The shift toward shared value within the corporate sector has impacts and implications on partnerships and other stakeholders in global health. At the workshop, stakeholders from sectors outside of private corporations described how a shift toward shared value strategies is impacting their own global health engagement strategies and how they are approaching partnerships. This chapter summarizes the remarks provided by Beth Bafford from Calvert Foundation, Aron Betru from Financing for Development, John Sargent from Broadreach Healthcare, Marjorie Paloma from the Robert Wood Johnson Foundation, Abbey Davidson Maffei from CARE USA, and Wendy Taylor from the U.S. Agency for International Development (USAID). Key messages from their remarks are included in Box 6-1.
Beth Bafford, Calvert Foundation
To set the stage for the discussion, Beth Bafford, Director of Investments at Calvert Foundation, a social investment fund that raises and deploys debt capital into community and economic development, explained some findings from a recent landscape analysis of global health investments that her organization conducted. Calvert Foundation has recently started exploring investment opportunities in global health and performed a landscaping of global health investments in sub-Saharan
Africa and India to understand how it could develop a portfolio strategy to invest more actively in the sector. As part of the analysis, Calvert Foundation spoke with about 40 fund managers working in the sector and, from that, discovered several relevant trends, Bafford noted.
She mentioned that the first discovery was the dearth of capital available that is disease and population agnostic. Bafford continued that most funders have been focusing on a specific disease or population, leaving a need for more flexible capital investments in infrastructure, hospital systems, pharmacy chains, and other avenues for service delivery. The second discovery was a lack of significant human capital at the intersection between business and health. Not many medical professionals and business experts have both skillsets and can build, run, and scale global health companies, enterprises, and innovations in developing countries. The third discovery was the eagerness of the public sector to welcome private investment and private-sector activity and the search for leadership from the private sector by the public sector. Bafford said there is an increasing recognition by the public sector that it cannot provide health services alone to its target population. Bafford suggested that all three trends point to a welcoming ecosystem for more corporate engagement.
Bafford said corporations can bring more flexible capital to build infrastructure and use their human capital to train and mentor entrepreneurs and medical professionals to grow and run businesses successfully. Their investment is welcomed to help develop more robust health systems in low- and middle-income countries. As an impact investor, Bafford is excited about the potential in global health, and suggested the individuals on the panel represent strong partners for private investors looking for shared value opportunities in global health.
Aron Betru, Financing for Development
Aron Betru the CEO of Financing for Development (until June 2016), a nonprofit organization, described how the organization is focusing on designing, structuring, and implementing innovative financing ways of creating shared value in the development ecosystem. Betru suggested that what is most needed to drive shared value initiatives forward is leadership and vision to ensure that there is mutual benefit for both the private investors and beneficiaries. Often this requires an external facilitator to make sure key issues are being brought to the table. Where the concept itself may seem easy, Betru suggested that its execution is very difficult. He provided some examples to illuminate this point. One example is based on a contraceptive device that is produced by Merck. It is implanted into a woman’s arm and is effective for up to 3 years. Working together with multiple partners, a system was developed to amortize the implants, so that the government of Ethiopia, working with donor assistance funds, could pay for the implants over the course of 2 years. This allowed Merck to be certain about what their business was going to look like over multiple years, creating incentive for the company to cut the price of the product.
The challenge with developing partnerships such as these is understanding and addressing the incentives of all parties and then developing solutions that create more value for all parties with fewer resources. However, once private-sector companies start understanding and experiencing examples where these partnerships work, the mindset begins to shift and the barriers are reduced, Betru noted. In the example from Merck, Betru pointed out that the company is now starting to ask whether there are opportunities with their other products to develop procurement structures based on shared value.
Betru suggested that the examples of shared value creation are outliers, and a shift in more organizations toward shared value likely will not
come from within, but from outside facilitators advocating for the shift or keeping them honest along the way. From his experience in developing innovative financing initiatives based on shared value principles, Betru offered several lessons he has learned: incentives matter and stakeholders who can move the needle need to be engaged. If there are good stewards of a key set of incentives at the table, shared value can be created. He suggested it is not complex in theory but, to succeed in practice, it should be well articulated and designed from the beginning.
Abbey Davidson Maffei, CARE USA
Abbey Davidson Maffei, Senior Director of Strategic Partnerships and Alliances at CARE USA, provided a perspective on why, as an international nongovernmental organization (NGO), CARE engages in partnerships with the private sector and how those partnerships have involved as shared value has become more common. CARE’s mission is to fight global poverty by empowering women and girls to bring lasting change to their communities. Private-sector companies have been an implementing partner of CARE’s for many years and, in the past 10 to 15 years, these partnerships have been shifting from philanthropic toward shared value models. This shift has happened in part because that is where companies have been moving, but also because CARE understands that far more impact on the ground can be realized by engaging companies through a variety of entry points.
