6

Several Lessons from Developing and Implementing Health-Focused Partnerships

Throughout the workshop series, speakers and participants remarked on the progress and successes that have occurred in global health through public–private partnerships (PPPs). The Sustainable Development Goals (SDGs) provide a new framework for engaging the private sector and developing partnerships to advance health. These new initia-

tives have the opportunity to build on and learn from previous successes, as well as failures, in global health. As part of the workshop series, pairs of presenters shared how they are partnering together to advance their individual organizational strategies, strengthening each other’s engagement, and building local capacity. These partnerships focus on using the core competencies of companies to provide technical assistance and build capacity in support of local needs. This chapter summarizes presentations and the related discussion on how lessons learned from these partnerships can be applied more broadly as partnerships are implemented to advance the SDGs.

STRENGTHENING LABORATORY CAPACITY TO SCALE PREVENTION, TREATMENT, AND CARE

Jane Mwangi of the U.S. Centers for Disease Control and Prevention (CDC), Kenya, and Renuka Gadde of Becton, Dickinson and Company (BD) gave an overview of the Labs for Life partnership and its outcomes. Both briefly provided background on their organizations. Mwangi described The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which is a U.S. government initiative to support partner countries in addressing the HIV/AIDS epidemic. PEPFAR is the largest commitment by any nation to combat a single disease on a global scale. Kenya’s CDC is one of the agencies through which the U.S. government implements the PEPFAR program. The CDC’s Division of Global HIV/TB provides critical leadership in the fight against HIV and tuberculosis (TB) by assisting partner governments to strengthen laboratory, epidemiology, surveillance, public health evaluation, and workforce capacity. Gadde described BD, a leading medical technology company established in the United States that partners with customers and stakeholders to address a number of the world’s pressing and evolving health needs. BD’s innovative solutions are focused on improving drug delivery, enhancing laboratory diagnosis, supporting the management of diabetes, and advancing cellular research. Its medical technologies range from simple blood-drawing equipment to more advanced tools treating HIV, TB, and cervical cancer, among others. BD strives to fulfill its purpose of “advancing the world of health” by advancing the quality, accessibility, safety, and affordability of health care globally.

BD and PEPFAR decided to partner when they identified an area of convergence in their different organizational objectives and complementary individual strengths that could collectively address a public health issue in Kenya. The Labs for Life partnership focuses on strengthening laboratory systems. Globally, billions of U.S. dollars finance HIV testing, treatment, and monitoring, and yet, as Gadde pointed out, a host of issues in blood collection persist. Errors in blood collection can lead to poor out-

comes and testing, and introduce risk. Given this context, BD met with PEPFAR and Kenya’s CDC to discuss issues observed in Kenya’s labs and how they could work together toward a solution. After many discussions, a memorandum of understanding was developed.

Gadde highlighted a provision in PEPFAR’s organizational mandate that allows for collaboration with private-sector companies as long as certain criteria are met, including clearly defined partnerships goals and a lack of conflicts of interest. Both sides had to first come to agreement on partnership objectives, definition of boundaries, definition of specific roles and communication channels, and pledge of contribution.

While forming the memorandum of understanding took time, fortunately a previous PPP in phlebotomy in which BD was involved facilitated the development of Labs for Life. This proven phlebotomy PPP with BD began in 2010 in Kenya. The PPP led to the development of a curriculum for training phlebotomists, nurses, and clinicians on how to draw blood. BD fellows and staff worked in Kenya to teach the safe blood-drawing practices at eight facilities. The curriculum developed was shared with the Kenya Medical Training College, a facility that trains 80 percent of Kenya’s health care workers. BD helped to establish a center of excellence for safe phlebotomy and specimen collection. Although this PPP ended in 2013, as a result, Kenya now has a national training curriculum and a center of excellence for in-service training of health care workers. The success of this PPP led to the development and expansion of Labs for Life.

