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Potential Strategies and Approaches for Private-Sector Engagement in the Sustainable Development Goals

Opportunities for private-sector engagement to advance the Sustainable Development Goals (SDGs) and improve global health outcomes have been acknowledged across sectors and promoted by the development community as well as private companies themselves.

Since the announcement of the SDGs, many companies have been seeking opportunities to support the goals that both create value for their business and contribute to economic growth, prosperity, and well-being through globally defined targets (UNGC and KPMG, 2016). Each company’s approach to the SDGs will be unique and determined by factors such as previous and ongoing engagement in social impact initiatives, industry sector, supply chain, geographic markets, internal support, and external expectations. This chapter summarizes presentations on the approaches of six different companies representing a range of industry sectors (health care, customer products, telecomm, and beverage) that are applying their expertise and resources to advance global health and the SDGs.

Allison Goldberg, representing Anheuser-Busch InBev (AB InBev), presented two AB InBev initiatives that align with specific targets of the SDGs. Gary Cohen of Becton, Dickinson and Company (BD) discussed the company’s four methods for contributing to positive social impact and opportunities for advancing the SDGs through them. Representing British Telecom (BT), Chris Bruce shared how the company is applying its competencies and interests to support the SDGs. From the Novartis Foundation, Ann Aerts presented the corporate foundation’s approach to collective impact and commitment to creating a continuous cycle of evidence-based practice with the goal of increasing the effectiveness of its initiatives to reduce the global burden of noncommunicable diseases. Susanne Stormer of Novo Nordisk explained the company’s triple bottom line approach, how it is integrated into its daily operations, and the related business case for engagement in the SDGs. Allison Tummon Kamphuis from Procter & Gamble Co. (P&G) shared how P&G is identifying opportunities across its product lines to contribute to the SDGs.

As several of these speakers acknowledged, advancing health and the SDGs requires building innovative and collaborative initiatives that engage a number of different sectors and partners. Included throughout this chapter are perspectives from other sectors on the role of private-sector companies and collaborative efforts in support of health and development (see Boxes 4-1 to 4-5). The chapter concludes with an example of how the investment community is engaging in global health promotion and the role of various stakeholders in fostering market-based solutions to finance the SDGs.

ANHEUSER-BUSCH INBEV

Allison Goldberg, Anheuser-Busch InBev¹

Allison Goldberg of AB InBev presented how the world’s largest beer brewer is approaching the global health agenda through its core operations to advance both social and business objectives. The company examined the SDGs and other health targets set by the international community and developed new evidence-based initiatives to contribute to them. Through these initiatives, AB InBev seeks to position itself as a private-sector model working innovatively across sectors to support global health objectives.

Together for Safer Roads

One of the global targets on which AB InBev has chosen to focus its efforts is the call to reduce the number of deaths and injuries from road traffic accidents (SDG target 3.6). The company is 1 of 16 members of the private-sector coalition, Together for Safer Roads.² The coalition is advised by an independent expert panel that provides guidance on how companies can fill a gap to address road safety challenges and defines a set of initiatives that the coalition can advance. The coalition applies each member company’s knowledge, data, technology, and global networks to focus its efforts across five areas: road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response. Part of those initial efforts included the launch of partnerships with the city governments of Shanghai, China, and Rio de Janeiro, Brazil, to develop locally focused initiatives that tackle road safety challenges. The coalition leverages each company’s capabilities as well as uses its integrated cross-company capacity to yield results through these city-level partnerships.

One key aspect of the coalition’s work is the importance it places on the local context of addressing road safety challenges. Goldberg pointed out that the local operating companies and on-the-ground stakeholders decide where their capabilities are best suited. Local actors such as universities, governments, civil society, and innovators can offer expertise and assets to help determine how best to formulate a partnership specific to a city’s needs. Ultimately, as Goldberg stated, through the experience of Together for Safer Roads, AB InBev has determined that the decentralization of ownership, from company to community, is critical to the implementation and sustainability of these programs.

