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Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief (2018)

Chapter: Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
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Proceedings of a Workshop

IN BRIEF

January 2018

Exploring Partnership Governance in Global Health

Proceedings of a Workshop—in Brief

On October 26, 2017, the National Academies of Sciences, Engineering, and Medicine’s Forum on Public–Private Partnerships for Global Health and Safety convened a workshop on the governance of global health partnerships. In his welcome to the participants, C. Dan Mote, president of the National Academy of Engineering, remarked that health challenges are multidisciplinary, often involving multiple determinants, affecting many, and requiring actions across sectors. Collaboration, a common approach in both 21st-century engineering and global health, brings together the talents, experiences, and resources of multiple sectors, and the diversity of these sectors leads to creative solutions for tackling system challenges.

In global health, collaboration frequently occurs through public–private partnerships (PPPs), with public and private parties sharing risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal. PPPs include government and industry as well as partners from a range of other sectors. Clarion Johnson from ExxonMobil noted that the governance of these PPPs refers to the structures, processes, and practices for decision making and ultimately accomplishing the PPP’s goal. The workshop examined what role governance assumes in global health PPPs through presentations and discussion on transparency and accountability, operational challenges, legal considerations, barriers and strategies for engagement, examples of governance structures and lessons learned, and measurement.

CORE ROLES OF TRANSPARENCY AND ACCOUNTABILITY IN THE GOVERNANCE OF GLOBAL HEALTH PPPs

To open the workshop, Michael R. Reich from the Harvard T.H. Chan School of Public Health introduced a simplified matrix for assessing and designing the governance of global health PPPs based on two commonly identified fundamental dimensions of effective PPPs: transparency and accountability. In preparation for the workshop, Reich reviewed the literature on partnership governance and found many recommendations, but limited implementation of the various proposals. He said his simplified matrix could provide a high-level analytical and planning tool applicable to different types of PPPs in global health that includes the core objectives needed to ensure that PPPs serve their public interest goals.

Reich’s matrix arranges transparency and accountability as two orthogonal and separate governance dimensions. In the literature, transparency and accountability are two of the most commonly discussed dimensions of governance and, Reich suggested, general agreement exists that both are key in effective governance. He noted that transparency is important on its own because it allows learning, contributes to accountability, and shapes organizational


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Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

performance. He continued that accountability provides a tool to ensure a PPP is achieving its public interest goals, and also contributes to improved organizational performance. Both contribute to democracy and public perception. The matrix analyzes transparency and accountability according to three dimensions (relationships, contents, and mechanisms) and assesses the level of each. Using a hypothetical PPP example, Reich illustrated how the matrix could be used in practice (see Table 1).

Reich acknowledged several caveats with the matrix. Transparency and accountability represent only two dimensions of governance for PPPs and the proposed matrix assesses their levels, but does not indicate how much transparency or accountability is good or desirable. At first pass, high levels of both dimensions may be perceived as good, but Reich intimated, high levels may not always be desirable. For example, applying the metaphor of a family as a partnership, he suggested what goes on between the parents is not always shared with the children (through transparency) even though they are part of the same entity (the family). In a PPP, certain decisions are made based on sensitive information, introducing questions of what information should be available and to which groups. Serious discussions on sensitive information can be impeded if representatives from all groups are present. The matrix provides a way to address high-level questions about the governance of PPPs, but also indicates a more complex set of empirical and normative questions that require additional thought, including how to assess high or low levels of transparency and accountability, and who performs the assessment. With these caveats, Reich emphasized that the objectives of the simplified matrix are to improve conceptual clarity and help identify concrete options for action in planning, assessing, and adjusting PPP governance. He concluded by expressing his hope that the matrix would be used by global health PPPs in practice, helping to improve their understanding and their plans for governance.

