5
Lessons from Partnership Experiences
The previous chapters have included the context, motivations, opportunities, and examples of innovations for public–private partnerships (PPPs) for health systems strengthening. In addition to these factors, Bruce Compton from the Catholic Health Association of the United States emphasized the need to learn from lessons and experiences in partnerships for health systems strengthening to improve efforts going forward. This chapter distills the lessons learned from both the successes and the failures that were presented and discussed at the workshop.
LESSONS LEARNED
Andrew Jones from the Tropical Health & Education Trust (THET), Christophe Longuet from Fondation Mérieux, and Clarion Johnson from ExxonMobil shared lessons learned from developing and maintaining partnerships through their individual organizations. Despite differences among their organizations, their roles within the organizations, and the specific focus of their partnerships, they shared common experiences and lessons. This section synthesizes these lessons and includes a summary in Box 5-1.
Understand Motivations and Objectives
Longuet acknowledged that partners often have different motivations and objectives. While partnerships among stakeholders with differing
motivations and objectives can be successful, it is important to understand each other’s perspective when entering the partnership. For instance, Longuet explained Fondation Mérieux typically enters partnerships with a focus on medium- or long-term objectives; whereas, their partners in Africa frequently are faced with short-term issues and resource needs that drive their motivations and objectives. Additionally, the foundation’s external funding partners often have specific interests in supporting parts of an overall project, such as a particular region or program component, rather than supporting the program overall. These divergent motivations and objectives can be managed; however, they need to be understood by all partners in order to be manageable.
Jones also emphasized the importance of understanding your partners’ motivations and objectives. Specifically, when partnering with the corporate sector, even if the company is funding the partnership through its corporate philanthropy or social responsibility, there will be expectations on what the company delivers as if it was any other business-line activity. Jones said, when starting a relationship with potential partners, get to know their motivations, talk to individuals, and learn how to work jointly for mutual benefit.
Build Trust
The panelists explained how they build trust with their local partners, as well as how they determine the trustworthiness of those with whom they partner. Johnson shared that to build trust with partners on the ground he starts with the mindset that they are invested in their communities, have been there longer than he, and have knowledge about
what has failed in the past and what is needed going forward. In terms of choosing trustworthy partners, Johnson noted that his company performs incredible due diligence with all of its partners to determine if they can be trusted. He must demonstrate to his senior leadership that he knows and understands the partners with which he engages and will be prepared to answer questions about the motivations, strategic plan, and flexibility of the partners if needed. Thus, he asks potential partners questions about how they are credentialed, how they work in a country, and, above all, if they are willing to share their procedures with the company’s auditors.
Jones commented that trust is about a number of different components, including mutual accountability, respect for each other, and the ability to acknowledge that there are mutual benefits. In the end, it is about how you act it out rather than what you say. Like Johnson, Jones noted that his organization also performs thorough due diligence on the partners with which it engages, all partners including those on the ground and corporate partners. Jones explained, “If I am going to enter into a meaningful partnership with you or with a corporate or another NGO (nongovernmental organization) or a government agency . . . I need to know and believe that not only do you want good things to flow from this relationship, you actually want the best. Of course, for this to work, you need to know and believe the same of me, too.”
Longuet added that it takes time and a demonstration that trust can be given to you. When it comes to selecting trustworthy partners with which to engage, sometimes it is not a choice. Occasionally, a partner is predetermined, and then decisions are made regarding what will and will not be accepted in the partnership.
Workshop participant Patricia Daly from Save the Children commented on the issue of trust from her perspective at a large, long-standing international NGO. She noted that often NGOs have been in communities for a long time and they have built trust with the community and the local government. When an NGO adds a partner, doing due diligence is incredibly important to maintain those trusted relationships. If the trust is lost, the organization cannot continue its work there.
Understanding Your Partner’s Language
Daly added that a common language is important and much time is spent educating each other on specific language, whether it is from an NGO or a corporate partner or a foundation. Language barriers can be overcome, but doing so requires having the right people in the room who are willing to learn from each other. Drawing on this point about language, Jeff Sturchio from Rabin Martin commented that it is hard to overestimate just how little individuals from different sectors understand
about how other sectors operate. Even when using the same words, different sectors may not mean the same thing. Referring to a particular partnership experience that involved a company, a foundation, and a national government, Sturchio said that it took years to develop a common understanding of what the partnership was trying to accomplish.