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¹ Allison Goldberg of Anheuser-Busch InBev Foundation as of May 1, 2017.

² For more information on Together for Safer Roads, see http://www.togetherforsaferroads.org (accessed June 22, 2017).

Global Smart Drinking Goals

The Together for Safer Roads Coalition has demonstrated AB InBev’s potential for impact on globally defined priorities. This experience garnered support from within the company to develop a new initiative focused on another SDG target, the reduction of harmful alcohol use globally (SDG target 3.5). The company has pledged a 10-year commitment to be the global champion for this target through its Global Smart Drinking Goals³ and associated demonstration projects in select cities around the globe. The Global Smart Drinking Goals will advance programs and initiatives that foster a culture of smart drinking through two principal efforts: changing behaviors through social norms and empowering consumers through choice. Public–private partnerships (PPPs) will be central in the implementation.

Goldberg noted that an important element for the Global Smart Drinking Goals strategy is the inclusion of external technical advice across sectors, along with unbiased and independent evaluation. After extensive deliberation the company created a technical advisory group composed of experts from various sectors and disciplines to provide independent guidance for the implementation, monitoring, and evaluation of the company’s work to reduce harmful alcohol. These external experts provide guidance on the use evidence-based approaches and program effectiveness and also have built support among company leadership for the initiative. Goldberg presented the framework for the initiative and drew attention to mechanisms to ensure transparency. She emphasized the importance of robust, yet practical, monitoring and evaluation methods to assess impact of the initiative on the SDGs, the company, and public health at large.

BECTON, DICKINSON AND COMPANY

Gary Cohen, Becton, Dickinson and Company

Gary Cohen of BD described several methods that BD applies when developing and implementing initiatives in support of global health and social good. The four methods are defined as follows:

1. Corporate philanthropy: Provides charitable donations of cash or in-kind products and services.

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³ For more information on the Global Smart Drinking Goals, see http://www.ab-inbev.com/better-world/a-healthier-world/global-smart-drinking-goals.html (accessed June 21, 2017).

2. Corporate social responsibility (CSR): Deploys business resources and competencies to achieve positive societal impact not directly linked to commercial outcomes.
3. Advocacy and policy alignment: Supports changes in laws or regulations for positive societal impact.
4. Shared value creation: Uses commercial business models to address unmet societal needs.

Because these approaches have been well defined, Cohen stated that deciding which approach to apply for a particular purpose can be relatively straightforward. He added that partnerships are central to all of BD’s global health initiatives across the application of these four methods. Cohen provided examples of BD’s application of each of these methods to global partnerships that address specific health issues, including immunization (corporate philanthropy: Maternal and Neonatal Tetanus with UNICEF; shared value creation: Safe Immunization Devices with PATH), lab system strengthening (CSR: Labs for Life; shared value creation: CD4 Testing with Clinton Foundation), health worker safety (advocacy and policy alignment: Healthcare Worker Safety Legislation; shared value creation: Healthcare Worker Safety Devices), and maternal and newborn mortality (shared value creation: BD Odon Device™ for Obstructed Labor).

Cohen explained in more detail how BD defines its shared value initiatives. Shared value initiatives are developed with an explicit intent to address unmet societal needs that are prioritized by governments and leading public-sector agencies, and are most often pursued in collaboration with other sectors. Cohen described BD’s shared value partnership for the Odon Device as an example. The initial device concept was invented by an auto technician from Argentina and won the Saving Lives at Birth: Grand Challenge for Development competition. Following the challenge prize, the World Health Organization (WHO) presented BD with the device concept and a request for BD to develop the technology and provide access, particularly for high-burden, low-resource populations. Although BD did not have specific expertise in obstetrics, it had the relevant core competencies in device design and manufacturing. The company agreed to develop the device. Beyond product development, to bring the device to scale including accessibility in high-burden, low-resource populations, BD is engaging in extensive cross-sector collaboration. This initiative is built on past PPP experiences, but is innovative for BD because of the high level of collaboration. Cohen asserted that unlike philanthropy and CSR, there is no limit on scale in shared value creation

initiatives such as this one; however, successful development and scaling of the device will depend as much on its partners as it will on BD.

Based on his experiences at BD with initiatives across these four methods of engagement, Cohen believes PPPs are an art, and their success is based primarily on trust and the alignment of motivations among partners. The SDGs offer BD a significant opportunity to engage around well-defined goals and targets and determine which are relevant to the company.

BRITISH TELECOM

Chris Bruce, British Telecom

Chris Bruce of BT presented the company’s approach to the SDGs. BT is the national provider of telecommunications in the United Kingdom and, although it was privatized more than 30 years ago, BT still has responsibilities to deliver service to the United Kingdom beyond its shareholder requirements.

BT recognizes the opportunity to contribute to the global agenda through engagement in the SDGs by applying its core competencies in information and communication technology (ICT) across the goals. Bruce explained that like most large companies BT has found it is most likely to be successful at delivering on social objectives when they are aligned with the company’s own interest and competencies. When approaching the SDGs, BT reviewed the goals and mapped the overlap across its own 2020 sustainability goals to determine where there was alignment with its ongoing objectives and potential to increase their impact on global targets.

Bruce highlighted BT’s Future Cities collaboration with national and local government, academia, small and medium-sized enterprises, and communities, which focuses on applying the value of the Internet of Things (IoT)⁴ for social good. Through this initiative, BT is using IoT technologies and building PPPs across four domains: health and social care, environment and energy, travel and transport, and the public realm. BT has pilot programs working to collect, analyze, and apply data. In Milton Keynes, a small city north of London, BT has created a data hub with The Open University to collect information about the city’s parking, traffic, and waste management, among other services. The data is made available to communities, citizens, and SMEs to improve the delivery of public services. Through this pilot, Bruce stated, BT is learning how to create and scale operating and commercial models that can benefit its business interests. In Manchester, BT and Cisco are working with public organizations, universities, and small innovative startups on a project called CityVerve. The program is developing use cases that address chronic condition management, community wellness, and nursing home care that can be shared globally. Beyond the United Kingdom, the company is working in India and Africa to apply ICT to support initiatives to tackle climate change, poverty, inequality, and health.

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⁴ IoT is defined as the “Internet-connected web of citizens (people) and electronic sensors/ devices (things)” that can serve many functions related to public and environmental health surveillance and crisis management applications. See https://ij-healthgeographics.biomedcentral.com/articles/10.1186/1476-072X-10-67 (accessed April 21, 2017).

Bruce mentioned BT’s initiatives to increase connectivity, a key component to bridge the digital divide. BT champions connectivity through its engagement in the Wireless Broadband Alliance (WBA), specifically the Connected City program and World Wi-Fi Day. WBA initiatives promote connectivity through sharing best practices, the creation of public–private ecosystems, and collaboration mechanisms. Bruce explained that Wi-Fi is the most basic way to connect communities, and the WBA has called on private companies, government bodies, sponsors, and others to contribute to connectivity efforts in a more sustainable way by paying for the line and service that allows communities to be connected. He noted that the potential social, economic, and environmental benefits of connectivity are interconnected.

In closing, Bruce summarized BT’s approach to the SDGs and shared some lessons learned from engaging in partnerships. After finding alignment between its own sustainability goals and the SDGs, the company determined that although ICT and digital technologies contribute to all aspects of the 2030 Agenda, for the company’s efforts to have long term impact, they should be focused on areas of natural corporate interest and competitive advantage. Cross-sector and public–private collaboration is central to BT’s efforts, and BT has learned such efforts can be fostered through the creation of a common language. Differences in language among multiple stakeholders remains a challenging aspect to recognizing, promoting, and sharing best practices. Initiatives such as the WBA can help promote sharing and the development of a common language. Bruce emphasized that companies must create incentives to improve the processes and delivery of initiatives in order to truly embed them into the organization. Lastly, Bruce emphasized the need to track results. The programs he presented are externally audited by various organizations, and the method and outcomes are communicated to employees, staff, suppliers, and customers.

