In the final session, Seema Kumar described key messages from the participants that were gathered throughout the workshop and discussed how to disseminate them. The objective of this session was to generate enthusiasm to test and build models for multi-sectoral engagement with defined value propositions and with a focus on areas where innovation is needed (see Box 7-1).
One of Kumar’s takeaways was that when a partnership creates impact and leads to success, it also creates a virtuous cycle that leads to further success. In addition, sharing stories of partnership success is important; doing so undermines the idea that partnerships only have challenges. She noted the workshop presented multiple innovative models that work well and are scalable and sustainable. The necessity of trusting other entities and creating an environment that fosters trust was also a key takeaway. Johnson agreed that a key point was honesty about both successes and challenges in partnership efforts.
Colatrella shared two messages and suggested priority actions and strategies. First, she addressed the unnecessary bias generated by preconceptions about organizations and what they do. She noted the importance of educating oneself about the realities of an organization and of having conversations with its members to identify potential ways to work together. Second, she noted that much work remains in order to create solutions that are both sustainable and fully integrable into governments and communities.
Jessica Herzstein, a preventive medicine specialist, noted another takeaway: value takes multiple forms. It denotes not only saving lives but also, for example, enhancing an organization’s mission, forming new relations, expanding into new markets, or learning from partners.
Mona Byrkit emphasized the need for partnership brokers or liaisons and suggested that interested parties could take greater ownership of brokering between sectors or even within organizations.
Ratzan suggested that ideology continues to present challenges and noted the importance of questions around how to obtain valid, reliable information about the efficacy of PPPs or public–private–academic partnerships. Although funding is needed to evaluate an initiative’s impact, evaluation results may not be as trustworthy if the same entity funds both the evaluation and the program itself. Ratzan pointed to a need for trustworthy evaluations or assessments to inform future investments and policy decisions. Kumar agreed and noted that anecdotes are often used to explain what works and what does not, but a need exists for real, longitudinal data and evidence. Kumar suggested that an independent party from the public, private, or academic sector own the evaluation. Ratzan also noted that evaluation findings, depending on what they are, could either change or reinforce an ideology. Nevertheless, Ratzan suggested that evaluation findings not be discredited simply because they were funded by industry; they may provide useful information. Ratzan also posed the question of how to apply existing programs to other regions as a takeaway from the workshop.
John Monahan added another takeaway to the discussion: value proposition has different components for each sector and organization involved. He pegged the brokering function as particularly interesting because it implies an ability to find aligned interests. Monahan suggested that more brokering be facilitated in the real world and questioned whether the PPP Forum could fulfill that role. Another important message was that partnerships are a means to an end and not an end in themselves. Monahan noted the global health community still questions whether partnering is the most efficient and effective way to accomplish work and whether measuring such efficiency is possible.
Silberschmidt agreed with Monahan about the importance of brokering and noted that the liaisons who broker can also be diplomatic and advocate for more capacity building. He noted that brokering cannot be imposed, but it is possible to identify people who have the skill sets and motivation to broker. Another takeaway, Silberschmidt explained, was his observation that people tend to identify problems where they do not exist—often because of ideology. Although the workshop did not discuss this topic, he suggested that people may not see existing problems because of their ideologies—for example, an ideology may blind them to the fact that an entity does not belong in a specific partnership or a particular role. Silberschmidt highlighted the importance of removing such ideological barriers. Kumar added that although problems sometimes exist with a partner, they can also exist when a partnership does not deliver outcomes that positively impact health.
BenDor raised the point that beneficiaries of PPPs are often absent from the table when solutions and partnerships are discussed, yet they are
the ones impacted. She suggested that allowing some of the beneficiaries to share their stories about initiative impacts could influence and inform future work.
Next, Brink highlighted two central messages. First, the case studies presented at the meeting demonstrate that extraordinary work has been achieved, and none of it would have been possible without partnerships. Partnerships are what enabled innovation and advances. Second, Brink suggested that partnerships are difficult and require much work to initiate and to sustain.