There are 340 accredited laboratories in Africa with 28 (8.2 percent) residing in sub-Saharan Africa, and the other 312 primarily private laboratories located in South Africa (WHO, 2016a). Gadde cited these numbers to emphasize the challenges in building an accredited public-sector lab, which she noted is the first point of contact for diagnosis for most individuals. In Kenya the lack of a sufficient number of accredited labs presented need for more action in strengthening lab capacity.

Mwangi noted that one critical reason for the success of Labs for Life is that it fit into the country’s existing policies and framework. Kenya had already adopted the Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) program, a process for leading labs to accreditation developed by the World Health Organization (WHO). Labs for Life follows the SLIPTA methodology.

Gadde highlighted key elements of success from the Labs for Life Partnership:

• Involve all stakeholders in each phase of the PPP.
• Establish goals of interest to all parties.
  • Be ready to negotiate—it is a give and take.
  • Clarify expectations early and often.

• Understand the needs on the ground.
  • Do not impose.
  • Allow room for flexibility.
• Allow sufficient time for stakeholder engagement and buy-in.
• Keep governance as simple as possible, with clear roles and accountability.
• Keep channels of communication active.
• Develop a trusting relationship.

She stated that Labs for Life is an example of how PPPs can be catalytic in advancing country goals. Most importantly Labs for Life supported a country-based plan, promoting ownership of the partnership within the country.

ENGAGING AT THE GLOBAL LEVEL TO CATALYZE PARTNERSHIPS AT THE LOCAL LEVEL

Mozammil Siddiqui from Gavi, the Vaccine Alliance, and Kevin Etter of the United Parcel Service (UPS), described Gavi’s partnership with UPS and conditions for the resulting successful initiatives that have been implemented through the partnership.

Siddiqui introduced the Gavi partnership model. Gavi’s mission is to provide access to lifesaving vaccines to the most underserved populations in the world in an equitable manner. It is a PPP that works directly with a range of stakeholders by building on their comparative advantages. Gavi has created shared value by pooling the demand for vaccines across 73 countries, negotiating with vaccine manufacturers on the price of lifesaving vaccines, reducing costs, and transferring those cost savings to countries. In 2001 Gavi started out with 5 vaccine manufacturers in 5 countries, and by 2015 there were 16 manufacturers in 11 countries. The increase in vaccine manufacturers demonstrates Gavi’s influence in diversifying and stimulating the vaccine market. Together with its many stakeholders and primarily driven by low-income countries, Gavi has produced significant results globally in vaccine advocacy, child immunizations, and deaths averted (Gavi, 2016).

Gavi’s spectrum of approaches to private-sector engagement range from engagement based on financing to expertise, accommodating a place for philanthropy, corporate social responsibility, and shared value partnerships. Some approaches are driven primarily by the needs that Gavi has identified; other approaches are driven by the needs that countries have identified. Regardless, all partnerships are targeted to address specific needs. Gavi has ambitious goals for its 2016–2020 term, including immunizing 300 million additional children but recognizes that this target

cannot be reached without strategic partnerships. Gavi’s model brings together collective resources of leading technical agencies as well as innovation from the private sector to achieve its targets.

Gavi, as part of its 2016–2020 strategy, is expanding its work to focus on coverage and equity as part of its goal to reach 300 million additional children. Gavi realized to reach this goal, it will need to target populations in areas that are not easily accessible. This specific need has served as the basis for the partnership with UPS, which focuses on strengthening the vaccine supply chain and training professionals in supply chain management.

Given its global reach, shared mission, and expertise in supply chain management, Gavi approached UPS. After extensive discussions, UPS loaned one of its professional staff, Kevin Etter, to Gavi to advise and consult on Gavi’s supply chain strategy. Etter noted that after a lengthy process of working on the strategy, the partnership has yielded approximately a dozen projects to date. The first project, known as the Strategic Training Executive Programme, focused on supply chain leadership. Many target countries lacked professional supply chain management. In these countries, supply chain management is typically a secondary responsibility of health professionals, and Gavi and UPS saw an opportunity to improve supply chain management by decoupling these jobs. Gavi and UPS began advocating for the professionalization of supply chain management as a means to shift mindsets about the value of the profession and, as a result, drove down costs within the system and led to a greater number of trained supply chain professionals. Ultimately, the project developed into a leadership program for low- and middle-income countries supported by Gavi’s supply chain strategy.

