Forum on Public–Private Partnerships for Global Health and Safety
Exploring Partnership Governance in Global Health: A Workshop
October 26, 2017
The National Academies of Sciences, Engineering, and Medicine
500 Fifth Street, NW, Washington, DC 20001
The Forum on Public–Private Partnerships for Global Health and Safety (PPP Forum) fosters a collaborative community of multisectoral leaders from business, government, foundations, humanitarian and professional organizations, academia, and civil society to leverage the strengths of multiple sectors and disciplines to yield benefits for global health and safety. The PPP Forum is premised on the understanding that partnerships among these stakeholders can facilitate dialogue and knowledge exchange; utilize technological and process efficiencies; promote innovation; and synergistically advance humanitarian, international development, and global health interests. The U.S. National Academies of Sciences, Engineering, and Medicine provide a neutral evidence-based platform through which the PPP Forum is convened.
This public workshop on partnership governance in global health has been planned by an ad hoc expert committee. The intended audience is the PPP Forum members and the organizations they represent, other public and private entities that have participated in or are considering collaboration across sectors to further global health and safety, and academics and researchers across multiple disciplines who are focused on understanding the value proposition and impact of various models of public–private partnerships to improve global health.
- Examine what role governance assumes in public–private partnerships for global health and how governance impacts the effectiveness of these partnerships in improving health outcomes.
- Consider the range of stakeholders and sectors engaged in global health partnerships and how specific organizational attributes impact a partnership’s governance and decision-making processes.
- Explore best practices, common challenges, and lessons learned in the varying approaches to partnership governance.
- Illuminate the key issues in the governance of public–private partnerships for global health with the goal of increasing their effectiveness in improving health outcomes.
Definitions of governance are varied and depend on factors such as the relevant actors, level of analysis, and existing political and social contexts. Broadly, governance is conceived of as the “art of steering societies and organizations” (IOG). Within the context of PPPs, governance refers to the structures, processes, and practices for decision making and for ultimately accomplishing the goal of the partnership. Governance defines the power structure of a PPP by regulating who makes decisions and how and when the decisions are made, as well as how other stakeholders are represented in the process. Effective governance mechanisms can be a tool for providing direction and monitoring performance, promoting accountability and transparency, enhancing legitimacy and ownership, and managing both real and perceived conflicts of interest.
The governance of a partnership impacts its efficiency and effectiveness in meeting its stated goal: strong governance can improve the performance of PPPs while weak governance can undermine it. In global health, PPPs have played a critical role in addressing global health needs; however, they require careful steering to avoid potential pitfalls (Reich, 2002). An examination of PPPs in global health has revealed some common shortcomings in their governance, including weakness in or absence of strategic direction, accountability mechanisms, monitoring and evaluation systems, and risk management; lack of clarity in roles and responsibilities; confusion between the roles of management versus governance; and inadequate attention to resource mobilization and to the human resources required to deliver programs and achieve objectives (Bezanson and Isenman, 2012).
While the importance of governance in global health partnerships has been identified, there is, in general, a lack of agreement on best practices
for their governance structures, policies, and practice (Stenson, 2010). This is partly because of the significant variation across global health partnerships in size, including the number of partners engaged, resources allocated, geographic focus, and scope of the goals; the focus area, ranging from infectious diseases to pandemic preparedness and to noncommunicable diseases and injury prevention; the level of formality; and the intended outcomes. Over the last several decades, with the increased number of interested stakeholders, resources invested, and initiatives launched within the global health field, effective governance of global health PPPs is critical.
These PPPs are formal collaborative arrangements through which public and private parties share risks, responsibilities, and decision-making processes with the goal of collectively addressing a shared health objective. While it is assumed that both government and a private-sector actor will be formally engaged in the partnership, it is worth noting the range of stakeholders engaged in global health partnerships, such as national governments, bilateral development cooperation agencies, United Nations agencies, multilateral and regional development banks, hybrid global health initiatives, philanthropic organizations, civil society organizations and nongovernmental organizations, private businesses, and academic institutions.
Given the broad range of determinants that affect and are affected by health, there are many subcategories within these stakeholder groups that are engaged in global health partnerships, for example, within national governments, ministries of health, finance, telecommunications, and transportation. These numerous stakeholders bring varying strengths and resources to global health partnerships, but they also carry their own organizational cultures, regulations, and expectations. Managing PPPs among these stakeholders is complex and requires intentional and thoughtful governance.
This workshop will explore the governance of partnerships that are defined by the following parameters: (1) a clearly defined, shared goal that centers on meeting the health needs of disadvantaged populations; (2) the inclusion of at least three partners with a government entity and business represented among them; (3) development of a formal joint agreement among the partners with a defined set of rules; (4) contributions of resources from all partners (resources can include financing, technical expertise, innovation, personnel, relationships, and research); and (5) expected value for all partners.
|C. D. MOTE, JR.|
|National Academy of Engineering|
|8:35am||Introduction to the Workshop from the Planning Committee Co-Chairs|
|ExxonMobil Malaria Scholar in Residence|
|Harvard T.H. Chan School of Public Health|
I. Global Health and Governance of Public–Private Partnerships in the Current Context
This opening session will provide an overview of the current trends and challenges in the governance of global health public–private partnerships (PPPs). The session will begin with a review of the existing literature on the governance structures, processes, and practices of global health PPPs. The roles of transparency and accountability will be explored in the governance of global health PPPs, with a focus on organizational design and decision making. Governance issues for discussion will include power dynamics and equity, inclusion and participation in decision making, and the management of real and perceived conflicts of interest.
