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

Research resourcesPartnership dynamics,issues and challengesArticle by Mary Moran (pictured),Anne-Laure Ropars and Javier GuzmanOne of the biggest issues for Public-Private Partnerships(PPPs) is that the term itself is a misleadingrepresentation of what many PPPs actually are and do– a factor possibly contributing to government confusion andhesitancy over the legitimacy of PPPs.The first area of confusion is the failure to distinguishbetween public-private partnering as an activity (a functionaldefinition) and Public-Private Partnerships as an organization(a structural definition).The functional definition encompasses many activitiesranging from drug donations (e.g. the Malarone donationprogramme for malaria), through to partnerships that involveexisting public and private organizations working together onjoint product development projects (e.g. the moxidectin antionchocerciasisdrug project between Wyeth and the SpecialProgramme for Research and Training in Tropical Diseases(TDR). In most cases, these activities are carried out as newor additional projects within existing organizations, and oftenfrom within existing resources.The structural definition refers to formal organizations,including the relatively small number of Product DevelopmentPublic-Private Partnerships (PDPPPs) specifically set up todevelop neglected disease products. Although these PPPsmay contract with multiple partners for multiple projects thatchange over time (i.e. a range of partnering activities), thePPP itself is a single organization that encompasses thesemany deals. Although each of these individual deals could becounted as partnerships under the first definition (andsometimes are), they do not constitute new PPPorganizations. Using this structural criterion, there are farfewer PPPs. Indeed, in the neglected disease drugdevelopment field there are only four, the last two of whomwould perhaps argue that they are not strictly PPPs.1. Partnerships for disease control–product development2. Partnerships for disease control–product distribution3. Partnerships for strengthening health services4. Partnerships to commercialize traditional medicines5. Partnerships for health programme coordination6. Other international health partnerships7. Country level partnerships8. Private sector coalitions for health9. Partnerships for product donations10. Partnerships for health service deliveryTable 1: Categories of Public-Private Partnerships for Health 1✜ The TB Alliance, which develops TB drugs;✜ Medicines for Malaria Venture (MMV), which developsanti-malarials;✜ Institute for One World Health (iOWH), which covers arange of technologies and diseases from malaria todiarrhoea;✜ Drugs for Neglected Disease Initiative (DNDi), which hasa first focus on the kinetoplastid diseases (sleepingsickness, leishmaniasis, Chagas’ disease).Collectively, these PPPs are now responsible for aroundthree quarters of all neglected disease drug developmentprojects, including with both small and large industrypartners; and have been the driving force behind the post2000 increase in neglected disease R&D (see Figure 1).The second key area of confusion revolves around amisunderstanding of how PPPs operate. The classicalunderstanding of PPPs, under both the structural andfunctional definition, is based on the notion of public andprivate groups working collaboratively on a project with jointdecision-making. This partnership dynamic is often seen aschiefly involving public contribution of funding and privatecontribution of expertise, effort or products (often as in-kinddonations). The Lapdap ® anti-malarial drug project is anexample of this classical model, with the UK’s Department forInternational Development (DFID); TDR providing staffresources but limited funding, and GSK conducting the R&Don a partially in-kind basis.However, many of the new PPP organizations – and the“partnered” activities they conduct – simply do not match theclassical understanding of what a PPP means or of how theyare thought to operate. Indeed, if we examine the four PPPorganizations who conduct neglected disease drugdevelopment, we find that both the organizations themselvesand the projects they conduct often diverge significantly fromthis classical partnership model.DynamicsRather than struggling with the many anomalies betweenPDPPPs and the classical definition, it is easier and moreproductive to look at what PDPPPs actually do and how theyoperate, i.e. their dynamics. (From here on in, the term “PPP”will be used to signify these PDPPP organizations, andinparticular drug development PDPPPs, which we have140 ✜ Global Forum Update on Research for Health Volume 4