Another benefit to developing the leadership training was the transfer of knowledge from the global to country level. Early in Gavi’s development, its leadership emphasized in-country implementation and leadership. Through the Gavi–UPS partnership, UPS has been able to transfer its technical knowledge as a multinational company in supply chain management and leadership to the country level.

A more recent project within the Gavi–UPS partnership focused on supply chain design and access to the hardest to reach populations. This project is a unique national drone network in Rwanda for the delivery of essential medical supplies that aims to reach the most remote areas. Etter noted the three levels of innovation demonstrated in the project: (1) technology through the use of drones, (2) use case in its ability to be deployed rapidly when there is a need, and (3) partnership through the engagement of not only Gavi and UPS but additionally the Rwandan government and the drone manufacturing company Zipline. In regard to bringing another private company into the partnership, Etter explained that Zipline was

selected as a partner for two reasons: (1) the company had developed the functional technology that the partnership needed; and (2) Zipline had an established business plan for engaging in humanitarian relief. The confidence that UPS had in Zipline encouraged Gavi to bring the company into the partnership.

DISCUSSION

After brief presentations on these partnerships, Boufford asked the panelists if the announcement of the SDGs has altered their priorities in their respective partnerships. Gadde affirmed that the SDGs have changed her thinking for the future potential of BD’s partnerships. The SDGs’ emphasis on collaboration have motivated Gadde to advocate for cluster-based approaches to collectively address problems of significantly larger scale than is feasible through individual approaches. She urged the application of lessons learned from past collaboration to the development of PPPs focused on the SDG. Siddiqui agreed and observed changes globally and within Gavi that are indicative of the effect the SDGs have had on refocusing partnership efforts. Since the SDGs implementation, Gavi has leveraged the call for partnership within the SDGs in its country-level approaches. The 2030 Agenda also has been a useful focal point for renewed engagement and partnership with the private sector and other non-state actors.

Boufford commented that in some ways Gavi is a platform for private-sector engagement in health, and she asked whether PEPFAR could also be identified as a platform. Gadde responded that PEPFAR has a license to engage with the private sector that is articulated in its mandate. Other leading health agencies were approached to engage in Labs for Life, but they did not have this license to work with the private sector. PEPFAR’s license was an important enabler for the partnership with BD.

Boufford asked Mwangi to elaborate, from personal and organizational observations, on her role in Kenya’s Ministry of Health as a representative of CDC, and the reaction of ministry colleagues to a partnership with the private sector. Mwangi acknowledged the complicated relationship. Before the partnership, BD was conducting business in Kenya, and Mwangi underlined that the first step in developing the initiative was fostering the mindset shift to engaging with BD as a development partner with CDC and PEPFAR rather than a company seeking profit from the initiative. Because PEPFAR is in-country and has an established relationship with the Ministry of Health, the partnership with BD was able to leverage trust that had been established within that relationship. Within the partnership, CDC acted as a mediator and BD was able to build on CDC’s in-country platform. The issue of trust was at the forefront of

the partnership. Mwangi noted that every partner had their skepticism, but with discussion came a transparency through which concerns were addressed. Gadde agreed with Mwangi and added that the trust was built over time. To illuminate one specific action taken to facilitate this trust, she mentioned that BD had an independent team to evaluate the qualifications of its staff who participated in the partnership.

Based on the discussion, Etter summarized the elements for success he saw across the partnerships that were presented: an open and willing government, an organization or international nongovernmental organization (NGO) that is willing to break the mold, and private-sector companies willing to take risks. All sides of the partnership must be willing to learn and be ready to work differently.

