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Exploring Partnership Governance in Global Health: Proceedings of a Workshop (2018)

Chapter: 4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance

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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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4

Examining Lessons Learned from the Development and Iterative Improvement of Public–Private Partnerships and Their Governance

In the workshop’s fourth session, five panelists shared lessons learned from development and operations of PPPs and their governance structures. The panelists—Danielle Rollmann from Pfizer, Lauren Marks from the U.S. Department of State, BT Slingsby from the Global Health Innovative Technology Fund, Jeffrey L. Sturchio from Rabin Martin, and Sonal Mehta from Alliance India—discussed lessons learned from experiences in determining governance needs and mechanisms based on partnership goals and engaging partners and other stakeholders in decision making. In addition, the panelists delved into the creation of iterative processes for continuously improving governance and how they approached adjusting to the evolving priorities of PPP partners and the global health environment. Table 4-1, included at the end of the chapter, provides an overview of the five partnerships included in this session. The text in this chapter summarizes the experiences and lessons learned shared by the panelists. Following the panel presentations, Clarion Johnson moderated an open discussion with the workshop participants.

ACCESS ACCELERATED (AA)

Access Accelerated (AA), explained Danielle Rollmann, is a multiyear program to sustainably address access barriers to care for noncommunicable diseases in low- and middle-income countries. The collective goal was conceived of and endorsed by CEOs of the 20+ companies that belong to this partnership. AA is composed of three elements. The

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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first, said Rollmann, includes a commitment from the member companies to do more work toward AA’s goal. The second element is a broad partnership with the World Bank on pilot programs in lower-income countries focused on strengthening local health systems by enhancing primary care, screening, diagnosis, and treatment of noncommunicable diseases. The third element is supporting disease-specific partnerships, the first of which provided seed funding for the Union for International Cancer Control (UICC) City Cancer Challenge, a multisectoral initiative supporting cities with more than one million people to take the lead in designing, planning, and implementing cancer treatment solutions as a means of increasing the number of individuals with access to quality cancer treatments.1

Since the launch, AA partners have initiated or expanded more than 20 company-driven programs. At the time of the workshop, the World Bank was in the process of designing three pilots that were pending formal announcements, and UICC had started working with three “learning cities.” The World Bank-partnered Kenya pilot2 has now begun operations, with a second due to launch in 2018, and the UICC has begun working with a fourth learning city. AA has been working with the Boston University School of Public Health to measure and evaluate progress. The expectation is that these activities will improve patients’ lives in ways that can be quantified and that the partnership will be able to leverage the results from the pilots toward a roadmap for sustainably addressing noncommunicable diseases in low- and middle-income countries. “Knowing that we cannot do this alone, we are hoping that through working together in these types of collaborations, we will build more robust multisector partnerships to drive these types of improvements, and that we will serve as an illustration of the impact that PPPs can have as we advance toward sustainable health system environments,” said Rollmann.

AA has three forms of governance: one for the 20+ participating companies, a second for its relationship with UICC, and a third for its partnership with the World Bank. The governance structure for its corporate partners reflects the differences among the companies; each has its own starting point with regard to existing programs, processes, resources, and footprint. Rollmann explained that the companies are goal oriented and share a belief in collective decision making. The governance structure includes committees, working groups, nomination processes, and a secretariat. A primary role of the secretariat, which is hosted by the

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1 See https://www.uicc.org/what-we-do/convening/ccan-2025-city-cancer-challenge (accessed January 25, 2018).

2 See https://accessaccelerated.org/day-1world-bank-access-accelerated-county-pilots-launched-tackle-ncd-crisis (accessed April 4, 2018).

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) and has a dedicated staff, is to ensure there is robust information sharing among the partners. Each participating company has a seat on the steering committee that meets regularly and serves as the core decision-making body. There is an operating committee comprised of the two co-chairs of the initiative, the chairs of each of the six working groups, representatives from one smaller company and one Japanese company (as steering committee calls may not always be convenient for all given time zones), a representative of the secretariat, and the IFPMA director general. The focus of the six working groups includes interface with the World Bank, the UICC, and with the companies, metrics, communications, and stakeholder outreach. AA is flexible and allows members to choose which working groups they serve.

In Rollmann’s opinion, AA has effectively built into its governance structure a process for continual learning and refinement. Twice yearly, the secretariat contacts each member company to do a formal check-in to ensure everyone is informed about the program’s progress, to answer questions, and to receive feedback. She noted that each of the World Bank and UICC partners has its own governance structure that AA respects while still ensuring there is alignment and accountability for the initiative. As a result, AA established explicit rules of engagement that were influenced strongly by the governance principles of the companies, as well as by the World Bank and UICC. Stakeholder engagement, said Rollmann, is handled by each of the partners, including UICC and the World Bank.

The company CEOs have been clear about the importance of measuring results and sharing learning. The independent Boston University team has established a framework with common metrics across programs to aggregate the data from each partner’s efforts (the measurement framework is described in detail in Chapter 6). “We are hopeful that through this [initiative] we will know the impact we had and also [can] start to build the knowledge . . . for a road map,” Rollmann explained. In closing, she said that the lessons AA has learned include the value of establishing a common vision and upfront commitment, being thoughtful about where consistency is needed and where flexibility can be designed into the partnership, and the importance of communication and face-to-face meetings. