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Introduction¹

Over the past several decades, the public and private sectors made significant investments in global health, leading to meaningful changes for many of the world’s poor. These investments and the resulting progress are often concentrated in vertical health programs, such as child and maternal health, malaria, and HIV, where donors may have a strategic interest. Frequently, partnerships between donors and other stakeholders form around these vertical disease or condition-specific programs, as stakeholders can coalesce on a specific topical area of expertise and interest. However, to sustain these successes and continue progress, there is a growing recognition of the need to strengthen health systems more broadly and build functional administrative and technical infrastructure that can support health services for all, improve the health of populations, increase the purchasing and earning power of consumers and workers, and advance global security (IOM, 2014).

On June 25–26, 2015, the National Academies of Sciences, Engineering, and Medicine’s Forum on Public–Private Partnerships for Global Health and Safety (PPP Forum) held a workshop on the role of public–private partnerships (PPPs) in health systems strengthening. The PPP

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¹ The planning committee’s role was limited to planning the workshop. The workshop summary has been prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.

Forum was established in late 2013 to illuminate the role of PPPs in meeting the health and safety needs of individuals and communities around the globe. The PPP Forum seeks to foster a collaborative community of multisectoral leaders to leverage the strengths of varying sectors and multiple disciplines to achieve benefits for global health and safety. By regularly gathering and learning from leaders of diverse, exemplary, and innovative entities, the PPP Forum focuses on catalyzing more effective global health initiatives that will capitalize on the complementary assets and motivations of the sectors involved. The membership is committed to engaging the expertise of its members and broader groups of stakeholders, its resources, and its networks to explore opportunities to catalyze partnerships; to elaborate norms that will protect the interests of those partnered and those served; to capture and share best insights, evidence, and practices for decision making and resource allocation for partnerships; and to foster innovations that may increase efficiencies of and equitable access to effective care. This workshop was the third public convening of the PPP Forum.

The workshop brought together stakeholders from the public and private sectors to examine a range of incentives, innovations, and opportunities for relevant sectors and stakeholders in strengthening health systems through partnerships; to explore lessons learned from previous and ongoing efforts with the goal of illuminating how to improve performance and outcomes going forward; and to discuss measuring the value and outcomes of investments and documenting success in partnerships focused on health systems strengthening.

For the purposes of the workshop, the term “health system” comprises all actors, organizations, and resources working toward improved health. It is inclusive of personal health care delivery services, public and population health services, health research systems, and policies and programs within other sectors that address the broader determinants of health. The World Health Organization (WHO) identified six building blocks of the health system—leadership and governance, financing, workforce, medical products and technology, information systems, and service delivery (WHO, 2007). Additionally, a health system with robust public health services includes mechanisms for monitoring health status to identify and solve community health problems; diagnosing and investigating health problems and health hazards in the community; promoting health; encouraging community participation in health; developing policies and plans that support individual and community health efforts; enforcing laws and regulations that protect health and ensure safety; promoting equitable access; developing and training human resources in public health; assuring quality; conducting public health research; and reducing the impact of emergencies and disasters on health (PAHO, 2008).

Further, recognizing that the health of individuals and communities is influenced by factors that are often outside the purview of the tradition health sector—such as the social, economic, and built environments—for this workshop, the “health system” has been operationalized to include policies and programs within other sectors that address these determinants. Among such sectors are finance, education, transportation, and information communication technology.

To strengthen health systems across these domains, different actors from the public and private sectors have unique resources that they can bring to bear, for example, information and technical systems development, human resources management, financing mechanisms, and product development and delivery capacity. For the purpose of this workshop, the private sector includes all nongovernmental actors, including for-profit companies, private providers, nonprofit organizations, and foundations. Partnerships are an opportunity for stakeholders to come together around a common set of objectives, with the ultimate goal of health systems strengthening, and identify not only how to work together but also where each stakeholder can contribute the most effectively. Within the current context of the post-2015 development agenda, a discussion on the role of partnerships in building sustainable and resilient health systems is particularly timely.

ORGANIZATION OF THE REPORT

This report provides a summary account of the presentations given at the workshop. Opinions expressed within this summary are not those of the National Academies of Sciences, Engineering, and Medicine; Institute of Medicine; the PPP Forum; or their agents, but rather of the presenters themselves. Such statements are the views of the speakers and do not reflect conclusions or recommendations of a formally appointed committee. This summary was authored by designated rapporteurs based on the workshop presentations and discussions and does not represent the views of the institution, nor does it constitute a full or exhaustive overview of the field. The summary report is complemented by an individually authored literature review of PPP activities in health systems strengthening that is included in Appendix A.

During the workshop, many of the sessions touched on more than one of the topics within the Statement of Task (see Box 1-1). Given the overlap of the issues and topics discussed at the workshop, this summary is organized topically rather than chronologically. The workshop agenda and a complete list of workshop speakers are included in Appendix B and Appendix C, respectively.