Boufford inquired about the source of funding for each partnership. Gadde responded that there was no exchange of money between BD and the governmental agency. The company’s technical competency is its contribution. Siddiqui noted that funding for Gavi’s Strategic Training Executive Programme is a combination of in-kind resources from UPS, Gavi, PATH, and UNICEF. For the drone network project, the operating cost is paid by the government of Rwanda. UPS has gone to a catalytic fund to build up the project, but Gavi sees the development in leveraging its expertise to determine how to take the project forward.

Bruce Compton of the Catholic Health Association of the United States observed that each partnership is based on targeted funding and targeted expertise. He noted that health centers without a supply chain often have needs beyond vaccines and labs. He asked the panelists whether their capacity building is strictly targeted for vaccine delivery or lab strengthening. Gadde affirmed that funding and interventions within the Labs for Life partnership are targeted, and explained that going beyond that targeted scope can be done, but it is often complex. Mwangi added that sometimes the PPP is a catalyst for health systems strengthening. In using a system-strengthening approach, the injection of targeted funds and targeted expertise can, once the country takes ownership and scales, magnify that the PPP was just a catalyst. Etter noted that UPS does not have mandates restricting its scope of work, so it is able to consider wider supply chain solutions and interventions. Siddiqui noted that Gavi considers the cost-effectiveness when deciding if it will go beyond its targeted approach, but Gavi is open to expanding its focus to other use cases with greater impact and look at a broader range of supply chain activities.

Richard Guerrant of the University of Virginia asked the panelists how they manage potential engagement or interaction with competitive companies. Gadde responded that strengthening a health system means lifting everyone up, including competition, and BD’s philosophy is to the let the best competitor win. Etter acknowledged that UPS has other initia-

tives that involve competitors, and the company is keenly interested in learning best practices for these types of initiatives.

Alexander Schulze from the Swiss Agency for Development and Cooperation asked whether there has been an uptake or a reflection from other labs in Kenya on how to embed the Labs for Life PPP in their existing systems. Mwangi responded that part of defining the success in creating their PPP was for it to work within the country’s policies and legal framework. While the BD partnership is supporting 10 labs, the Kenya National Public Health Service is able to look at the other 47 counties in Kenya and propel the lab accreditation process forward.

Boufford asked Etter whether UPS has considered taking the supply chain management training a step further to bolster career development. Etter affirmed their interest in career development and pointed to its East African Community regional health center of excellence. The center helps degree holders develop a profession in supply chain management. The center also targets midcareer professionals, offering a series of technical training short courses that are continuing education in nature.

Marcel Mballa-Ekobena commented that the partnerships presented clearly indicate that good ideas are being fostered and developed, but he failed to see the business aspect within them. According to Siddiqui, the ability to use Gavi as a platform to demonstrate what is possible to countries is the way to achieve scale and promote sustainable business models. He explained that if Gavi is able to demonstrate the business case of an initiative and the initiative harmonizes with the country strategy and satisfies the country’s need, then Gavi recommends to the country to take the program further. While this approach has garnered funding, Gavi wants countries to fund themselves so a fundamental business model to assess long-term viability is necessary. Etter described the initial steps to making the business case from UPS’s perspective. The partnership allows the company to build recognition within the country and develop an understanding of the markets they are entering. Engaging with Gavi opened doors to build recognition for UPS, which Etter sees as a key lever in creating their partnership. Efficiency and innovation in delivery are also key to making the business case. Etter promoted innovation that eliminates burdensome and costly technologies, as well as efficiency in the process so health professionals are attending to people instead of directing their time to product acquisition. These two aspects can make a compelling business case.

PARTNERING TO ADDRESS LOCAL HEALTH PRIORITIES

Benjamin Makai from Safaricom described the company’s approach to address health needs in Kenya and key considerations for how it

develops partnerships in support of its approach. Safaricom is a leading telecommunications company in East Africa that for the past 15 years has engaged in partnerships as part of the transformative change that is sweeping across Kenya. Safaricom believes that a greater understanding of the needs of its customers enables the company to offer better products and services. The company has approximately 25 million subscribers and a portfolio of close to 100 products. Beyond its telecommunications products, Safaricom is engaging in value-based discussions on leveraging its network for additional value to its subscribers and Kenyans more broadly.