Gael O’Sullivan from Georgetown University seconded Ratzan’s point about the importance of multiple datasets, including longer studies with metrics that show impacts and outcomes; case studies that provide partnership models and explain the roles of different entities; and examples of best practices and lessons learned. She noted that multiple products would help disseminate messages to wider audiences and create more shared value in untapped markets and sectors. O’Sullivan also explained the importance and relevance of health literacy and noted that, in order to be engaged, the people targeted by initiatives need to understand medical information in direct, simple terms and to know how to access products and services. In her experience, medical people often overwhelm audiences with a lot of technical information that is unnecessary or is presented in the wrong format for the audience. In order to design effective partnerships, it is important to keep in mind the knowledge, skills, and abilities of the audience.
Wilkinson noted that the ability to create effective partnerships is growing at the same rate as improvements in global health. Although he acknowledged causality may be absent, he suggested these two growth rates are correlated. He also agreed with the point about the benefits of increased capacity to broker better partnerships. Wilkinson suggested that there is often too much hesitation around moving forward with partnerships and that partnerships may never be perfect. Finally, Wilkinson mentioned that significant change is occurring in the consumer marketplace as people gain access to more information, knowledge, and tools to manage their own health. These marketplace shifts will necessitate continual evolutions in partnerships to remain aligned with changing consumer needs.
Responding to the conversation about brokers, another participant added that brokering diplomacy requires understanding the perspectives of all involved sectors. The participant agreed that the voices of beneficiaries, as well as those of local governments, need to be amplified. Related to sustainability, the participant added that time lines for seeing intervention deliverables may differ across stakeholders and that lack of alignment may be problematic. For example, the profitability time line for
the drone initiative in Rwanda is much shorter than the time necessary to see the economic benefits of improved health in the country.
Kumar asked participants about their thoughts on how to disseminate workshop takeaways to audiences beyond those at the meeting. O’Sullivan suggested the PPP Forum could support an effort to publish more research and case studies among a larger audience to share information about what works, what lessons were learned, and which best practices were identified. Kumar agreed that disseminating messages more broadly is important but noted that questions remain about who constitutes appropriate audiences and how to get messages to them. She noted that publishing reports may be the appropriate vehicle for certain audiences, but others may seek information from alternative sources.
Coughlan described the need for more information and data in public health so that they may be used to make well-founded business decisions. He noted a central question: what role could the National Academies play to ensure information derived from forums such this would contribute to more successful interventions?
BenDor suggested that, as a first step, workshop participants could share the themes and lessons learned from the workshop with their colleagues and begin to build capacity within their organizations by becoming partnership brokers. She also suggested working with academic institutions and students of public health and business to advance these messages because they represent the future of the field. Silberschmidt addressed the importance of engaging middle-income people in middle-income countries because they form the majority of the world’s population.
Mistry added that it is as important to learn from unsuccessful partnerships as it is to learn from successful ones. He suggested the need for a more deliberate communication strategy that could be led by the American Association for the Advancement of Science or by a subcommittee of the PPP Forum. Mistry suggested this strategy could address social media communications, best-practice tools, and checklists or guidelines for effective partnerships.
Ratzan noted the need for recommendations that a certain percentage of project funds be dedicated to evaluation, monitoring, assessment, and communications and that these activities be built into a project from the start. He also commended the idea of developing and implementing checklists, guidelines, and principles, which he called “frugal innovation.” Ratzan noted he is working on such lists related to multi-sectoral
engagement for sustainable health with a group at the Harvard Kennedy School. He also suggested that some of the National Academies’ strategies already effectively disseminate ideas: the PPP Forum, the webcast of the forum, and the proceedings that are developed and disseminated from it. He also suggested a need for ongoing social media engagement to combat counterfactual information.
Monahan agreed with earlier points about the importance of capacity building, which he noted needs to include education and training at levels from students and professionals to executives. Because professionals may not have much time for outside classes, he suggested exploring ways to disseminate the information to organizations that support professionals who manage partnerships. He also agreed that social media may be an important tool for distributing more messages and ideas about best practices around PPPs. Additionally, Monahan noted the importance of convincing government officials that partnerships can offer ways to accomplish public purposes that are part of a government’s mission.
Kumar then acknowledged the importance of segmenting audiences and being clear about what messages and strategies are appropriate for which audiences; goals and strategies may be different, for example, for government officials, students, frontline health care workers, and a company’s own employees.