TABLE 1 PPP Governance Matrix: Assessing Transparency and Accountability for a Hypothetical PPP

Relationship: Party B Contents Mechanisms Level (High/Low)
Information to? Information on? How informed?
Transparency: Party A (PPP) General public Limited number of outputs Annual Report available on PPP webpage Low
Beneficiaries Information on a few outputs Written report and public meeting Low
Board of directors Detailed reports on key inputs, processes, outputs Board meetings, financial and operating reports High
Accountable to? Accountable for? How accountable?
Accountability: Party A (PPP) General public Limited number of metrics PPP webpage, public hearings Low
Beneficiaries A few metrics on outputs Ombudsman and complaints, using public pressure and reputation Low
Core partners Detailed metrics on inputs, processes, outputs Annual reviews of key staff, with firing or bonus, and of key partners High

NOTES: Contents include inputs, processes, and outputs. PPP = public–private partnership.

SOURCE: As presented by Michael R. Reich, October 26, 2017.

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
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CHALLENGES IN THE GOVERNANCE OF GLOBAL HEALTH PARTNERSHIPS

Regina Rabinovich from the Harvard T.H. Chan School of Public Health led a panel discussion with Steve Davis from PATH, Mark Dybul from Georgetown University, Muhammad Pate from Big Win Philanthropy, and Tachi Yamada from Frasier Partners on challenges they have encountered with the governance of PPPs in global health.

Davis challenged the use of the term “PPP” to describe the current partnership arrangements in global health. He said that many actors assume “private” in PPP refers only to for-profit industry, and social-sector partners—including nongovernmental organizations (NGOs), academics, and philanthropy—that are often critical to the effective functioning of global health partnerships are overlooked. Some debate emerged during the workshop on the relevance of the PPP term in the current global health environment and Davis emphasized that language reflects a mindset. Reflecting on Reich’s matrix and on transparency and accountability as core dimensions of governance, Davis proposed three additional dimensions: altitude, alignment, and adaptability. He said these dimensions imply the following questions: At what altitude is each element of the governance structure expected to operate and is it clear and intentional? Are the partners aligned on a clear objective? Is the governance structured to adapt as needed?

The governance structures of the two largest global health PPPs, Gavi and the Global Fund, attempt to put into practice a philosophical shift in development articulated in the 2002 Monterrey Consensus: prioritizing country ownership, results, accountability and transparency, and engagement of all sectors. Dybul emphasized that these two PPPs have succeeded because of their strong public, private, and civil society support. Nonetheless, he acknowledged that going first to create a new model of partnership was accompanied by several governance challenges. Dybul indicated that the Global Fund board is arranged as a parliamentary structure that incentivizes voting based on constituency interests rather than organizational goals and performance. The voting structure, he said, has proven to be difficult to amend following its implementation and has prevented the PPP from adapting over time to better align with the current global environment. From this experience, Dybul cautioned PPPs to clarify the reasons and expectations for board membership and to be transparent about who is included and why. Beyond the central governance structure, Dybul emphasized focusing on how PPPs operate at the country level. The Global Fund is structured through country coordinating mechanisms that, he suggested, have had an uneven record of effectiveness.

Expanding on country-level governance, Pate suggested, in global health, interpretations of country ownership vary. Divergence between the governance of supranational partnerships and national governance may explain why some intended objectives fall short, he said. At the country level, governments are the legitimate authorities, but Pate noted that other entities that lack the same legitimacy or accountability at the local level are linked to global, often well-resourced, partnerships. He described how imbalances in influence result. Pate questioned where the ethical dimension fits in the governance of global health PPPs. Ethical principles in public health are derived from medicine. In global health stakeholders come from a diversity of sectors, and whether ethical principles are shared among them is unclear, Pate said.

The term PPP itself describes a clash of cultures, Yamada said; understanding different expectations of these cultures can help to navigate better governance structures. To illuminate this point, he contrasted his experiences with governance boards of for-profit companies and PPPs. Company boards have three responsibilities: fiduciary, strategy, and CEO selection. Management is delegated to the authority running the company and the board’s focus is at a higher altitude. The board is accountable to the company shareholders. Within the public sector, accountability is to ensure the needs of the public are served. In PPPs, Yamada has found governance boards tend to struggle in three ways: members represent their organizational interest with limited accountability for the welfare of the partnership, the composition is too large to make substantial decisions, and delegation of responsibilities to management is unclear.