Makai leads the social innovation unit at Safaricom, which works to identify and develop products and services for social good. Safaricom has considered what contributions it can make to improve the quality of lives in Kenya, particularly in health and aligned with Goal 3 of the SDGs. The company identified several specific areas: access to health; maternal, newborn, and child health; health financing; and health systems strengthening. So far, Safaricom has developed eight unique products and services in these targeted health areas. Though these products are not within a commercial unit portfolio of the company, all of the products are considered viable and sustainable commercially rather than corporate social responsibility initiatives. In describing a few examples, Makai noted that while these products are seemingly simple solutions, the potential effect they can have on the lives of Kenyans can be immense.

Makai emphasized the importance of partnering as part of these initiatives. Similar to how the company approaches innovation, in partnerships Safaricom follows the philosophy of “failing forward.” Some partnerships might not work in the end, he notes, but through attempts, partners can learn what works and what does not, and thus progress can be made.

According to Makai, partnerships should be based on clearly identified reasons for collaboration. Once these reasons are articulated, then a determination can be made if the partnership will be based on a commercial business model or social impact intentions. In addition to setting well-articulated goals and objectives, partners must be flexible as there will inevitably be changes and barriers that emerge throughout the partnership. Flexibility can allow partners to accommodate each other’s needs. Makai highlighted dedicated leadership as a key element to driving partnerships forward. At Safaricom individuals in top management are keen to support partnerships for social impact, promoting the company’s use of innovation for good. Lastly, partners must define the right time to move to the next stage of a partnership.

Maureen Kamene Kimenye of Kenya’s Ministry of Health described the ministry’s TIBU partnership with Safaricom. TIBU, a program that delivers health care and manages TB patients in Kenya, was developed

with Safaricom in 2011, and is now in phase three of its rollout. Kenya has a high burden of TB, drug-resistant TB, and HIV. In 2015 the total TB incidence in Kenya was estimated at 107,000 and, out of those, around 33 percent were HIV infected (WHO, 2016b). According to UNAIDS nearly 900,000 HIV positive adults in Kenya are receiving treatment but an estimated 1.5 million people in the country are living with HIV (UNAIDS, 2016). Kamene Kimenye pointed out these statistics to show the number of people that Kenya’s Ministry of Health has not yet reached. In addition to the high disease burden, socioeconomic or geographical factors complicate the health system’s ability to track patients.

Kamene Kimenye noted several challenges in data collection and treatment for TB patients in Kenya that predated the TIBU partnership: paper-based systems for data collection with repeated data entry and error possibilities; paper-based financial systems with delays in disbursement and feedback of missing information; inadequate information in the community of TB, leprosy, and lung disease; delays in patient support reimbursements; expensive communication systems; vertical systems; and little to no electric automation or integration across systems.

The Ministry of Health identified the need for both horizontal and vertical communication from the facility level to the ministry level. The ministry saw opportunities in the increased adoption of electronic data management, increased availability of system developers, mobile banking and money transfer systems, and high mobile phone penetration in the population. A comprehensive framework was developed to connect the ministry’s program management, patient management, geographic information system (GIS) framework, and data collection systems. The systems would communicate directly through one program management system called TIBU, eliminating the need to send monthly data and a separate financial system. Implementation of this system would be through TB coordinators at the district level using the TIBU app. The app is used for data collection, payment requests, receiving funds, patient requests, among other functions. Safaricom was approached as a partner in this endeavor because of its reputation as a leader in mobile use and developing digital products and social innovations.