NOVARTIS FOUNDATION

Ann Aerts, Novartis Foundation

Ann Aerts of the Novartis Foundation presented examples of the foundation’s collective impact model for promoting innovative health care delivery for noncommunicable diseases (NCDs). The 2030 Agenda called out NCDs as a major challenge for sustainable development with four out of five deaths from NCDs worldwide occurring in low- and middle-income countries (LMICs). Cardiovascular disease is the leading global cause of death, accounting for an estimated 17.5 million deaths per year, and hypertension is a prime risk factor for the disease (WHO, 2017). Given

the foundation’s expertise in cardiovascular disease and the opportunity to create a model to approach other NCDs, it chose to focus its efforts on hypertension. The Novartis Foundation determined that to address hypertension, and other health issues that can lead to chronic care needs, there must be innovation in delivery of care rather than the delivery of more innovation.

The Novartis Foundation’s strategy is centered on measuring progress and outcomes to provide evidence that can be translated into policies, creating a continuous cycle of evidence-based practice. In the past, successful models would be presented to the government with a request to replicate around the country, thus translating the model into policy. This model has worked for the foundation, but often took years to see the resulting successes. The foundation explored ways to improve upon its approach, identifying the following key ingredients for successful PPPs:

• Tailor efforts to respond to the reality of patients on the ground.
• Cocreate with local partners from day 1.
• Leverage synergistic expertise of cross-sectoral partners.
• Stick to commonly defined goals, and track and measure outcomes and impact together.
• Define strategy for sustainability at scale up front.

Using these elements, the foundation has partnered with FHI 360, Ghana Health Service, London School of Hygiene & Tropical Medicine, VOTO Mobile, and numerous local partners to address hypertension care in Ghana’s low-income urban settings. Aerts stated that the program is a PPP through which partners share lessons learned and cross-fertilize to tackle hypertension in a holistic way. To have impact, Aerts suggested there is a need for innovation in the type of partnerships that are developed and the partners that are approached. Therefore the foundation is now also joining forces with nontraditional health players to collaborate and cocreate larger initiatives, as the foundation’s programmatic work is shifting from using isolated models to collective impact for systemic change. Aerts described five conditions for success in collective impact models:

1. agreement on a common agenda and goal
2. shared measurement system
3. mutually reinforcing application of core expertise by partners;
4. continuous communication to foster learning between partners
5. strong global leadership

She noted that locally there is support for collective impact interventions, but the difficulty is finding global partners willing to bring financial and human resources to the table to start such initiatives.

The foundation’s local partnerships are moving forward. These partnerships are bundling resources to provide the seed funding for interventions that are then built into a business plan with the intention to attract investors to join or fill in the gaps to scale the partnership and impact on the ground. It is a model that is not based on business profits for the partners but on a local business plan with social entrepreneurs, public services, and other types of interventions. One of the benefits to such partnerships can be the corporate expertise that Novartis provides. For example, when partnerships require strengthening in human resources, or finance management, the foundation invites Novartis employees to mentor local partners onsite. That expertise and engagement is appreciated by partners and this support, Aerts claimed, is a testament to corporate philanthropy and what corporation foundations can bring to the table.

NOVO NORDISK

Susanne Stormer, Novo Nordisk

Susanne Stormer of Novo Nordisk presented the company’s triple bottom line approach and the related business case for engaging in the SDGs. Novo Nordisk’s triple bottom line (TBL) is the foundation for how the company creates and maximizes value. TBL is a lens applied to Novo Nordisk’s business through which the company evaluates how it can be financially, socially, and environmentally responsible in its decision making. The company defines financial responsibility as long-term profitability while earning and spending capital in a way that contributes to society; social responsibility is defined as enabling people, including patients, employees, and communities, to thrive; and environmental responsibility is minimizing negative impacts on the environment. Novo Nordisk’s approach is premised on the belief that a healthy environment, society, and economy are fundamental to long-term business success.

The TBL approach institutionalizes how the company operates. Internal reward systems and performance metrics promote its integration across decision making and encourage employees to hold management accountable to it. Novo Nordisk sent a strong message to investors and partners by including the approach in the by-laws of the company to ensure that regardless of leadership changes the approach will continue to guide Novo Nordisk’s business conduct.

The company’s long-term outlook for successful business operations includes sustained health in the environment, economy, and society. The SDGs guide the company on how to contribute to that sustainability. Novo Nordisk has chosen to focus on goals regarding sustainable cities and communities, climate action, responsible consumption, gender equality, reducing inequalities, and partnerships. As a health care company, good health and well-being are a prominent focus, but the company recognizes that health is engrained in all 17 SDGs. Novo Nordisk is looking at the other goals to consider how it can contribute across them.

In closing, Stormer presented Novo Nordisk’s case study series called “Blueprint for Change,” which show the business value of the TBL approach to investors. One case study in Algeria showed the measurable benefit to companies of using the TBL approach in the early diagnosis and optimal treatment of diabetes (Novo Nordisk, 2016). The case study illuminates the value of taking action early with a long-term perspective can result in saving lives and leveraging economic growth potential.

PROCTER & GAMBLE CO.

Allison Tummon Kamphuis, Procter & Gamble Co.

Allison Tummon Kamphuis of P&G presented the company’s approach to the SDG agenda. P&G, established nearly 180 years ago as a local business in Cincinnati, has found that its long-standing approach to delivering products and services aligns with the principles of the SDGs, including promotion of good governance, ethical responsibility and behavior, transparency, health improvement, and environmental protection among others. Since the company’s purpose, values, and principles that drive its current strategies overlap with the principles of the SDGs, instead of realigning efforts, the company has chosen to incrementally and uniquely add value to them.

Partnerships are central to P&G’s approach. Partnerships with governments have led programs such as P&G’s Pampers UNICEF, which is focused on eliminating maternal and neonatal tetanus, to scale beyond company-led efforts. P&G is advancing programs and partnerships oriented toward determinants of health and disease prevention as well as promoting campaigns that address social norms, particularly around women, a key group in the implementation of the SDGs.

Tummon Kamphuis affirmed that the company is always looking for opportunities to work with new partners at both the global and local level, but she noted the challenge in balancing the company’s global pri-

orities and the incorporation of local input and context into the partnership’s business strategy. She has observed from the long history of P&G’s partnerships that the partnerships most successful in achieving that balance have a champion working within the company, one who advocates not only for the local cause but more broadly for the importance of trust among partners. Tummon Kamphuis emphasized that the key to developing and maintaining a partnership is to have an internal champion support and drive the case for building trust, a critical aspect for P&G to continue to operate and grow its business while embracing the SDGs through partnerships.

COLLABORATIVE APPROACHES TO MARKET-BASED SOLUTIONS AND INNOVATIONS TO FINANCE THE SDGs

In addition to the engagement of the private sector in the SDGs through the individual approaches of companies and related partnerships, investors and entrepreneurs increasingly are engaging through market-based solutions that can spur investments in innovative solutions to advance the SDGs. The investments are complemented by public-sector and philanthropic investments, in small and large enterprises, to scale and sustain these innovative solutions. Renuka Gadde from BD led a panel discussion on approaches to supporting market-based solutions and innovations to advance health and the SDGs.