Another challenge observed by Yamada is that implementing governments often become passive partners in PPPs. He said it is a two-sided problem: PPPs often fail to consider how to make it possible for government to engage and governments passively support externally funded programs without taking ownership. A workshop participant noted that governments may lack the resources to engage in PPPs. Pate recounted that when he was Minister of Health in Nigeria, his ministry had no civil servants with experience in private-sector engagement.

The panel addressed conflicts of interest (COIs). While industry partners often are assumed to have potential COIs, Dybul stated that all partners have conflicts, including other external funders and grantees. Davis noted that conflicted individuals or organizations often bring relevant expertise and their inclusion can be beneficial to a PPP. Davis, Dybul, and Yamada each noted that, in general, conflicts are acceptable and manageable if declared transparently and partners abstain from voting when appropriate. In terms of perceptions of conflicts, Dybul noted that all sectors tend to take a position of innocence and assume others are the problem. He suggested overcoming cultural biases requires establishing trust

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

and understanding among sectors. Davis agreed and advocated for building a cohort of individuals with experience across public, private, and social sectors to help bridge these cultures.

The panel reflected on asymmetries in influence and legitimacy of partners. Davis commented that asymmetries in financial resources of different sectors will always exist. He encouraged acknowledging it in the governance structure and defining roles based on unique resources. Yamada recounted that during the early stages of the Bill & Melinda Gates Foundation, the foundation had financial resources but limited legitimacy. He focused on developing partnerships in which the foundation’s best contribution was its financial resources and the other partners contributed legitimacy to the initiative based on their experience. Pate suggested the most effective partnerships have diversity in contributed resources and acknowledge the varying sources of legitimacy from financial to technical to political resources.

LEGAL CONSIDERATIONS FOR PPP GOVERNANCE IN GLOBAL HEALTH

Lauren Marks from U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) led a multisectoral discussion on legal considerations for structuring global health PPPs. As part of the exercise, Douglas Brooks from Gilead Sciences, Inc.; Anthony Brown from Gavi; Kenneth Miller from the Gates Foundation; Nina Nathani, an attorney with experience representing international NGOs; and Valerie Wenderoth from the U.S. Department of State discussed their organizational approaches to managing COIs, defining and structuring different PPP arrangements, and handling intellectual property and data-sharing issues.

The first legal step in structuring a PPP is assessing potential COIs and Marks asked the panelists to each describe their approach. Nathani said she would suggest that as a first step, all parties should execute non-disclosure agreements to provide a baseline of transparency with regard to potential COIs. Miller emphasized that the discovery of a potential COI does not necessarily prevent an organization’s or an individual’s inclusion in a partnership; rather, the Gates Foundation’s approach is to weigh risks against the potential to achieve impact. Brown echoed Miller’s comment and shared that Gavi’s approach focuses on transparency and creating balance rather than on avoiding COIs. Marks noted that avoiding COIs can be difficult when potential partners are knowledgeable experts with a vested interest in the PPP. Brooks shared that Gilead is cautious to avoid perceptions that it is attempting to create a competitive advantage through the inclusion of the company or an employee in a PPP. In the U.S. government, Wenderoth said, existing relationships between federal employees and potential partners are evaluated for internal COIs before the government can even engage in a formal external discussion and begin to perform due diligence for COIs of potential partners.

The panel discussed the legal differentiation between procurement relationships and partnerships. Brown said a procurement agreement is a contract with terms for delivery and price of goods and services. Partnerships are structured through a Memorandum of Understanding (MOU) that sets the roles and responsibilities of the partners. Miller and Wenderoth both explained that their organizations often manage multiple partnerships or procurement relationships or both with the same organizations. Often, the governance of these arrangements differs, depending on the individuals involved in that process.

