Combining health and social protection measures to reach the ultra ...

Research resourcesA new landscapeof partnershipsArticle by Stefanie Meredith (pictured) and Elizabeth ZiembaOver the last few years, partnerships between publicand private sector organizations have become agrowing phenomenon. These partnerships grew out ofa need to fill gaps in the health systems of developingcountries and have become an increasingly commonmechanism to address some of the diseases of the poor indeveloping countries.The ultimate goal of most of these partnerships is toimprove and increase access to treatment, particularly for the“neglected diseases”, and many also express the goal ofcontributing to the alleviation of poverty.The need for such partnerships is explained by a failure ofthe public health system – the inability of the public sector toprovide the public goods entirely on its own due to lack ofresources; competing priorities for the limited resourcesavailable; management issues; conflict and post-conflictsituations, etc. There is also a failure on the part of the privatesector when there is little or no commercial incentive for thedevelopment of diagnostics and medicines for most of thediseases endemic in developing countries and affectingmainly the very poor.IntroductionEvery year, approximately US$ 70 billion is spent in healthresearch but only about 10% of funding is targeted to thediseases that account for 90% of the global disease burden.The unavailability of medicines to people in developingcountries results in enormous human and economic costs 1 .During the past ten years, the global health community hasidentified gaps in research and development of medicines toprevent or cure diseases that are primarily associated withextreme poverty and its attendant lack of access to cleanwater, adequate nutrition, and basic sanitation 2 . Whilediseases such as malaria, tuberculosis and others that areeven less well known are rampant in developing countries;they are of lesser or no consequence in developedcountries 3,4,5,6 .There is little or no economic incentive to developpharmaceutical products 7,8 for these diseases as well as otherissues including: “distribution challenges in countries withpoor infrastructures and lack of awareness about thesediseases in more developed countries” 3 , “liabilityconsiderations, inadequate science base, andunderestimation of the disease burden” 9 . As a consequence,compared with other diseases, minimal research on diseasesaffecting the poor has been conducted. To address thisenormous and widening gap in availability of medicines, theinnovative approach to address this problem has been theformation of Public-Private Partnerships (PPPs) 10 .The PPPs bring together skills, knowledge, and resourcesfrom a variety of sectors including academia, nongovernmentalorganizations, philanthropists, not-for-profitorganizations, government and intergovernmental agencies,as well as members of the for-profit private sector such aspharmaceutical and biotech companies to create a uniqueapproach to solving a global health issue. From 1986 whenthe first such PPP for health was created until the end of2003, 91 such partnerships have been instituted, 78 ofwhich are still in existence 11 . Each partnership has its ownseparate legal status, broad range of goals, combinations ofpartners from the public and private sectors, managementstructures, and strategies 11 .Many partnerships reflect a mix of representatives from thepublic and private sectors on their boards of directors, someof whom represent a particular institution while others sit inan individual capacity; however, it remains unclear whichmodel is optimum for ensuring success.The nature, variety, and individuality of public-privatepartnerships make definition difficult 12,13,14 . For a workingdefinition, Public-Private Partnerships for health can bedefined as “arrangements that innovatively combine differentskills and resources from institutions in the public and privatesectors to address persistent global health problems” 15 .Although the philosophy behind PPPs includes shared risk,using complimentary skills and expertise from each partnerorganization and equal input from public and privateorganizations, the reality is that many of these so-called PPPswould be better described more classically as partnerships oreven collaborations due to the traditional division of financialand technical roles of the organizations.Global health partnerships frequently use the term“neglected diseases” when referring to a group of diseasesaffecting developing countries. According to the Drugs forNeglected Diseases Initiative (DNDi) 16 , “neglected diseases”can be characterized as diseases that:✜ kill millions each year, primarily in the poorest areas of132 ✜ Global Forum Update on Research for Health Volume 4