Making partnerships work for health, focusing on low-income countries

Andrew Harmer Panel 2: Role of the international donor community
Panel 2:
Role of the international
donor community
Global Health Public-
Private Partnerships: What
they are, what we know,
and why they matter.
Andrew Harmer
Research Assistant, Health Policy Unit
London School of Hygiene and
Tropical Medicine, UK
Do <strong>partnerships</strong> impact positively or
negatively on countries’ <strong>health</strong> systems,
and if they do how do we know?
What is the role of the private sector in
strengthening <strong>health</strong> systems in low-income
countries? Indeed, what constitutes
the ‘private’ sector in this context?
What are we to make of private partners
in public-private <strong>partnerships</strong>: what are
their roles and responsibilities, and how
might they contribute to making <strong>partnerships</strong>
<strong>work</strong> better? These are difficult
questions, and there are no easy
answers.
Fortunately, where once there was an
intractable ideological divide between
proponents of ‘the public’ and proponents
of ‘the private’ – making debate
and dialogue between the two camps all
but impossible – now there is open space
and open minds <strong>for</strong> constructive rather
than adversarial discourse. This conference
is one example of this open space
and, hopefully, open minds.
The emergence of global <strong>health</strong> public-private
<strong>partnerships</strong> is one radical
output from this shift in understanding;
something tangible occupying the
grey area between public and private
spheres where magic happens. What do
we know about these <strong>partnerships</strong>?
To begin with, they are few in number;
certainly not the 100+ so often cited
in the literature. In fact, if by global
<strong>health</strong> public-private <strong>partnerships</strong> we
mean <strong>partnerships</strong> where both public
and private sector representatives have
a meaningful voice on their Board of
Directors (i.e. where the real decisionmaking
takes place) then we barely get
into double figures. That means that
they are rare: rare, but special.
GHPs are special <strong>for</strong> three fundamental
reasons. First they are a <strong>for</strong>um <strong>for</strong> the
exchange of ideas and values – a place
where the World Bank and the World
Health Organization (WHO); where
McKinsey and Bill and Mellinda Gates
Foundation; where NGOs such as Medecins
sans Frontieres and Rockefeller
can get together regularly and talk to
one another. This <strong>for</strong>um simply didn’t
exist ten or twenty years ago.
Second, they re-define public and private
sector actors as partners with clearly
defined roles, responsibilities, and
expectations about appropriate behavior.
Transgressors lose credibility as bad
partners; good partners earn respect and
praise. Crucially, partners learn from
one another, and by increments their
identities are re-shaped: from public or
private to public-private partners.
Third, they function as an accountability
mechanism. Being a partner matters
because commitments made are
made transparently, documented, uploaded
to the partnership’s website and
thus available <strong>for</strong> scrutiny by the global
<strong>health</strong> community. The Global Fund
to Fight Aids, Tuberculosis and Malaria
and GAVI have championed this global
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