Develop Clear Agreements and Be Flexible
Appropriately managed expectations are vital to successful partnerships, Jones emphasized. Either partner is capable of letting the other partner down. Well-managed expectations and clear agreements at the outset will mitigate this likelihood. Longuet agreed but used the example of the Ebola epidemic in West Africa to illuminate the importance of being flexible within agreements. The epidemic required a reallocation of the foundation’s resources and the establishment of new objectives for its partnerships. Some original objectives were placed on hold while the foundation focused for one year on laboratory capacity building for hemorrhagic fevers. Because of the flexibility built into the agreements with its partners, the foundation was able to reallocate its resources as needed.
Catalyze Actions and Give Ownership
Longuet explained that through Fondation Mérieux’s partnership model, its partners in country own and implement the projects. The foundation sees its role as supporting actions and implementation, but the countries have the ownership. The reasoning behind this model is that those on the ground know best what they want to accomplish and they know how to do it. However, Longuet admitted there can be challenges when the capacity and infrastructure on the ground to implement projects is limited and needs to first be assessed and addressed to create the necessary environment to implement the program.
Jones noted that much of the current work in global health and international development is based on the principles set out in the Paris Declaration on Aid Effectiveness in 2005. The Paris Declaration placed an emphasis on development interventions being led by developing countries. This created a parallel emphasis on partnerships and country ownership rather than one on traditional development and donor models.
Learn from Your Partners
Partnership is a learning process. Longuet stressed the need to be open to learn from other partners, particularly those in country where activities are being implemented. Local partners have a lot to teach about
the community needs and local context and how to develop and create more sustainable results.
View Partnerships as a Mindset Not a Formula
Jones emphasized that successful partnerships are based more on relationships than on systems. Rather than developing a “formula” for successful partnerships, sectors should focus on developing a partnership mindset. When partnerships are based on relationships, even when the funded activities end, the relationship continues and there is an opportunity for ongoing and sustainable support to the overseas institution. Jones noted that in his organization, they need to constantly remind themselves that there is a difference between the time-bound project into which they invest and the partnership itself, which provides the basic infrastructure for and the relationship to deliver the project.
Share and Learn from Failures
Jones commented on the importance of learning when partnerships fail. To improve partnerships and create a better chance for success, it is important for partners to assess why the partnership failed and begin to learn from it. Those lessons are reiterated and then incorporated into the next partnership. In the end, success is understanding the application of the principles of partnership. Failure lies in ignoring them. To share the knowledge THET has learned from its successes and failures, the organization has developed a set of partnership principles.1
THE MACRO CONTEXT
Based on workshop discussions and his experiences working in global health across sectors, Sturchio shared several lessons learned when considering the macro context in which partnerships are being developed.
New Paradigm of Global Health Governance
Referring to the context Rifat Atun set regarding the post–Bretton Woods Agreement environment, Sturchio commented that a new paradigm of global health governance is emerging in which all sectors will need to conduct business in a new way—not just the private sector but also governments and NGOs. New mechanisms will be required, reflect-
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1 THET Principles of Partnership is available at http://www.thet.org/health-partnershipscheme/resources/principles-of-partnership (accessed December 15, 2015).
ing the principles of good governance, transparency, participation and engagement; clear accountability for success and failure; coordination and coherence; and a new eye on priority setting to achieve ambitious global goals while balancing equity and efficiency. Within this framework of broader issues around politics and public policy, Sturchio suggested global health needs to be better positioned as a critical factor in achieving the new Sustainable Development Goals. He added that new ventures within this context will require not “just-all-government” but also “whole-of-society” approaches with practical mechanisms to ensure participating stakeholders have the opportunity to contribute to new solutions, both in defining goals and priorities and working together in implementation. Sturchio added that, at the country level, these new mechanisms will only be successful with high-level political commitment and engagement.
Managing Complexity
Within this context, Sturchio noted that currently there is already significant investment in health care in the developing world, from international donors, private-sector partners and domestic government resources. In many countries, more than half of health care services are delivered through the private sector. It is not a question of whether the private sector can help, but rather how best to manage the complexity. That complexity includes the entire spectrum of prevention, care, and treatment. At the country level, there are private clinics, private pharmacies, drug kiosks, social franchises, and even informal practitioners. Further, the private sector is involved at all stages of the value chain. Like the lessons shared for partnership experiences, this complexity and the macro context in which individual partnerships are developed are factors that influence both the prospects for new partnerships and their potential for success.
