Since the announcement of the Sustainable Development Goals (SDGs), countries have been mapping out their national action plans, updating health and development information, reviewing national priorities and current international development assistance, and determining which policies and strategies align with SDG targets as well as what changes are needed. Through this process, many countries are identifying opportunities for greater effectiveness in reaching their goals through partnerships with the private sector.
National plans can serve as a guide for the private sector to align business interests with the needs and priorities identified by countries.
Starting with national priorities, partnerships can be built from the beginning on a clear, shared sense of purpose and common health objectives. As acknowledged by speakers throughout the workshop series, increased coherence between the private sector and national development plans can more successfully ensure that the delivery of resources matches a country’s priorities and promotes sustainable change.
This chapter summarizes presentations and discussions during the workshop series on how countries are developing and aligning their priorities with the SDGs, the rationale for public–private collaboration to achieve national-level sustainable development priorities, and the establishment of platforms for ongoing discussion on cross-sectoral alignment in support of the national sustainable development priorities. The chapter first describes the approaches of two high-income countries, Norway and Switzerland, to implementing the SDGs agenda and how they envision the role of the private sector in supporting their priorities. A regional perspective from the Pan American Health Organization (PAHO) on supporting countries across the Americas and Caribbean in implementing their national plans follows. The chapter concludes with a description of multisectoral coordination and collaboration to support the SDGs in Uganda.
Ambassador Geir Pedersen of Norway described the country’s priorities within the SDGs agenda, its approach to implementation, and the role of the regulatory environment to drive the goals forward. While Norway is committed to delivering all 17 goals, the country has identified several top priorities within the agenda: sustainable consumption and production, health and education, equality, employment, and migration (UN, 2016a). Norway’s implementation strategy centers on national leadership, engagement across government, and the inclusion of the private sector. Since the beginning of the SDGs discussions, the prime minister has been engaged, giving her the responsibility to deliver on the goals and provide the political capital to move all government ministries toward coherence in policy and direction, Pedersen stated.
Public-sector leadership realizes that the 2030 Agenda cannot be achieved through old approaches that rely on governments or development assistance alone. Additionally, in Norway, the private sector understands that its continued success requires the adoption of the new realities of the SDGs. Business is responding to the SDGs, and Norway provides a welcoming atmosphere to engage the private sector. Pedersen attributed this welcoming atmosphere to a combination of factors: the small size of the country allows for easier debate and discussion; civil society is strong; and consumers are increasingly seen as having power. Pedersen encour-
aged cooperation with the private sector to achieve the global agenda; however, he emphasized that success also depends on the mobilization of domestic resources. Norway’s sovereign wealth fund is a unique opportunity and key component in Norway’s strategy, and there are current discussions on how the fund can invest in industries and businesses that support sustainable development.
In addition to mobilizing resources, Pedersen stated that in Norway there is a strong belief that government is responsible for putting in place a clear regulatory framework to guide investments. For example, Norway has a very high import tax on cars; however, in alignment with the goal to reduce carbon emissions, the government exempts electric cars from this tax. Consumers have reacted dramatically to this incentive, resulting in a high proportion of electric cars to population size (Jolly, 2015). This example highlighted how the government can lead and incentivize change.
In the international community there is continuing disagreement on whether regulations are necessary to address market failures and guide investments but, according to Pedersen, without a strong regulatory push Norway would not have a path to implement the SDGs agenda.
Globally, Pedersen suggested that there is a lack of understanding on both the public and private sides on how to drive forward investments that align with the SDGs: from investors about available opportunities and from countries about creating an enabling environment. Given this lack of understanding, he suggested that there would be value in bringing together investors, development banks, and governments to discuss bottlenecks and opportunities to facilitate the acceleration of these needed investments.
Alexander Schulze of the Swiss Agency for Development and Cooperation (SDC) provided an overview of the Swiss implementation process for the 2030 Agenda, and how SDC is approaching collaboration with the private sector. Switzerland has two parallel implementation processes for the SDGs—a national implementation process based on the existing national strategy for sustainable development that will be adapted to align with the 2030 Agenda, and a global implementation process for the 2030 Agenda, outlined in the Dispatch to Parliament on International Cooperation (Swiss Confederation, 2016). Both implementation processes are not only complementary but act as an integrated approach at the national and international level.
For the national process, Switzerland is finalizing a baseline assessment of where it stands on each of the 169 targets and determining whether the targets are reflected in current Swiss policies. The next step
will be conducting a gap analysis to identify areas for action and define priorities. The government will then establish appropriate structures and processes, define responsibilities, and adapt a monitoring framework for progress on the goals. Schulze noted that cantons, cities, nongovernmental organizations (NGOs), and the private sector are all relevant stakeholders in this final step of the national implementation process.
Regarding the global implementation process, Schulze stated that there are overlapping priorities and objectives among different national policies and international frameworks such as the 2030 Agenda, the Swiss Health Foreign Policy, and the SDC health policy. Based on these reference documents, specific to health and private-sector engagement, SDC’s Global Health Program focuses on five key components—research and development (R&D) and access to medical products, universal health coverage, sexual and reproductive health and rights, determinants of health, and global health governance—as a nexus for including the private sector in policy debates. SDC recognizes that (1) the SDGs are a shared responsibility and cannot be achieved without business and (2) business will benefit from more stable, resilient, and equitable societies. As a development agenda, SDC believes that there is a need for collaboration between host countries and development agencies to build strategic partnerships with the private sector that have the potential to implement scalable solutions.
SDC engages in three types of partnerships with the private sector. The most prevalent type is operational, which includes either specific product development or the provision of products and services. The second type is within the area of responsible business conduct. The third and least common type of partnership is where the private sector is involved in national or global policy dialogue on sustainable development. To strengthen the collaboration with the private sector going forward, the SDC’s strategy includes building its own competencies to promote mutually beneficial public–private development partnerships (PPDPs). This strategy includes building internal competencies to better understand business terminology and interests. SDC is also developing a PPDP framework to help colleagues working within different thematic areas determine the appropriate type of partnership according to the purpose of the partnership, for example, whether focusing on policy dialogue or producing a specific health commodity. In addition, SDC is setting up a process to evaluate potential partnerships based on key criteria. To support these actions, SDC is preparing the establishment of a fund to initiate PPDPs. SDC’s medium-term goal is to foster more formalized, institutional partnerships that go beyond specific products or projects to encompass more areas within the 2030 Agenda.
Overall, SDC is in the beginning stages of developing a systematic approach to engage with the private sector. It is reaching out to the
companies or industry associations for discussion on different issues, for example, improving alignment of different product development partnerships and involving more companies. Schulze concluded by suggesting SDC should position itself to better articulate what it needs from the private sector and then build strategic partnerships with the goal of increased impact.
During the Millennium Development Goals (MDGs) era, positive development outcomes were achieved in the Americas, including a decrease in extreme poverty and infant mortality, and an increase in life expectancy. Despite this progress, the Americas still face significant development challenges, including the new realities of the rise of noncommunicable diseases, the need for universal health coverage, and growing inequity. The comprehensive agenda of the SDGs reflects many of these current challenges. Countries in the Americas are developing new national plans to address these challenges and align with the SDGs. Kira Fortune of PAHO described how PAHO is providing assistance to support countries in this process with a focus on health needs and priorities.
To provide a baseline, PAHO performed an analysis to compare the SDG targets with current country health policies and programs (PAHO and WHO, 2015). The resulting document serves as an advocacy tool for PAHO to assist countries in addressing health across the SDGs, and encourage the use of multisectoral approaches (PAHO and WHO, 2015). Additionally, PAHO is convening national consultations to better understand the specific challenges in individual countries and how PAHO can support countries in the development of their national plans. Fortune noted two points of consideration in developing these plans: (1) while the SDGs agenda is universal, local context is important to understanding and addressing health issues within each country, and can determine the success of the strategy, and (2) information sharing and cooperation across the region is vital to collectively push the agenda forward.
Recognizing inequality as a high priority across the region, among PAHO’s first steps to support the implementation of the SDGs agenda was launching a high-level commission in May 2016 that is leading a regional review of health inequities. The commission and review are part of a partnership between PAHO/World Health Organization (WHO) secretariat, member countries, and the Institute of Health Equity at University College London. The purpose of the review is to gather and synthesize quantitative and qualitative data on the associations between gender, equity, human rights, ethnicity, and health in 13 focus countries. The
key output of the commission to determine actionable recommendations for member states to reduce or eliminate health equity gaps (PAHO, 2016).
