Several bad habits of highly ineffective global public-private health partnerships
Steven Covey must be proud right now as his “Seven Habits of Highly Effective…” business book series are now entering the realm of global health. It makes sense though that his concepts would emerge in the talks about partnerships for global health in public and private realm. Business is the common denominator in both realms, even though the global public good is the selling point for cooperation.
Kent Buse and Andrew M. Harmer divulge into this notion of seven habits of highly effective global public-private partnerships in their paper titled Seven habits of highly effective global public-private health partnerships: Practice and potential. Similar to their paper’s structure, this blog will mirror related topics. Before recommendations and identifying good and bad habits, let’s discuss some important contributions by having global health partnerships (GHPs) to global health.
GHPs have always done a great job on “getting specific health issues onto national and international agendas” and gathering “additional funds for these issues” (Buse & Harmer, 2007). Raising awareness and gaining additional funds are positive successes by global health partnerships. These partnerships allow the health topics of AIDs and TB be included in typical educational outreach in most countries along with many worldwide efforts as seen by Stop TB’s promotion of DOTS. Without the GHPs, the world would not have so many commercials and fundraisers for global diseases.
By having GHPs, research and development for international health have risen. New drugs along with better, affordable, and efficient practices are becoming used and adopted. According to an open letter to leaders of G-8 nations, “GHPs report pipelines with over 8 diagnostics, 25 drugs, 8 microbicides, and 50 vaccines in development addressing diseases predominantly affecting the poor” (Open Letter, 2005). From these statistics, public-private partnerships seem to have faster and superior solutions to diseases (for example with drugs and vaccines) than just a solely private entity such as pharmaceutical companies. It seems that these partnerships make sense for stimulating growth and better solutions in global health especially for vulnerable populations.
As an overall contribution, most GHPs seem to enhance the efforts to establish better healthy “norms and standards in treatment protocols, technical management, and financial strategies” (Druce & Harmer, 2004). GHPs do have a promising aspect in theory. The capability of actually solving the global health problems can finally happen without involving the bureaucracy and politics. Well, maybe that is too promising to say as GHPs have yet to prove of drastically altering countries and other groups’ agendas for a better and healthy world. Change has been said to come but without changing the business approach to GHPs, no change will be significant or remain long.
If change is going to happen, many unhealthy habits must be amended for GHPs to be effective. First, GHPs do not entirely represent their legitimate stakeholders such as low-income countries with a strong voice in the decision-making. An average of 17% in the 23 GHPs fitting the selection in the study by Buse and Harmer shows that constituencies from low- and lower-middle-income countries (LMICS) are on governing bodies as the private sector has an average of 23% (Buse & Harmer, 2007). Of course, this does not mean that the final decision is not reflective to the LMICS. Most of the choices are heard intently to the countries where programs are implemented. The problem lies when the private conglomerates still go ahead with the project when having a split in the LMICS voting members. There must be a process to improve the contribution of local perspectives either by increasing representatives or induction materials. Now this leads to diversity and gender equity on the governing body as those factors are also important, but understood pretty well in America so let’s move on.
Another unhealthy habit is poor leadership and governance especially since there is a lack of specifying roles and responsibilities, performance monitoring, oversight and management, and transparency in decision making. This is probably the biggest challenge and worse habit of GHPs. It is difficult to correct since there is not an independent and unbiased entity that can perform as oversight, management, and mediator. Corruption is a reality when discussing leadership and global governance. From witnessing first hand, even the most loyal and pure individuals have a price or very susceptible especially during that one bad day where they give up on personal principles. Similar to businesses, GHPs will have no problem to make transaction to any entity or people who will have the responsibilities on decision-making, monitoring, and/or management. “When the commercial sector has a monopoly position with respect to a product, or the GHP requires critical assets from a particular corporation, the GHP is not in a strong position to dictate principles of good corporate ethics” (Buse & Harmer, 2007). For more on corruption please read Sonya Soni’s blog below as she discusses the topic further. Of course, the idea of making the United Nations to have that oversight and management role will be a bust due to lack of enforcement. Where does that leave the world?
The world and all its’ global citizens should demand that GHPs to adopt several better habits in hopes for a better global health. First off, GHPs must show “humility”, assimilate their efforts with local planning processes, and minimize local transaction costs (Buse & Harmer, 2007). By being humble, GHPs will hopefully shed the biased agenda and become more open and big picture minded. Another habit is GHPs need better representation for their stakeholders and better oversight (Buse & Harmer, 2007). This means that there must be some sort of standardization and rules created among all GHPs. They have to be universal and fair for all especially for managing conflict of interest. Overall, GHPs must be honest and share their demands upfront in hopes to reach a common agenda that will accomplish problem. This can happen by having accountabilities for each partner along with build a good-faith trusty relationship. In addition, shifting to better habits will lead to incentives for encouragement while remaining with the bad habits should lead to some sort of significant and meaningful sanctions such as trade embargo.
