had the following objectives:  To assess the relevance, effectiveness, efficiency, impact and sustainability of the Rockefeller Foundation’s support to the DSN Initiative.  To assess the underlying hypothesis of the DSN Initiative, that robust trans-boundary, multi-sectoral and cross-disciplinary collaborative networks lead to improved disease surveillance and response.  To make forward looking recommendations to the Foundation on 1) the implications of the achievements, challenges and lessons from the DSN Initiative for the strategy and investments of the Rockefeller Foundation at a global and regional level; 2) priority linkages and synergies for DSN learning to benefit the work of other Rockefeller Foundation initiatives, regional offices, and key partners; 3) key priorities for funding and partnerships to sustain the gains made by the Foundation in the field of disease surveillance networks; and 4) other implications as identified.  To contribute to the field of philanthropy by emphasizing the use of evaluation in grantmaking and by informing the field of development evaluation and assessment about methods and models to measure complex networks.
The DSN Initiative has five outcome areas:
 Networks: Trans-boundary disease surveillance networks in Southeast Asia and in Eastern and Southern Africa are formed, sustained, and evolved to enable disease surveillance practitioners to collaborate, share information, and learn how to more effectively address disease threats.
Based on feedback by grantees, stakeholders, field interviews, and desk studies, the Global Evaluation Team found that the DSN Initiative achieved these outcomes to a moderate or great extent. The hypothesis of the Initiative was generally supported by global and regional data, showing that robust trans-boundary, multi-sectoral/cross-disciplinary collaborative networks lead to improved disease surveillance and response. This is more systematically addressed in the regional reports covering specific outbreak responses and joint exercises.
The major contributions of the DSN Initiative to global health were found to be the fostering of the new fields of One Health and Global Health Diplomacy; use of informal networks in surveillance; and transnational collaboration and governance.
Stakeholders at global, regional and national levels validated the relevance of a networked approach to disease surveillance, and supported the concept, rational and logic underlying the DSN Initiative. The DSN Initiative was seen by stakeholders and influential leaders as an effective way of building trust among partners in historically unstable regions, and contributed to increases in capacity through training, tools, and technical support.
The evaluation found that grantees at the global level are showing good signs of sustainability by leveraging the funds of the Foundation to attract other donors. While the data indicates that many of the DSN Initiative activities and concepts are taking root globally and regionally, there is a risk that winding down support to the emerging fields of One Health and Global Health Diplomacy may leave
them without much needed support at this stage of their development.
A major dimension of sustainability is the ability to achieve and sustain the profile of new ideas and practice. The evaluation noted that the DSN Initiative grantees in Asia and Africa do not write and publish their work as much as would be expected and needed to maintain and grow a new field. The Global Evaluation Team encourages the Foundation to emphasize the need for grantees to publish their work in peer-reviewed literature to enhance the work’s influence in health and policy fields.
The effectiveness of Foundation management of the DSN Initiative was evaluated within the limitations of available data. The evaluation found a good alignment of resources (staff, grant funding and non-grant activity) to the outcome areas and strategy of the DSN Initiative throughout the course of
the initiative. Changes in management of the DSN Initiative, however, affected the continuity and consistency of grantees’ relationships. Changes also limited the synergies across Rockefeller Foundation initiative portfolios.
For more effective ongoing management, the Global Evaluation Team encourages the Foundation to improve the documentation and data capture of initiative work to include the use of benchmarks and indicators in the initial review of proposals, improve documentation of changes to plans as work
evolves, and synergies between portfolios of work.
The breadth of the influence of the DSN Initiative beyond disease surveillance warrants consideration of a new title for the body of work that reflects the many contributions made to communities of practice. The evaluation proposes “rebranding” some of the DSN Initiative work as Communities of
Transnational Public Health Policy and Practice, to better reflect an evolving field going forward.