Fortune emphasized the need for interagency collaboration on the SDGs to expand cooperation. PAHO has an agreement with the Organization of the American States to establish joint activities primarily focused on equity, social inclusion, and social determinants of health. This alliance will unite other Inter-American and United Nations (UN) system agencies like the Economic Commission for Latin America and the Caribbean and the UN Development Programme. The collaboration will enable the flow of information, promote dialogue between health and foreign affairs ministers, and identify existing means to facilitate the process.
PAHO is also promoting collaboration through the Health in All Policies (HiAP) approach. In the Americas the HiAP approach focuses on reducing health inequities using multisectoral approaches and identifying mutually beneficial situations with other sectors. Fortune noted that the Americas is a global leader in driving this initiative, and is the first region to establish a plan of action on HiAP. The significance of this plan lies in the opportunity it provides to bring together different sectors, including the private sector. However, Fortune noted that within the Americas challenges to private-sector inclusion persist. She pointed to the history of the tobacco industry as an example of mistrust that has left the region wary of working with the private sector, and stressed that issues like trust must be addressed to enable effective collaboration with the private sector.
Fortune has observed language barriers between PAHO and other sectors, as well as within the health sector, that affect the HiAP approach. Ultimately, to drive effective collaboration, she suggested different sectors and different actors within the same sector will need to make a concerted effort to learn each other’s languages. Despite these existing challenges, the HiAP plan is evidence that multisectoral participation in the Americas can be achieved.
Fortune mentioned Mexico as a case study of a partnership methodology that was successful in bringing together different actors, clearly defining roles and responsibilities from the outset, and developing a common objective to achieve concrete health outcomes. In 2010 Mexico introduced its National Agreement for Nutritional Health in an effort to combat an alarming rate of obesity and overweight prevalence in the country (Mexico Secretariat of Health, 2010). Addressing obesity calls for participation of various government sectors, civil society, and, given the central role of the food and beverage industry on health outcomes, the private sector. Although the national agreement underlined public–private collaboration, Fortune noted some of the challenges it faced, including the harmonization between industry interests and public health objectives, technical discussions on definitions and concepts, and accountability and
transparency. She put forward several lessons learned from this initiative: (1) the same companies that produce unhealthy foods also produce healthy foods, (2) negotiations should be evidence based, and (3) public–private partnerships can expedite adoption of product changes across competing companies.
Looking to the future, PAHO is exploring the potential for public–private partnerships (PPPs) to address maternal mortality and noncommunicable diseases. The Americas failed to achieve the MDG on maternal mortality, making it an even more important priority for the region in the SDGs. PAHO sees maternal health as an opportunity to work with the private sector to develop new strategies and technologies to reach communities that previously have been excluded. The global community has also called on the private sector to contribute to the prevention of noncommunicable diseases. These diseases remain a major issue for the Americas and provide an opportunity for further collaboration as exhibited in the case study of Mexico.
In conclusion, Fortune outlined three steps to move past stand-alone initiatives toward comprehensive and integrated approaches addressing multiple development priorities across sectors. First, draw on lessons learned from HiAP in the Americas as the SDGs agenda is implemented; second, clearly define roles, responsibilities, and expectations; and third, ensure robust monitoring of progress.
For decades Uganda has demonstrated leadership and commitment to sustainable development, including through the shaping of its national constitution, adoption of the Addis Ababa Action Agenda, and support for Africa’s Agenda 2063, among others actions. Christian Acemah of the Uganda National Academy of Sciences (UNAS) opened a panel discussion on Uganda’s experience in multisectoral collaboration to advance its sustainable development priorities by pointing out that Uganda was the first country to mainstream the SDGs into its national planning frameworks, which it did in 2015 through its second National Development Plan (NDP). The NDP establishes the country’s development priorities for 2016 to 2021 and aligns with the principles of the 2030 Agenda. As part of its efforts to implement the NDP, and thus also implement the principles of the SDGs, the Ugandan government has developed a range of new social programs and is enhancing its capacity to steer inclusive development by strengthening institutions and financing mechanisms. The government developed a National Standard Indicator Framework through which the implementation of SDGs will be monitored, evaluated, and reported on (UN, 2016b). Legislation intended to facilitate the
implementation of the 2030 Agenda has been introduced, including the Public Finance Management Act (2015), the Public Private Partnerships Act (2015), Public Procurement and Disposal Act (2014), the Financial Institutions Amendment Act (2015), and the Registration of Persons Act (2015).