Several years ago, based on this realization, CARE developed a multiasset model through which it works with companies in supply chains; in distribution and services to communities at the bottom of the pyramid cooperating with workforce on gender, equity, and diversity training and other ways to engage employees; in branding and communicating efforts to engage consumers; and in working with government relations teams to align on advocacy issues that are of mutual interest. Davidson Maffei noted that CARE has developed effective partnerships based on this model with companies in food and agriculture, apparel, and financial services, and summarized some lessons learnt from those partnerships.
Davidson Maffei suggested that shared value efforts, at least from CARE’s perspective, are fundamentally change initiatives. These initiatives are pushing the envelope of what CARE’s core business tends to be, moving from a focus on development programs to alignment for mutual benefit. They also push the envelope for companies. When CARE partners with companies on these initiatives, their partners are drawn from sustainability teams and business innovation teams within the companies
that are pushing the edges of what their businesses are doing. Together, CARE and its partners are learning how to make these processes work, engaging all the stakeholders from the beginning to work toward developing the right models.
Davidson Maffei offered an example from a partnership with PepsiCo in West Bengal to integrate gender and nutrition into their potato supply chain. This partnership is addressing a couple of key issues: 90 percent of the women in the potato value chain are anemic, women are making crucial contributions to the potato chain that are not necessarily recognized, and women are not necessarily receiving the training and resources to become more productive to generate better livelihoods for them and for their families and to improve efficiencies in PepsiCo’s chain. The partnership is looking at the linkages among these issues along the upstream portion of the value chain. If this pilot shows the intended results in terms of productivity, efficiency, and benefits to the community, it is something that PepsiCo hopes to scale through its Sustainable Farming Initiative, which runs across all of its key agricultural ingredients. Davidson Maffei noted what a great opportunity it would be if together these partners can achieve their desired outcomes.
However, Davidson Maffei suggested, the reality is that not all of CARE’s desired outcomes in terms of development impacts will have a business case, and the organization needs to be upfront about that. This means figuring out what CARE is willing to live with as companies work to scale these approaches and where CARE can get supplemental funding that is not going to come from a business unit to address those aspects that really are public goods. Getting that balance right is a priority that CARE is trying to manage.
Davidson Maffei described a couple of challenges CARE has encountered in its shift toward shared value partnerships. First, the business units CARE is engaging in these partnerships, such as innovation and research and development (R&D) teams, have considerably lower budgets than corporate foundations with whom CARE has more traditionally partnered. These partnerships have smaller budgets, shorter time horizons, and little room for error to prove the concept on the ground. Despite these constraints, these initiatives are the most innovative ones.
Another challenge is finding the right expertise for these projects, which often requires writing budgets and resourcing these activities to bring in supplemental expertise. Davidson Maffei suggested this is an area where corporate partners can sometimes help to provide expertise. Sometimes this expertise has to come from outside CARE and its corporate partner to serve in a translator role between business and development.
Beyond engaging CARE and its corporate partners in these initiatives, Davidson Maffei noted that there is often a recognized value in bringing
USAID or other development agencies into these partnerships. However, CARE has found that it can be challenging to align timelines and funds procurement from development agencies and companies. Another challenge with bringing in additional partners is managing proprietary interests of companies.
Davidson Maffei suggested that a fundamental difference with shared value versus philanthropic partnerships is the co-design of the initiative with teams from both CARE and the company. The innovative nature of the work requires expertise from both sides and co-designed models. These models are still emerging. Davidson Maffei suggested that documenting and sharing experiences are needed to develop best practices moving forward.
John Sargent, BroadReach Healthcare
Sharing his personal experience of his journey as a social entrepreneur, John Sargent, Co-Founder of BroadReach Healthcare, described how his organization evolved, illuminating three points about shared value from his perspective: information is a critical catalyst to shared value, entrepreneurs and social entrepreneurs will be a major driver of innovation, and the shared value revolution has not yet happened.
Sargent started BroadReach with his best friend from medical school, Ernest Darkoh. Growing up, both Sargent and Darkoh lived in and visited a diversity of low-resource communities and saw firsthand the lack of access many communities had to basic health care or basic services such as running water. However, a range of consumer products, such as soft drinks, soap, and cigarettes were always available. Sargent and Darkoh asked themselves, what is it that the private sector knows that makes this happen? After completing medical school, they started on the quest to find out. Instead of moving on to medical residency, Sargent and Darkoh went into management consulting with the idea that it would be a residency in business.
After 4 or 5 years of gaining private-sector management consultancy experience, they started their own organization with the objective of taking what they had learned from the private sector and medicine to improve access to health care for underprivileged populations. Over time, their organization, BroadReach, has evolved to focus on information, an area where Sargent and Darkoh found they have both expertise and would help achieve their original objective.
