Global public-private health partnerships: tackling seven poor habits

Global public-private health partnerships, as a means of global health governance, have become increasingly common. Initially, much was expected of them but enthusiasm has now waned, with concern raised over costs and unanticipated consequences. What bad habits impact negatively on their performance and what actions could make them more effective?

Shortly before theturn of the millennium, international health reached a crossroads. A resurgence in TB and malaria and the AIDS pandemic weremet with a dramatic rise in funding to fight these diseases. At the same time,the world saw the start of a new approach, through public-private partnershipswhich brought new resources, a business approach and a renewed sense of urgencyto tackling these diseases. These partnerships, such as the Global Alliance forVaccines and Immunisation (GAVI) and the MectizanDonation Program, are innovative initiatives that bring together multiple publicand for-profit private sector organisations in joint decision-making overglobal health problems.

A study by theOverseas Development Institute (ODI), based on research, interviews with globalpublic-private health partnerships and findings from various evaluations,assesses where these partnerships are going wrong and what they are doing well,and suggests how they could perform better. It finds that they have madeimpressive contributions to the fight against diseases of poverty, inparticular by raising the public profile of certain diseases with regards topolicy-making and by drumming up funding commitments. Many have, however, also developedseven “unhealthy” habits, including:

• Theyare often ‘out of sync’ with the recipient country’s national priorities,imposing instead the priorities of their donor partners.
• Manyfail to adequately include representatives of all stakeholders on theirdecision-making governing bodies: of the 23 partnerships reviewed,representation of poor country constituencies stands at just 17 percent.
• Theydo not adequately adhere to critical governance procedures, such as clearlyspecifying partners’ roles and responsibilities, screening potential partners,or performance monitoring. 
• Theydo not adequately compare the costs and benefits of public approaches comparedwith private approaches.

Globalpublic-private health partnerships are likely to keep underperforming unlessthey take steps to address the seven unhealthy habits that some front runnershave adopted. This entails taking the following actions:

• They shouldundertake internationally agreed principals of good aid practice in order tointegrate their work with national planning processes and to keep costs to aminimum.
• Theyshould seek to ensure a more balanced representation of stakeholders on theirgoverning bodies.
• Beforeentering into new partnership ventures, they should carry out a realisticassessment of the true risks and costs of private sector involvement.
• Theyshould adopt standard operating procedures such as stating objectives, definingroles and regular partnership-wide planning.
• They shouldimprove stewardship by applying standards for the selection of partners,setting up systems to manage conflict of interest, and ensuring transparencyand accountability.
• Theyneed to ensure sufficient funding, which means setting more realistic targetsor ensuring that plans identify partners that can fill in any financial gaps.
• Moreattention should be paid to the managing of partnership relationships, such asestablishing staff rules and incentives, and clarifying tasks and roles.