Through cooperative efforts, the business of public and private partners in global health must ensure the world that a sufficient amount of global public goods are created and shared (Skolnik, 2008). Business minded and greed driven are the two realities for most partners, but the strongest link between public and private entities should be solving these health problems now in hopes that prevention will save the world hundred times more than reacting deeper in a crisis. It only makes sense that making a business of global public goods for GHPs can rapidly increase by having better represented shareholders throughout the public and private sectors along with better oversight.
References:
Buse, K., & Harmer, A. (2007). Seven habits of highly effective global public-private health partnerships: Practice and potential. London: Social Science & Medicine, Volume 64, Issue 2, January 2007, Pages 259-271.
Druce, N., & Harmer, A. (2004). The determinants of effectiveness: Partnerships that deliver review of the GHP and ‘business’ literature. London: DFID Health Resource Center.
Open Letter. (2005). Open letter to the leaders of the G-8 nations. 17 June 2005.
Skolnik, R. (2008). Working Together to Improve Global Health. In Essentials of Global Health (p. 264). Suddbury, MA: Jones and Bertlett Publishers.
Sonny did an excellent job of presenting global public and private partnerships in a new way. I like the detail in both the good and bad aspects of the partnerships. Specifically, when he says "Another unhealthy habit is poor leadership and governance especially since there is a lack of specifying roles and responsibilities, performance monitoring, oversight and management, and transparency in decision making. This is probably the biggest challenge and worse habit of GHPs." This is exactly what needs to be focused on today. As more and more global health problems arise, we need to make leadership also arises and these problems do not go left untouched. He also puts an excellent conclusion to this paper
I agree with Yahaira and Sonny that poor leadership and governance are a huge problem in global health partnerships. Without clear cut roles and positions for global health authority figures, it is impossible to implement effective programs and health solutions. It is important for GHPs to have a unifying leadership system that is organized by a higher authority such as the United Nations or the World Health Organization. Perhaps incorporating GHP roles and positions into a written document would help to alleviate many of the issues that GHPs are facing. Additionally, having several figures in a leaderhsip role may help to organize the community of GHPs. Regardless, a solution must be found in order to improve global health programs worldwide.
This is a good post, Sonny. I think that GHP’s are making decent progress considering they have only been around a short period of time in their modern form. It seems like oversight committees, monitoring and evaluation groups and other measures are becoming standardized in many partnerships and becoming critical parts of new partnerships as well. These aspects are so intrinsic to public health practice now that we’re even being taught them here as an integral part of the curriculum. The problem of corruption does seem dramatic though, and the fact that many global health partnerships are unduly influenced by interest groups is regrettable. Especially where public health is concerned, multinational drug companies have been adept at lobbying governments and organizations to create better business environments for their products. At the same time, on occasion influence from citizens and governments has forced pharmaceuticals to make concessions they may not have made before. While enforcement is definitely an issue, it seems like a more formalized system of checks and balances might be more effective at making sure no party in a partnership gains too much power. Increased education and awareness might help stimulate creating of grass-roots organizations that can curb the lobbying influence of the traditionally dominant parties. Also, I really like the 7 habits analogy, thanks Sonny!
Sonny did an excellent job of presenting global public and private partnerships in a new way. I like the detail in both the good and bad aspects of the partnerships. Specifically, when he says "Another unhealthy habit is poor leadership and governance especially since there is a lack of specifying roles and responsibilities, performance monitoring, oversight and management, and transparency in decision making. This is probably the biggest challenge and worse habit of GHPs." This is exactly what needs to be focused on today. As more and more global health problems arise, we need to make leadership also arises and these problems do not go left untouched. He also puts an excellent conclusion to this paper
ReplyDeleteI agree with Yahaira and Sonny that poor leadership and governance are a huge problem in global health partnerships. Without clear cut roles and positions for global health authority figures, it is impossible to implement effective programs and health solutions. It is important for GHPs to have a unifying leadership system that is organized by a higher authority such as the United Nations or the World Health Organization. Perhaps incorporating GHP roles and positions into a written document would help to alleviate many of the issues that GHPs are facing. Additionally, having several figures in a leaderhsip role may help to organize the community of GHPs. Regardless, a solution must be found in order to improve global health programs worldwide.
ReplyDeleteThis is a good post, Sonny. I think that GHP’s are making decent progress considering they have only been around a short period of time in their modern form. It seems like oversight committees, monitoring and evaluation groups and other measures are becoming standardized in many partnerships and becoming critical parts of new partnerships as well. These aspects are so intrinsic to public health practice now that we’re even being taught them here as an integral part of the curriculum.
ReplyDeleteThe problem of corruption does seem dramatic though, and the fact that many global health partnerships are unduly influenced by interest groups is regrettable. Especially where public health is concerned, multinational drug companies have been adept at lobbying governments and organizations to create better business environments for their products. At the same time, on occasion influence from citizens and governments has forced pharmaceuticals to make concessions they may not have made before. While enforcement is definitely an issue, it seems like a more formalized system of checks and balances might be more effective at making sure no party in a partnership gains too much power. Increased education and awareness might help stimulate creating of grass-roots organizations that can curb the lobbying influence of the traditionally dominant parties.
Also, I really like the 7 habits analogy, thanks Sonny!