The Ugandan government recognizes the importance of partnerships with the private sector to advance its sustainable development agenda as well as platforms for advancing the development of these partnerships. Margaret Kigozi of Business and Professional Women, Uganda, described past action taken by the Uganda Investment Authority (UIA), a governmental body, to establish multisectoral forums to advance development and the SDGs. Recognizing that multisectoral collaboration was needed to effectively attract foreign investment, UIA developed a forum to advance dialogue between the government and the private sector. While the dialogue advanced through the forum was considered successful to an extent, it largely focused on the needs of the private sector and their demands from government. The dialogue did not include academic and civil society stakeholders,1 losing out on the benefit of the respective knowledge base of these stakeholders within the PPP discussions. As a next attempt, UIA launched a public–private–academia forum, with the support of Uganda’s Makerere University and, in particular, its vice chancellor. The forum was viewed as a success but unfortunately, when the vice chancellor left the university, support for the project did not continue. From this experience, Kigozi learned the importance of planning for sustainability during the early stages of such an initiative. Following the setback, UIA attempted to establish a forum among civil society, the public sector, and the private sector. While there was some interest among stakeholders, it has failed to gain traction.
Learning from these past experiences, UIA has now joined in UNAS’s recently launched Forum on Transparency and Accountability (FOTA), which brings together stakeholders from government, the private sector, academia, and civil society while providing a stable convening platform. Nelson Sewankambo, president of UNAS, described the role of the academy and the steps that led to the development of FOTA. UNAS provides evidence-based scientific advice to the Ugandan government and the public, and promotes the use of scientific evidence for national development. In 2014, UNAS hosted the Network of African Science Academies (NASAC) annual meeting, which focused on the need for a mind-set
1 Civil society includes charities, development NGOs, community groups, women’s organizations, faith-based organizations, professional associations, trade unions, social movements, coalitions, and advocacy groups (See http://www.who.int/social_determinants/themes/civilsociety/en [accessed April 20, 2017]).
shift among all stakeholders, including government, the private sector, other leaders, and citizens, when approaching the SDGs. This meeting coincided with the release of NASAC’s report, referred to in Chapter 2, which laid out a strategy for African countries to take greater ownership of the development agenda (UNAS, 2014). The report and the 2014 NASAC meeting set the stage for UNAS’s meaningful engagement in the implementation of the SDGs.
At the start of the SDGs discussions, UNAS recognized there was an opportunity to serve as a facilitator in Uganda’s implementation process. Following the annual NASAC meeting, UNAS considered developing a forum focused on PPPs, led by the governor of the Central Bank of Uganda, as a platform to contribute to the implementation of the SDGs within the country. This initiative evolved into FOTA, which UNAS launched in 2016. The ongoing forum has been established as an intermediary platform for discussing multisectoral engagement to advance Uganda’s development priorities. The forum has three objectives. The first objective is to be a forum for discussion on evidence-based data for the public, private, and civil service sectors in Uganda. The second objective is to produce consensus studies to provide evidence-based advice on promoting transparency and accountability. The last objective is to be a neutral, apolitical setting for stakeholders to discuss midcourse progress in managing development efforts. The forum is moving forward with the support of the Ugandan government. Several members of the UNAS forum, including Sewankambo and Kigozi, shared their perspectives on engaging the private sector and developing partnerships to advance the SDGs in Uganda as well as the role of FOTA.
