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Introduction¹

Solving the world’s health challenges requires multidisciplinary collaborations that bring together the talents, experiences, resources, and ideas from multiple sectors. These collaborations in global health frequently occur through public–private partnerships (PPPs) in which public and private parties share risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal, said Dr. C. D. Mote, Jr., president of the National Academy of Engineering, in his welcome remarks at the National Academies of Sciences, Engineering, and Medicine’s workshop on Exploring Partnership Governance in Global Health. PPPs bring together talents and experiences, thereby enhancing the strengths, perspectives, and resources of the collaboration. This diversity, along with the commitment to work together, can lead to the development of the creative and multidisciplinary solutions required to tackle system challenges such as those in global health.

It is assumed that both government (public) and industry (private) will be partners in a PPP; however, the range of stakeholders engaged in global health partnerships includes entities such as national governments, bilateral development cooperation agencies, United Nations agen-

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¹ The planning committee’s role was limited to planning the workshop and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

cies, multilateral and regional development banks, hybrid global health initiatives, philanthropic organizations, local and global civil society organizations and nongovernmental organizations (NGOs), 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 engage in global health partnerships, for example,

within national governments and/or ministries of health, finance, telecommunications, and transportation. The number of stakeholders beyond government and industry engaged in and often critical to the success of these partnerships was mentioned frequently throughout the workshop and led to discussion on potential new terms to replace “PPP.”

These numerous stakeholders bring varying strengths and resources to global health partnerships, but they also bring their own organizational cultures, regulations, and expectations. Managing partnerships among these stakeholders is complex and requires intentional and thoughtful governance. Over the last several decades, as the number of interested stakeholders, resources invested, and initiatives launched within the global health field has grown, effective governance of global health PPPs has become increasingly critical.

Broadly, governance is the art of steering partnerships, said Clarion Johnson from ExxonMobil, and specifically refers to the structures, processes, and practices for decision making and ultimately accomplishing the PPP’s goal. While the importance of governance in global health partnerships has been identified, there is, in general, a lack of agreement on best practices (Stenson, 2010). This lack of agreement is partly a result of the significant variation across global health partnerships in size, including the number of partners engaged, resources allocated, and geographic focus; issue area; level of formality; and intended outcomes. An examination of PPPs in global health 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).

To explore the role of governance in PPPs for global health and potential best practices for design and operations, the Forum on Public–Private Partnerships for Global Health and Safety (PPP Forum)² created an ad hoc committee to plan a workshop with the following objectives (see Box 1-1):

• Examine the role of governance and its dimensions in PPPs for global health.

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² The PPP Forum was launched in late 2013 with the objective to foster a collaborative community of multisectoral health and safety leaders to leverage the strengths of multiple sectors and disciplines to yield benefits for global health and safety. PPP Forum workshops are an opportunity to share lessons learned and promising approaches and to discuss how to improve future efforts in areas of global health and safety promotion that have been prioritized by forum members.

• 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 key issues in the governance of PPPs for global health with the goal of increasing their effectiveness in improving health outcomes.

The workshop focused on 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.

ORGANIZATION OF THE PROCEEDINGS

An independent planning committee organized this workshop in accordance with the procedures of the National Academies (see Appendix D for the workshop agenda). The planning committee members were Clarion Johnson, Regina Rabinovich, Jo Ivey Boufford, Kevin Etter, Lauren Marks, John Monahan, Cate O’Kane, and BT Slingsby. The workshop was held in Washington, DC, on October 26, 2017, and included invited presentations, panel discussions, and small group discussions. This publication summarizes the workshop’s presentations and discussions, and it highlights common challenges, lessons, practical strategies, and suggested ideas for improving PPP governance in global health. The content of the proceedings is limited to what was presented and discussed at the workshop and does not constitute a full or exhaustive overview of the field.

In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. The workshop proceedings was prepared by workshop rapporteurs Rachel M. Taylor and Joe Alper as a factual summary of what occurred at the workshop.