Workshop participant Justin Koester from Medtronic commented that opportunities to create new markets often incentivize industry to invest in a PPP. He asked the panelists how they evaluate these scenarios. Miller responded that when an industry partner can create a commercial market and provide access to their products at an affordable price in developing countries, the Gates Foundation is interested in engaging. Nonetheless, as a charitable organization, the foundation’s funds are required to further charitable purposes. In these entrepreneurial PPP scenarios, Miller shared that the foundation cautiously evaluates if the charitable purpose outweighs the commercial one. Brown pointed out that these scenarios sometimes offer creative solutions to tricky and thus far unsolvable problems. Gavi and the Global Fund have transparent frameworks for evaluating these scenarios that allow other parties to participate. At times, Brooks noted, by engaging in these partnerships, companies begin to see a public health problem in a new way and how they can more effectively apply their products or services to help solve it. Another workshop participant, Jeffrey L. Sturchio from Rabin Martin, pointed out that creating a new market itself sometimes helps to accomplish the social goals of a PPP. An example is the transformation of the market for antiretroviral medicines (ARVs) in low- and middle-income countries (LMICs) through investments by PEPFAR, the Global Fund, and national governments, which led to access to ARVs at a much lower cost for many more people living with HIV. Creating a market for industry, Sturchio said, is a question of balancing interests for social good rather than of avoiding engagement.

Intellectual property (IP) management is a frequent legal issue in global health PPPs and includes rights to IP contributed, augmented, or developed through a PPP. Miller shared that retaining IP ownership rights can serve as an incentive for industry, particularly start-up companies, to engage in global health PPPs. From the Gates Foundation’s

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

perspective, as long as a partner company upholds an agreement to provide access at an affordable price for the foundation’s target beneficiaries, the IP holder can use the IP for any other purposes, including commercialization. Regarding IP rights to data collected during a partnership, Nathani noted that any data that have been collected or developed with federal government funds are required to be shared with the federal government under a royalty-free license. This issue can become complicated in some countries where the local government asserts ownership rights to all data collected in their country. Miller added that the Gates Foundation has an open-access policy requiring published data it funds directly or indirectly to be published in an open-access journal; at times aligning open-access policies across partners can be challenging.

When asked about creating a standard legal template for global health PPPs, Miller responded that each partnership is unique in its participants, geography, and focus issue, among other variables, and developing a template to apply to all of them is not feasible. Nonetheless, he emphasized the value of forums for sharing lessons and developing best practices. Additional legal issues discussed by the panel included liability, valuation, preferential treatment, harmonizing philosophical and strategic differences, and establishing a governance structure.

IDENTIFYING BARRIERS TO ENGAGING IN PPPs AND STRATEGIES TO MANAGE THEM

Following the opening presentation and panels, participants engaged in a World Café exercise to surface barriers experienced when engaging in PPPs and strategies used to overcome them. Jo Ivey Boufford from the New York University College of Global Public Health and Kevin Etter from United Parcel Service (UPS) led the session and summarized examples of some responses from individuals from the six participating groups (see Tables 2 and 3). These examples should not be construed as reflecting any group consensus.

TABLE 2 Responses to World Café Question 1: What are the main barriers your organization has experienced when engaging in PPPs?

Group 1 Group 2 Group 3 Group 4 Group 5 Group 6
Failure to document vision, mission, intent Alignment of expectations; definition and measure of success; leadership differences; adaptability Identifying the champions: skill sets and expertise; retention of relationships Lack of metrics/agreed performance Alignment: defined purpose of PPP Assumptions; private-sector mistrust; speaking the same language; power dynamics
People: champions and host lost; capacity Risk: political, financial, reputation, legal Lacking the right indicators to measure success of the partnership Lack of management capabilities Measure and evaluate comparative value-add of PPP Lack of trust: difference in ideology
Understanding the business and players Local ownership: exit strategy and sustainability Alignment of interests: evolution and redefinition Lack of mutual understanding in motivations, assumptions, purpose, and language Transaction costs Strategy seen as luxury versus necessity

NOTES: This table shows examples of responses from individual participants and should not be construed as reflecting group consensus. PPP = public–private partnership.

SOURCE: As presented by Jo Ivey Boufford and Kevin Etter on October 26, 2017.

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

TABLE 3 Responses to World Café Question 2: How have you/your organization overcome or managed these barriers to engagement?