Since launching TIBU in 2012, the Ministry of Health now has 100 percent project accountability of financial resources. The program uses Safaricom’s M-PESA, a mobile money transfer service for the disbursement, which has improved the governance and accountability of project outcomes. This accountability has strengthened partnerships with donors, Kamene Kimenye noted. If an organization wants to fund TB programs, the M-PESA system allows a view into how funding is being used at what level, and what is remaining at any given time. The M-PESA system is still supporting TIBU, handling $3.42 million in disbursements, and more than

400,100 beneficiaries have received payments through this system. The Ministry of Health has continued to encourage Safaricom’s engagement.

Partners within the TIBU initiative include the Kenya Ministry of Health, Kenya’s TB program, Safaricom, U.S. Agency for International Development (USAID), and Tuberculosis Accelerated Response and Care, as well as Tangazoletu Ltd., which developed the finance system, and IridiumInteractive, which developed the patient management system. To create sustainable partnerships, Kamene Kimenye recommended that business should start with government plans, find an entry point to fit into them through their competencies, and that business play a bigger role in joint planning initiatives. Together government and business can then work to identify gaps and shared goals for partnering. She cautioned that finances from the private sector alone will not be enough to meet the identified needs, and experience and expertise from private-sector partners should be included early to achieve better outcomes.

The Honorable Ahmed Sheikh Mohamed of Kenya’s Mandera County Health Section described another health-focused partnership in Kenya: The 6 County Initiative, a multistakeholder partnership led by the United Nations (UN) Population Fund. The initiative leverages the strength, resources, and expertise of the private sector, in alignment with the Global Financing Facility, the government of Kenya, the World Bank, and companies, one of which is Safaricom. The partnership targets six remote counties with the highest maternal mortality rates in Kenya. Through the partnership, the private sector’s collective actions are focused on a number of activities in these six counties:

• Strengthen supply chain management for health commodities.
• Increase availability and demand for youth-friendly health services.
• Build capacity for health professionals.
• Create innovative health management systems.
• Increase access to energy for facilities.
• Empower youth.
• Continue research.
• Mobilize resources.¹

According to Mohamed, partnerships are critical for the implementation of this initiative and two key aspects within the partnerships are sustainability and ownership. He suggested that ownership of the health problems and the initiatives to address them lies with the government, and the sustainability of solutions lies with communities. Mohamed

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¹ See https://www.everywomaneverychild.org/commitment/kenya-private-sector-collective-action-for-rmncah (accessed April 21, 2017).

emphasized the need and opportunities in Mandera County for partnerships that focus on health products, health financing, and building capacity in human resources to move the health sector forward.

BUILDING CAPACITY IN SCIENTIFIC RESEARCH AND INNOVATION TO SUPPORT DEVELOPMENT THROUGH REGIONALLY LED PARTNERSHIPS

In a joint presentation, Frans Swanepoel of the Future Africa Institute, and Tim Genders from Project Isizwe introduced the partnership between their South African–based organizations and explained how the partnership works to advance the SDGs. Swanepoel first presented the mission and work of the Future Africa Institute, which he described as a platform for supporting new frontiers in research and development, with a special focus on adaptability, resilience, and codesign of systems for sustainable and equitable development in Africa. Based at the University of Pretoria, the Future Africa Institute focuses on multi- and trans-disciplinary approaches, capacity development, partnerships, and innovation to facilitate global impact in support of the SDGs. Within the SDGs, Swanepoel noted that the Future Africa Institute focuses on agricultural support and improvement, as all 17 goals are dependent on a thriving agricultural system, including Goal 3, centered on improving health and well-being.

Genders introduced Project Isizwe and its overarching mission to provide free Wi-Fi. Access to Wi-Fi, Genders explained, is extremely limited in South Africa, and lack of access to the Internet places extensive limitations on economic security, educational achievement, and socialization. With support from local governments, Isizwe installs Wi-Fi boxes, called FIZ boxes, in communities lacking Internet access, and the initiative has seen success with more than 700,000 users empowered through their free services and able to access online job searches, educational tools, and social networks. Genders noted that Wi-Fi usage is generously limited to 500 megabytes per day, or 15 gigabytes per month.