|Session Moderator: REGINA RABINOVICH|
|8:50am||The Core Roles of Transparency and Accountability in the Governance of Global Health PPPs|
|MICHAEL R. REICH|
|Taro Takemi Research Professor of International Health Policy|
|Harvard T.H. Chan School of Public Health|
|9:15am||Addressing Major Challenges in the Governance of Global Health PPPs|
|President and CEO|
|Professor of Medicine and Faculty Director|
|Georgetown University Center for Global Health and Quality|
|Big Win Philanthropy|
|Frazier Healthcare Partners|
II. Legal Considerations for PPP Governance in Global Health
Through a problem-solving exercise, this session will surface legal considerations within different sectors when developing global health PPPs. The discussion will aim to address questions including—What governance structures, processes, and practices are advisable from a legal perspective given a myriad of considerations such as leadership, conflicts of interest, data ownership, publicity, and flexibility in decision making? How does or should PPP governance emulate private-sector governance? How does it differ? What are the legal considerations when operating across countries and international systems? In terms of acknowledging and valuing resources from all partners, questions include—How are resources contributed from each partner acknowledged within the governance document? How is the value of in-kind resources defined? Panelists will discuss these questions and elaborate on the legal and regulatory constraints they have encountered and problem-solved for when structuring PPPs.
|Session Moderator: LAUREN MARKS|
|Director, Private-Sector Engagement for PEPFAR
U.S. Department of State
|Senior Director for Community Engagement|
|Senior Legal Counsel|
|Gavi, the Vaccine Alliance|
|Associate General Counsel|
|Bill & Melinda Gates Foundation|
|Matalon & Nathani, LLP|
|U.S. Department of State|
III. Internal Governance of Individual Partners and Impacts on Approaches to Public–Private Partnerships
The internal governance structures, processes, and practices of individual partners impact how they approach and engage in PPPs. Greater clarity and understanding of the practical, legal, and regulatory constraints of individual organizations, which may impact the partnership and how it is governed, can promote transparency and manage expectations. Through defined strategies, priorities, and procedures for partnership engagement that reflect their internal governance considerations, individual organizations can articulate their expectations, needs, and limitations prior to engagement and throughout the partnership operations. Developing a partnership strategy not only provides a signal to other stakeholders and potential partners but also requires organizations to internally review and assess their own priorities, expectations, and
resources as they develop their capacity to engage in PPPs. In this interactive session, participants will collectively discuss the issue and related questions posed by the facilitators. The session will be conducted in two rounds followed by a harvest with the larger group to reflect on the themes and deeper questions that arose during small group discussions.
|Session Facilitators: JO IVEY BOUFFORD|
|Immediate Past President|
|The New York Academy of Medicine|
|UPS Loaned Executive Program|
|1:00pm||World Café/Small Table Interactive Discussions|
IV. Lessons Learned from Development, Iterative Improvement, and Reform of Public–Private Partnerships and Their Governance
In this session panelists will first illuminate their decision making when developing and establishing a PPP and its governance structure, processes, and practices. Panelists will share lessons learned from experiences in determining governance needs and mechanisms based on the partnership goal; engaging partners and other stakeholders in decision making for the design of the PPP and its governance; developing the governance mechanism; and defining metrics for evaluating the effectiveness of the PPP and its governance performance.
Subsequently, panelists will delve into the creation of iterative processes for the continuous improvement of PPP governance as well as approaching PPP reform. Using the experiences of their respective partnerships, panelists will share lessons learned in decision making when adjusting to evolving priorities of the PPP to partners and in the broader global health environment, and related impacts of issues such as expectations, language, and internal decision-making processes of each partner.
|Session Moderator: CLARION JOHNSON|
|2:00pm||Panel Presentations and Discussion|
|Access Priorities, Global Policy|
|The DREAMS Partnership|
|Director, Private-Sector Engagement for PEPFAR|
|U.S. Department of State|
|Global Health Innovative Technology Fund|
|CEO and Executive Director|
|Global Health Innovative Technology Fund|
|ACHAP Partnership in Botswana|
|JEFFREY L. STURCHIO|
|Board Member, ACHAP|
|President and CEO, Rabin Martin|
|Avahan Program in India|
V. Evaluating and Reporting on Public–Private Partnerships in Global Health
When conducted effectively, evaluating and reporting on the progress of PPPs on their stated goals and outcomes promotes transparency and accountability and can guide decision making within the partnership. Standardizing reporting and making it publicly accessible could more broadly contribute to decision making in global health. This session will present an initiative to develop a framework to standardize measurement and reporting across private-sector initiatives to improve access to noncommunicable disease treatment and care. The presentation will focus on the decision-making process for the framework’s design and how it is being applied. Following the presentation, participants will engage in a discussion on the potential of such frameworks for decision making in the development and operations of partnerships in global health.
|Session Moderator: JOHN MONAHAN|
|Senior Advisor for Global Health|
|3:45pm||Evaluation of Access Accelerated|
|Assistant Professor, Global Health|
|Associate Professor, Global Health|
VI. Identifying Key Issues in the Governance of Public–Private Partnerships in Global Health
The objectives of this session are to identify the key issues in the governance of global health partnerships, and apply what has been learned to decision making in the establishment of a new partnership. During the session, governance issues raised in the earlier sessions will be reviewed, participants will be guided through a role-playing exercise to apply lessons learned from the workshop, and key messages from the workshop will be identified.
|Session Facilitator: CATE O’KANE*|
|4:15pm||Report Back from World Café|
|JO IVEY BOUFFORD|
|4:25pm||Facilitated Small-Group Activity|
|6:15pm||Adjourn to Informal Reception|
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