Group 1 Group 2 Group 3 Group 4 Group 5 Group 6
Invest time upfront on common purpose Document everything Institutionalize partnership with buy-in from leadership and staff Use metrics to manage Plan with candor Invest time upfront to discuss goals, roles, and responsibilities
Realize disagreement will happen; document pattern for resolving disagreement Establish/build in mechanisms for change in advance Cultural liaison to guide partnership and align interests and expectations Define relevant qualification for leaders (and be willing to act if change is needed) Articulate key performance indicators to be evaluated Understand motivations of each partner and be honest about limitations
Define the end game Involve local ownership from beginning; be transparent about sustainability goals/roadmap Be open to rethinking roles; leave room for innovation from the beginning Reminder of agreed purpose; declare prejudices; understand common interests; apply metrics to guide decision making Passion, initiative, efficiency Experience success and be honest in failure

NOTE: This table shows examples of responses from individual participants and should not be construed as reflecting group consensus.

SOURCE: As presented by Jo Ivey Boufford and Kevin Etter on October 26, 2017.

LESSONS LEARNED FROM GOVERNING PPPs IN GLOBAL HEALTH1

To provide detailed perspectives on the decision-making processes when developing and adapting the governance of global health partnerships, the workshop included panel presentations on the governance models and lessons learned from five specific partnerships: Access Accelerated (AA), DREAMS, the Global Health Innovative Technology Fund (GHIT), the African Comprehensive HIV/AIDS Partnership (ACHAP) in Botswana, and Avahan in India.

Access Accelerated

Danielle Rollmann from Pfizer Inc. described the governance of AA, an initiative of more than 20 biopharmaceutical companies, working with public- and NGO-sector partners with the goal of advancing care and treatment for non-communicable diseases (NCDs) in LMICs. AA was conceived by the partner companies’ CEOs and includes three elements: individual companies’ access programs, partnership with the World Bank to advance access and health system strengthening in pilot countries, and disease-specific partnerships. From the beginning, AA invested in a robust process for standardized measurement across these programs, with the objective to identify and share effective approaches that can contribute to the goal of sustainable NCD care and treatment (see section on Measurement of Industry-Led Access-To-Medicines Programs).

AA’s governance structure operates in two forms: a central partnership of supporting biopharmaceutical companies and partnerships of AA with additional entities, including the World Bank and the Union for International Cancer Control. The central partnership’s governance approach reflects a common set of operating principles: goal focused, shared decision making, opportunities for all partners to contribute, and recognition of individual company independence

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1 More information on the partnerships in this section can be found at http://www.accessaccelerated.org;

http://www.dreamspartnership.org; https://www.ghitfund.org; http://www.achap.org; and https://docs.gatesfoundation.org/documents/avahan_hivprevention.pdf (all URLs accessed January 2, 2018).

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

and variability. The approach is enshrined in a formal governance structure managed by a dedicated Secretariat. The governance of AA’s partnerships with additional entities is based on the common principles of respect for partner governance principles, processes, and needs; alignment and accountability; measurement of progress and results; and sharing of learnings. Rollmann described several lessons from developing AA’s governance: the value of establishing a common vision at the outset, thoughtfulness about where consistency is needed and flexibility can be built in, building a common language and communicating frequently, and designing time and resources to solicit feedback.

DREAMS

The multisector partnership DREAMS has a clear and specific objective to reduce HIV infections for girls and young women in 10 countries by 40 percent through preventative interventions. Marks shared that DREAMS’s focus on social and behavioral change interventions created the opportunity to engage partners outside of the health sector with strategic common interest in empowering girls and young women. PEPFAR, she described, took a proactive approach to identify partners with discreet and unique contributions beyond funding.

DREAMS operates through a flexible governance structure. A non-binding MOU holds partners accountable to their commitments and defines the governance policies. DREAMS has a collective decision-making process; however, the U.S. government retains veto power over how U.S. government resources are allocated. The flexible governance structure has allowed the partnership to add new partners and subcomponents and expand into more countries. Marks shared that developing common metrics for evaluating the partnership led to hard but productive conversations on what constituted success for each partner. Responding to a question about how disagreements among the partners are managed, Marks shared that data have been an effective tool for objectively resolving differences.

GHIT

GHIT catalyzes product development partnerships that galvanize Japanese innovation and investment for global health. To align its portfolio with its mission, all GHIT investments are made in global partnerships between a Japanese and a non-Japanese entity. GHIT launched in 2013 with $100 million and 8 partners and has expanded to $350 million with 26 partners.

