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Between February 2005 and May 2006, we undertook an in-depth, broad-ranging, independent external review of The Special Programme for Research and Training in Tropical Diseases (TDR). TDR, based in Geneva, was created 30 years ago, with the World Health Organization as its executing agency and the World Bank and United Nations Development Programme (UNDP) as initial co-sponsors, with the United Nations Children's Fund (UNICEF) being added in 2003. Its mandate to address research and training in neglected tropical diseases made it a pioneer in its first two decades. But the landscape has changed enormously since its inception, with new sources of funding, different disease patterns, and greater capacity for research and training within disease-endemic countries. Therefore, the Joint Coordinating Board (JCB), TDR's main governing body, requested that this Fourth External Review focus on helping it develop a relevant vision for a future role in this shifting environment. We considered TDR's past and present performance, and its strengths and weaknesses, in order to suggest ways forward.  Because of the nature of TDR's work, especially with its many partners, it is difficult adequately to capture the breadth and depth of its accomplishments in brief. We approached the review as a “case study” [1] guided by the principles of qualitative data collection and analysis. Data were obtained from previous external reviews, internal documents, a management review commissioned by the World Bank, two commissioned papers [2],[3], and other sources. Our main data, however, were from interviews with over 250 people, of whom about 150 were key informants from all major stakeholder groups who participated in face-to-face, in-depth, open-ended interviews, using an interview guide developed for this purpose. Interviewees included TDR staff, including its current director, Dr. Robert Ridley; members of its governing bodies; former directors (Drs. Adetokunbe Lucas [1976–86], Tore Godal [1986–98], and Carlos Morel [1998–2003]; staff of co-sponsor organizations, donor countries, funding agencies, public–private partnerships (PPPs), philanthropies and other global health organizations; countries' representatives; and TDR alumni. We visited various regions to talk to stakeholders and to study institutions, and examined cases illustrative of TDR's work and its relations with others working in global health research and training. Additionally, we made observations of the workings of its various governing bodies and advisory groups, and the Secretariat in Geneva, where our executive secretary was based. We began by asking, Is the original mandate of TDR still valid? Can others discharge this mandate better? What would happen if TDR ceased to exist? If it were to be re-invented for the future, what would the new TDR look like? TDR was given an opportunity to submit comments. These general questions were supplemented by specific ones tailored to particular informants. All were asked to give examples to support their views. The comprehensive material was submitted to a thematic content analysis on the basis of which a taxonomy of issues was developed. Further analyses built on this taxonomy and on continuing discussions and regular “reality checks” with informants. The final 130–page report was completed at the end of May 2006 and is now available on-line, both as a full report [4] and an executive summary [5].

TDR Thirty Years On: Taking Stock and Envisioning the Future for the Special Programme for Research and Training in Tropical Diseases