Information as a Catalyst
Sargent and Darkoh realized one of the challenges hindering progress across all of these sectors was a lack of information, including a lack of understanding of the health priorities in a country, the effectiveness of health interventions, effective business models that can meet health needs and provide a return on investments, and which partners can be trusted enough to engage.
Sargent believes one of the big catalysts for encouraging organizations to partner and to create shared value models is information. BroadReach has built information technology and software cloud-based systems to analyze clinics and the overall health care system in countries to better understand what the problems are and what needs to be done to improve them. It provides access to information at the highest levels of ministries of health down to key personnel at the district level. Information that was previously being collected but not used can be applied to meaningfully predict modeling at the local and country levels. For pharmaceutical companies, BroadReach’s system can help to analyze market size and potential for certain products. For NGOs, BroadReach is licensing its system to help them better manage their performance and report to development agencies. The system also provides an opportunity for dialogue among these different stakeholders to help align priorities and programs.
Entrepreneurs as a Major Driver of Shared Value
Sargent and his organization are not a lone example of social entrepreneurship in solving global health challenges. In the past few years, there has been a growth in social entrepreneurs, particularly those that are locally based and come from the communities they are serving, developing new models to solve social problems. They are connected to their communities, they know what is going on and what does not work. They do not necessarily have the capital or knowledge to scale or the technical support that they need. Sargent believes there is a massive opportunity for private-sector companies to be more deliberate and thoughtful about partnering with entrepreneurs as a way to create new business models, whether it is through strategic investment, joint ventures, or providing human capital.
Critical Mass for Shared Value
Sargent suggested that one of the biggest challenges in creating a critical mass for shared value is perceptions and attitudes. From his perspective, besides a few exceptions within top leadership positions, few people
understand what shared value means. To move the needle, he encouraged publishing more research and case studies, and being relentless to achieve the critical mass to flip the switch and change the attitudes among all of the different stakeholders.
Marjorie Paloma, RWJF
Marjorie Paloma, Director and Senior Program Officer at the Robert Wood Johnson Foundation (RWJF), described the foundation’s focus on building a culture of health and why business is a critical partner in this initiative, and several ways in which the foundation has shifted its mindset to engage with business through a shared value framework.
For the past 2 years, RWJF has focused on building a culture of health in America and, through this lens, sees the connections between health and all sectors of society, both public and private, including housing, transportation, urban planning, and architecture. Paloma noted that RWJF realizes achieving a culture of health will require healthier, more equitable communities and strengthening the integration between the health and health care systems. Additionally, Paloma stressed, will take a national movement, and the business sector, because of its vast size and its ability to drive cultural change, must be at the table. RWJF has funded research showing that companies that sell healthier products are more profitable and have a better reputation with their consumers.
Paloma noted that collaborating with business has been a part of RWJF since it was founded by Robert Wood Johnson, one of the brothers of the Johnson & Johnson Company. However, the foundation has always been separate from Johnson & Johnson and was organized as a purely philanthropic foundation. The company’s mindset shift to engaging with the business sector through shared value has evolved more recently.
Paloma described the key ways in which the foundation has adapted its mindset. The first is through embracing new ways of working. RWJF recognizes that it is not a business expert, and most businesses are not health experts. What RWJF can bring to these partnerships is its research, networks, broad experience, strong reputation, and demonstrated success in working to improve health. For businesses to be able to benefit from RWJF resources and for RWJF to benefit from the business expertise that companies bring, both sectors need to adapt to new ways of collaborating so they can collectively tap into each other’s expertise. With this shift, RWJF has had to become more open minded about business as a player in the social movement and understand business motivations and goals. RWJF also has to understand that profit is not a dirty word. Building on
a point made by Davidson Maffei, Paloma noted that the foundation has needed to become much more iterative and adaptive when trying, testing, and prototyping engagement opportunities to learn and build the right model together.
Paloma added that impact is another important factor for RWJF when considering collaborating with the private sector. RWJF does not partner with everyone who approaches the foundation. Instead, the foundation evaluates the potential partnership based on answers to the following questions: how does it fit with the foundation’s values, what is the risk of engaging, what are the conflicts of interest and even perceived conflicts of interest, how does this affect our value in terms of charitable purpose and the public good, and what are peoples’ views around proprietary information? After evaluating the potential based on these factors, RWJF then evaluates whether there is a unique role it can bring through the initiative to activate or accelerate progress, and what the potential is for the scale and spread of its impacts.