B.T. Slingsby, GHIT’s founding CEO, stated that the fundamental question when designing the fund’s governance structure was: How can you create a PPP where the same entities that provide funding can be beneficiaries of it? He shared that the fund addresses this question through a governance structure that includes representation from all funding partners, but establishes firewalls to manage COIs. Notably, industry partners’ inclusion in the governance structure is limited to the council—the entity within the governance structure that operates at the highest level of altitude and is removed from decision making on investments, strategy, and management. Their distance from these decisions allows the industry partners to apply for grants. GHIT’s governance structure and other policies were developed by a launch committee composed of individuals from the eight founding partners that met every 2 weeks over the course of 1 year.

Slingsby described some persistent governance challenges for GHIT. The diversity of partners and their participation at different levels of the governance structure necessitates active awareness raising on the overall governance structure and process. Members serving on governing bodies volunteer their time, and sustainability of leadership from high-level individuals requires thoughtful management. GHIT is a public Japanese entity with a global mission and international partners that at times requires aligning differing legal standards.

ACHAP

ACHAP was a PPP established in 2000 to support the Botswana government’s goal of significantly reducing the incidence and prevalence of HIV/AIDS in the country. The ACHAP partners—the Botswana government, Merck & Co., the Merck Company Foundation, and the Gates Foundation—came together with clear agreement on a specific purpose: to transform Botswana’s response to the HIV/AIDS epidemic across the spectrum of HIV prevention, care, and treatment. Sturchio, a member of the ACHAP board, explained that the PPP received strong support from the president of Botswana and was integrated into national strategies; this political will and commitment were critical to ACHAP’s success.

Structured as an NGO in Botswana, the board included two members from the Gates Foundation, two from Merck, and an independent expert well known to key stakeholders in Botswana. Common objectives and the roles and responsibilities of each partner were clearly defined, communication processes established, and metrics for impact developed. To promote alignment, transparency, and accountability, ACHAP worked closely with the National AIDS Coordinating Agency; participated in the national forum of development partners; and established the Madikwe Forum for the ACHAP board and Permanent Secretaries of all government departments involved in the AIDS response to meet triannually

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

to identify and work through bottlenecks. An international advisory group provided advice and investments were made in monitoring, evaluation, and publication.

ACHAP developed from an emergency need to address a crisis. Discussions on sustainability emerged, Sturchio said, when shifts in government priorities and an impending end of financial support from the original partners necessitated adaptation to a new reality. The board identified transferable capabilities ACHAP developed in program design and implementation and created a plan to build on them, to broaden ACHAP’s geographic focus, and to diversify its donor base. The partnership created in 2000 ended in 2014, but ACHAP continues to apply the knowledge and skills that were developed to address HIV/AIDS to a diversity of population health issues.

Avahan

Avahan, a partnership to lower the prevalence of HIV and sexually transmitted infections in vulnerable populations through prevention, was implemented between 2004 and 2014 in two phases in six states in India. Sonal Mehta from Alliance India shared that the first phase of Avahan focused primarily on controlling HIV through scaled prevention response; the second phase focused on the sustainability of Avahan’s achievements during the transition from external funding to local government ownership. Mehta emphasized that a significant change between the phases was the strong focus on community engagement in the latter phase. Avahan had five levels in its governance structure: organizational governance focused on processes and systems, donor oversight to regularly review progress, partner meetings for ongoing coordination and mutual accountability, government oversight to monitor role clarity and expectations, and the community advisory group. She commented that the community advisory group was the most effective governance mechanism for increasing accountability across the partners. Mehta summarized several lessons learned: articulate each partner’s motivation for engagement and clarify their specific roles, balance partners’ interests and develop an approach that respects all represented ideologies, manage expectations of each partner and acknowledge power dynamics when some partners provide funding, and develop systems for transparency and accountability.

