6

Identifying Key Issues in the Governance of Public–Private Partnerships in Global Health

The objectives of the workshop’s final session were 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 new partnerships. To achieve those objectives, session moderator Cate O’Kane guided the workshop participants through a role-playing exercise to apply lessons learned from the workshop and identify key messages. In this role-playing exercise, participants in groups of six took on identities reflecting six key organizations working together to form a new partnership and were guided through a process of collectively developing a governance structure for the partnership. At the end of the exercise, participants shared some reflections.

Brenda Colatrella said her group was able to reach a consensus to put the responsibility for leading the partnership in the hands of the partner they felt was best positioned to do it. Kenneth Miller said his group had more hard than easy decisions, in part because the focus of the partnership in the exercise was outside the group members’ areas of expertise. A workshop participant said that managing opposing views from outside the partnership was challenging. Another participant noted that there was some conflict over how quickly the partnership needed to make its decisions about governance, with some members being more impatient than others. A second participant in the same group said there was some question about why the NGO representative was feeling so urgent and whether it had to do with a near-term financial need. O’Kane said that seemed like a trust issue.

Continuing the discussion, two workshop participants felt there was a need to bring in additional parties to move the partnership’s work along more quickly. In one group, the corporate partner took the stance of not wanting competitors to be part of the initiative, with her reasoning being that her company could provide the value that was needed from the private sector. A satisfactory compromise was to create an external advisory committee that could include competitors.

CLOSING REMARKS

Clarion Johnson and Regina Rabinovich began the closing workshop discussion by sharing their key takeaways from the workshop. Johnson said he had developed a newfound appreciation for restraint with regard to when to use various governance mechanisms. Rabinovich was taken by the need to spend time getting the governance structure right from the start. She wondered if those within the global health community could lay out the questions that a governance structure needs to answer as a guide for groups starting new partnerships. Her second takeaway was that the structure matters, and it is important to understand the ramifications of choosing a specific structure. Her third key lesson was that conflicts of interest are common in all sectors, not just the private sector, and that there are effective approaches for managing conflicts. She wondered if the Forum on Public–Private Partnerships for Global Health and Safety could better characterize and understand the many approaches available for resolving conflicts of interest in public–private partnerships. Rabinovich was also struck by the idea of the ethical dimension of governance and expressed interest in exploring that idea further.

Jo Ivey Boufford was surprised by the power of the preexisting stereotypes each sector has of one another and by the ubiquity of conflict of interest outside of the private sector. She also observed that language chosen to describe governance may present a challenge to the public health community, a comment that Robert Bollinger seconded. She noted that the language used in the public administration literature is much clearer than the literature coming out of public health or business. Bollinger provided the final comment, which was that it troubled him how difficult it remains to put together these partnerships and how easy it is to exclude key players and miss opportunities for progress.