The partnership between the Future Africa Institute and Project Isizwe, named FIZ4FOOD, aligns with both of their organizational missions and uses their individual competencies. Through FIZ4FOOD, Wi-Fi networks installed through Project Isizwe are used to implement a nutrition initiative monitored by the Future Africa Institute. The partnership allows users to increase their daily Wi-Fi allowance on the network by completing a census survey administered when they log on to the network. The census survey asks about food and nutrition consumption and behaviors. In this way, Genders explained, the free Wi-Fi provided through Isizwe functions as reward currency, in which the network enables the collec-

tion of nutrition consumption data that can be used by the Future Africa Institute to understand and monitor eating patterns and, in turn, design and promote policies to enhance nutrition. Through connecting technology with development-focused research, FIZ4FOOD provides an innovative example of a partnership supporting the achievement of the SDGs by using the individual competencies and advancing the missions of the individual partners.

DISCUSSION

Boufford asked Makai to elaborate on Safaricom’s decision making and established processes for the transition from pro bono engagement to a sustainable business model. Makai stated that with most of the company’s products there are two levels of transition. The social innovation unit incubates projects and once the pathway to scale is clearly defined, the products are transitioned to the business unit. The business unit is able to route solutions to the market and has the ability to scale. However, Makai emphasized, care must be given to support the customer, or partner, and avoid abrupt transitions to the business unit. The transition has to be managed in a way that supports the customer and creates an opportunity for Safaricom to potentially develop more business opportunities. Additionally, mechanisms are needed to ensure the service does not halt when the donor moves to a different model. Safaricom works together with the ministry, government, and other collaborating partners to ensure there is a smooth transition.

Kathy Taylor of the University of Notre Dame asked the panelists to describe more granularities in the partnership development stage, including how partners decided who will lead, how each voice would be heard, and what weight each partner has in the partnership.

Makai responded that the voice of the customer stands first, and in TIBU it was the ministry. While TIBU was funded by USAID, the requirements were specified by the ministry. The partnership development included a steering committee and an operational team. The teams defined their norms and responsibilities, and they had clearly defined timelines for each particular task. Kamene Kimenye added that the steering committee had a chair who was the main visionary leading the team. When there were decisions to be made or conflicts to be addressed, they were managed at the chair level. She stated that leadership made implementation easier. Also, because there were so many partners, focal points for each organization were established, which created continuity during the development.

Makai went on to say that the 6 County Initiative is a classic coalition of like-minded organizations, where competing organizations like Merck

and GlaxoSmithKline have come together to collaborate. The initiative determined the role of each organization and how each could contribute toward reducing the overall burden, which was the maternal health-related cases in those six counties.

MOVING FORWARD

In concluding the workshop series, Boufford and Gadde noted that a number of approaches, considerations, and lessons learned for engaging the private sector and developing partnerships to advance health and the SDGs had been presented. In moving forward in their individual engagement and approaches to global health the SDGs agenda, they asked the participants to reflect on the workshop content and consider the following three questions.

1. What if businesses approached their engagement in health PPPs based on SDG priorities that have been identified by countries through their national plans?
   • Where the partnership is built from the beginning on a clear, shared sense of purpose and common health objectives based on country-set priorities. Perhaps increased coherence between the private sector and national development plans can more successfully ensure that the delivery of resources matches the objectives of the country, and change can be more sustainable.
2. What if businesses had a clear definition of the core knowledge, skills, resources, and assets they are prepared to bring into a PPP to support a country’s outlined SDG and health priorities?
   • Avoiding duplication, and moving toward complementary engagement.
   • Increasing potential for leveraging other resources, and building the capacity needed for sustainable change.
3. What if multiple businesses across sectors had a better understanding of how to coordinate and collaborate on their engagement in-country while working toward separately targeted health priorities based on their core competencies?
   • Building coherence across business engagements in countries to advance health and identified SDG priorities.
   • Opening opportunities for business-to-business partnerships.
   • Facilitating transformational partnerships.

REFERENCES

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