MEASUREMENT OF INDUSTRY-LED ACCESS-TO-MEDICINES PROGRAMS

Peter Rockers and Veronika Wirtz from Boston University presented a framework to measure access-to-medicines programs, particularly those within AA. The framework development was guided by key principles: independence from industry, methodological rigor, and transparency to the public. The framework supports the AA initiative’s objectives to identify effective strategies across company programs and to share learnings. The framework includes a taxonomy of 11 commonly used program strategies.2 Each strategy has a logic model that describes the primary pathways through which program activities may achieve impact. All inputs, outputs, outcomes, and impacts included in the logic models have corresponding indicators with descriptive metadata. Program information collected using the framework is made publicly available through the Access Observatory.3 The AA Secretariat Metrics Team, which includes representatives from companies, provided regular input during the process of developing the framework. Wirtz shared that during framework development, several tensions (e.g., public versus confidential reporting of data) occurred that provided opportunities to clarify the perspectives of different partners and strengthen the framework. Rockers and Wirtz found that developing a common language facilitated discussion and agreement when tensions arose.♦♦♦

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2 The 11 strategies within the framework’s taxonomy are community awareness and linkage to care, health service strengthening, health service delivery, supply chain, financing, regulation, manufacturing, product development research, licensing agreements, pricing scheme, and medicine donation.

3 More information can be found at https://wwwapp.bumc.bu.edu/AccessObservatory/Home.aspx (accessed January 2, 2018).

Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×

DISCLAIMER: This Proceedings of a Workshop—in Brief was prepared by Rachel M. Taylor as a factual summary of what occurred at the workshop. The statements made are those of the rapporteur or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

PLANNING COMMITTEE FOR EXPLORING PARTNERSHIP GOVERNANCE IN GLOBAL HEALTH: A WORKSHOP*

Clarion Johnson (Co-Chair), ExxonMobil; Regina Rabinovich (Co-Chair), Harvard T.H. Chan School of Public Health; Jo Ivey Boufford, New York University College of Global Public Health; Kevin Etter, UPS Loaned Executive Program; Lauren Marks, U.S. Department of State; John Monahan, Georgetown University; Cate O’Kane, Partnership and Collaboration Strategist; B.T. Slingsby, Global Health Innovative Technology Fund.

*The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop—in Brief rests with the rapporteur and the institution.

REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Jo Ivey Boufford, New York University College of Global Public Health; John T. Monahan, Georgetown University; and Jeffrey L. Sturchio, Rabin Martin. Lauren Shern, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS: This workshop was partially supported by Anheuser-Busch InBev; Becton, Dickinson and Company; Bill & Melinda Gates Foundation; Catholic Health Association of the United States; ExxonMobil; Fogarty International Center of the National Institutes of Health; GE; Global Health Innovative Technology Fund; Intel; Johnson & Johnson; Medtronic; Merck; Novartis Foundation; PATH; PepsiCo; Procter & Gamble Co.; The Rockefeller Foundation; Safaricom; United Nations Foundation; University of Notre Dame; UPS Foundation; U.S. Agency for International Development; U.S. Department of Health and Human Services Office of Global Affairs; U.S. Department of State Office of the U.S. Global AIDS Coordinator and Health Diplomacy; U.S. Food and Drug Administration; Verizon Foundation; and The Vitality Group.

For additional information regarding the workshop, visit nationalacademies.org/PPPGlobalForum.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Exploring partnership governance in global health: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24997.

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Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
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Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
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Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
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Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
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Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
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Page 5
Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
Page 6
Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
Page 7
Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
Page 8
Suggested Citation:"Exploring Partnership Governance in Global Health: Proceedings of a Workshop - in Brief." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief. Washington, DC: The National Academies Press. doi: 10.17226/24997.
×
Page 9
Exploring Partnership Governance in Global Health: Proceedings of a Workshop–in Brief Get This Book
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On October 26, 2017, the National Academies of Sciences, Engineering, and Medicine’s Forum on Public–Private Partnerships for Global Health and Safety convened a workshop on the governance of global health partnerships. Collaboration, a common approach in both 21st-century engineering and global health, brings together the talents, experiences, and resources of multiple sectors, and the diversity of these sectors leads to creative solutions for tackling system challenges. In global health, collaboration frequently occurs through public–private partnerships (PPPs), with public and private parties sharing risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal. PPPs include government and industry as well as partners from a range of other sectors. The workshop examined what role governance assumes in global health PPPs through presentations and discussion on transparency and accountability, operational challenges, legal considerations, barriers and strategies for engagement, examples of governance structures and lessons learned, and measurement. This publication briefly summarizes the presentations and discussions from the workshop.

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