Wendy Taylor, USAID
At USAID, engaging business, often through shared value opportunities, is fundamental to how the agency views development. In the past several decades, the role of aid agencies has shifted dramatically. The percentage of capital flows in developing countries from development agencies has shrunk dramatically, while business investments are increasing. Currently, 91 percent of funding into developing countries comes from the private sector. Wendy Taylor, Director of the Center for Accelerating Innovation and Impact at USAID, suggested this increase in funding is happening as businesses realize economies in their traditional markets are slowing down and, at the same time, there are growth opportunities in emerging markets. However, Taylor noted that not all of these funding flows are focused on subpopulations within countries that are most in need. To continue to achieve development objectives, there is a need to align development agency initiatives with private-sector investments.
Taylor clarified that USAID, as well as several other development agencies, are well aware of the shift toward shared value within the private sector, that adapting to this shift requires a mindset change in how development agencies approach partnerships, and have already implemented changes in this direction. A recent review of USAID’s partnerships over the past decade found that a significant number of them focused on shared value and, of those partnerships that were based on shared value, a number of them still aligned with strategic corporate
interests. She provided a perspective on the agency’s approach to partnerships, highlighting lessons learned and some of the challenges in the shift toward shared value opportunities.
While partnering with the private sector has been part of USAID’s engagement strategy since its founding in 1961, Taylor acknowledged that how USAID is engaging is shifting. Traditionally USAID focused on developing its programming, bringing in an implementing partner, and then identifying a private-sector player almost as an afterthought. However, the sweet-spot of shared value is identifying collective interest and how to address problems together. It is a co-creation process that requires the private-sector partner to be at the table from the outset of the program development. Taylor admitted that, while essential, it is not always easy to do, and USAID is trying to mainstream the co-creation process into its work.
One of the lessons USAID learned is that partnerships are most effective when the core competency of the private-sector partner is engaged. To highlight this lesson, Taylor provided an example of a partnership with Coca-Cola that taps into the company’s core strength. Through the partnership, Coca-Cola is lending its expertise in optimizing systems, distribution channels, and outsourcing to deliver its products to last-mile populations to teach USAID and in-country government better practices for the distribution of medicines.
A second lesson Taylor described is related to scale and sustainability. She noted that often partnerships are challenging to scale to the level needed and be sustainable. She suggested shared value partnerships can overcome some challenges of scale and sustainability and illuminated this point with an example of a multistakeholder alliance within the agriculture sector. This alliance, developed by USAID’s food security team, is engaging the private sector on sustainable agriculture development in Africa. The alliance includes 45 private-sector companies that have committed to making $3 billion of investments in African agriculture if policy changes and the enabling environment in country are improved to create strategic business opportunities. Part of the equation to make the partnership work is policy changes implemented by African governments. USAID is able to leverage their relationships with the governments to facilitate these changes. The governments have incentives if all of these private-sector investments are going to come in, and other donors can be brought on board to be the catalysts to make many of these changes happen.
A third lesson Taylor described was that partnerships work best and will have the greatest development impact when they are built on notions of shared value. She illuminated this lesson through the example of the Helping Babies Breathe partnership. This multistakeholder partnership
focused on newborn resuscitation, tackling one of the leading causes of death for infants in the developing world. The partnership is centered on a device called a neonatal resuscitator, which is cheap and can be used in developing countries. The partnership involves a company that manufactures the devices as well as training dolls to help teach health care workers how to use the devices. The American Academy of Pediatrics developed the training protocols. An implementing partner introduces these programs in each country involved. In 5 years, the partnership raised $58 million; more than half of it came from outside of USAID. It has been introduced in 77 countries and is scaling up in many of those countries. Taylor noted that the corporate partner, Lerdahl, is a small company and this program is its first initiative in the developing world. Lerdahl needed to figure out how to introduce a product in these harder to reach markets and the partnership provided the platform. It was so successful that, as a result, Lerdahl developed a new business unit to develop new innovations on maternal/neonatal health in the developing world.
Despite the great successes from USAID’s engagement in shared value-based partnerships, Taylor emphasized that there are challenges and she pointed to a few of them—alignment takes time and effort; and procurement challenges can make it difficult to move money fast enough. USAID is developing the tools to help move things faster, but sometimes it is still difficult to do. To streamline some of the challenges with time and effort, Taylor suggested exploring more wholesale approaches rather than just retail. Each partnership takes time and effort to build and, once the partnership is built, it needs to be managed. Teams can easily become bogged down in managing many small-scale partnerships. Larger wholesale opportunities, such as the agriculture-focused multistakeholder alliance that she mentioned, can provide opportunities for greater impact.
On a closing point, Taylor emphasized the potential of innovative financing. Recently, impact investing has become more mainstream and major investment banks are now paying attention. However, she noted there is a ways to go in increasing innovative financing in health. Insurance and reinsurance companies are developing creative ways of thinking about how reinsurance can help in creating pandemic funds to prepare for future pandemics and forging social impact bonds. Taylor believes there will be an increase in experiments and, hopefully, more successes in innovative financing in global health.
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