Angela Akol represents FHI 360 on UNAS’s FOTA and shared her perspective on the value for FHI 360, an international nonprofit organization focused on infusing science into all of its approaches, in participating in the forum. FHI 360 and UNAS are aligned in their priorities to integrate evidence-based approaches into development and to promote transparency within PPPs. Predating the SDGs agenda, FHI 360 has approached its work through integrated development, which aligns with the interconnected and indivisible characteristics of the SDGs. FHI 360 started as a health-focused organization, specifically, in family planning and maternal and child health, but quickly shifted to act as a human development organization. The organization focuses on infusing integrated development at the household level based on the theory of change that if all areas of an individual’s needs are covered at the same time by single or multiple entities, their life can be transformed.
Within Uganda, engagement of the private sector in development is relatively new, and all sectors are seeking to define their value proposition when entering partnerships. Within the private sector in Uganda,
Kigozi noted that the role of business leaders in SDGs is becoming clearer. There is a greater sense of national ownership with the SDGs, and various private-sector actors have been asked to act as ambassadors for specific SDGs in Uganda.
Acemah, Akol, Kigozi, and Sewankambo discussed the role of different sectors in partnership arrangements and elements for effective sustainable partnerships. Acemah noted that business’s primary focus is on profit, not development, so there is a need for development actors to make sure that the value proposition is clear to businesses. Kigozi emphasized the importance of science and research. Academia, civil society, and national academies conduct research that can be critically beneficial to the private sector, so she believes that partnering with these stakeholders is the way to drive the SDGs and overall development forward. Kigozi emphasized that partners must indicate their relevance to build support for their inclusion.
Regarding sustainability of partnerships, Kigozi emphasized the importance of initiatives to institutionalize rather than depend on an individual champion. Akol stated that country ownership of the partnership is essential for long-term sustainability. For Sewankambo, the key to building lasting partnerships is trust, mutual benefit among partners, disclosure from all partners of their interests and goals for the partnership, and agreement on a well-defined purpose. Sewankambo added that partnerships should document and share results clearly and early to rally support and continued investments. He emphasized that trust is necessary for successful partnerships, and it cannot be built without transparency that requires all information and conflicts of interest be disclosed before entering into partnership arrangements. Sewankambo acknowledged that trust is difficult to cultivate, but it can be developed over time and reinforced through actions.
From a civil society perspective, Akol commented that trust is a necessary element, enabling various stakeholders to effectively work together. She believes there is some level of trust between business and society in Uganda, but there is room for improvement. Data show that Ugandans use the private sector for health services, so it is clear they trust the private sector to deliver health commodities more than they trust the government. However, instead of using banks and financial services, people are more comfortable holding the money on their phones or under their pillows than taking it to private-sector institutions. She highlighted these examples to show that trust is fickle. In Akol’s opinion the central challenge is how partners can trust each other enough to work well together over the long term. Currently she observes an environment where many partnerships are not based on mutual interest but are more transactional, in which civil society and development partners provide in-kind services
to the public sector and the government receives them. Akol emphasized trust as the first step to build sustainable partnerships for development. Kigozi believes trust can be built if there are mutual benefits that can be identified and disseminated to all parties. The commitment to the SDGs means there is an assumption that every sector can contribute and benefit from one another.
Kigozi acknowledged that there will be a great deal of sensitization required to build effective partnerships. Civil society can be an effective partner for the private sector by providing understanding and access to communities; however, the private sector has limited information on what civil society does or how it can benefit from civil society’s work. Objectives and intentions of partners and the partnership must be clear from the start to generate trust, and then, she emphasized, quick clear results must be presented to bolster support.
Robert Clay from Save the Children reflected on his prior work in partnerships at the U.S. Agency for International Development (USAID) to note the importance in creating a safe space for stakeholders to come together and discuss; he said this can be achieved in several ways. In addition to multisectoral forums, Clay encouraged field excursions where together partners can directly observe the problems they are working to address, which can help break down barriers. He also underscored the need for a concrete product not only to justify the work of forums, but for the success of partnerships. Results can rally people’s ambitions and passions and aid communications, helping to inform a partnership.
In concluding the discussion on the Uganda experience, Renuka Gadde of Becton, Dickinson and Company praised UNAS’s leadership in establishing a neutral forum that will broker discussion and showcase different types of public–private partnerships to achieve the SDGs. The UNAS platform lends itself to make recommendations on how to issue a call for private-sector engagement in a manner that involves trust, honest intervention, and the promotion of cross-sector collaboration.
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