Peter Singer from Grand Challenges Canada (GCC) shared how GCC is promoting private-sector engagement in the scaling up of promising sustainable innovations in global health. GCC’s fundamental model is to integrate science and technology with social, business, and financial innovation. GCC focuses on bringing innovation to scale to achieve sustainable benefits through the concept of integrated innovation. This model is premised in part on the belief that while it is possible to source innovation without the private sector, the private sector is critical for bringing innovations to scale. Thus, rather than focusing on grant financing, which can be effective for sourcing innovation, GCC uses nongrant financing mechanisms to help promote private-sector investments that can bring innovations to scale. These nongrant financing mechanisms include repayable grants and debt convertible to equity. Singer emphasized that these mechanisms are not subsidizing private-sector investments but rather are public–private combined financing mechanisms that facilitate the ability of multinational companies to invest in global health innovations by cushioning the risks and decreases barriers to invest. He also noted that ultimately these innovations will only be brought to scale if there is a need for them and domestic governments allocate resources to procure them. While there are some examples of success, this process from sourcing to scaling innovations and bringing them to market is often extremely inefficient with fragmentation and failures in trust among the many stakeholders. Thus, Singer emphasized the critical need to learn from both successes and failures in order to address challenges within the system and identify more effective and sustainable solutions.

Picking up on Singer’s comments regarding the frequent inefficiencies in the process to bring innovations to market at scale, Alan Staple from the Clinton Health Access Initiative (CHAI) shared how CHAI is addressing the market failures that prevent scalable implementation and impact from health care technologies. CHAI’s approach focuses on improving market dynamics for medicines and diagnostics by creating access programs that lower the cost and price of treatment. CHAI works alongside governments and other partners to negotiate access agreements that lead to savings and an expanded market for important new products. Staple described this model as simultaneously engaging the demand side and the supply side of the economic equation. Staple said the demand side has been the most difficult area for the private sector, and many well-intentioned efforts have been stymied from a misunderstanding of fundable demand and creating the appropriate product definition.

CHAI has a network of offices that work closely with the ministries of health in LMICs to better understand the priorities on the ground, what will get funded, what the ability is to expand capacity, or what the need is to build capacity before a particular innovation can be used. Staple

emphasized that CHAI takes a realistic approach to identifying fundable unmet needs; not all unmet needs can be addressed through products that are fundable; thus, CHAI is strategic in identifying and prioritizing the fundable unmet needs, particularly in the short term when products are launched. On the supply side, CHAI analyzes the cost of globally developing specific innovations in a dynamic forecasting process that considers changes in volume, design, and procurement among many other factors.

Within this process described by Singer and Staple, investment funds can provide a financing vehicle to bring to market promising global health innovations that are in the development pipeline. Glenn Rockman from the Global Health Investment Fund (GHIF) shared GHIF’s model for identifying and investing in innovations that can generate investment return while simultaneously making measurable improvements in global health. Traditionally, investment opportunities in global health have been overlooked because the financial returns for investments in LMICs are lower than those of drugs and medical products developed for high-income markets. However, there are some opportunities for investments in global health that can still provide a return, and GHIF works to identify them. These investment opportunities include

• high-volume and low-margin opportunities for bulk purchasing of medicines or technologies with low margins;
• opportunities to participate in existing government incentive mechanisms, such as the U.S. Food and Drug Administration’s (FDA’s) priority review voucher program designed to reward funders who support the development of neglected tropical disease treatments and rare pediatric interventions; and
• dual-market opportunities for technologies that can be used to improve health in both high-income and low- and middle-income settings.

GHIF raised $108 million for investments over a 10-year period, with two option years, to identify these investment opportunities and demonstrate the potential for sustainable investments in global health.

Reflecting on the process of taking global health innovations to scale and the models employed by GCC, CHAI, and GHIF to spur market-based solutions, Singer suggested the financing of innovations in health can be thought of as a relay race: the first leg of the relay race is supporting the development of innovation, often through development agencies and private philanthropy; the second leg is handing off the innovation to companies that can serve as scaling platforms; and ultimately the third and final leg is handing off the innovation to domestic governments whose significant financial involvement will allow the innovation to scale.

On the sidelines of the relay are organizations such as GCC, CHAI and GHIF supporting the runners and helping to make the handoffs possible.

REFERENCES

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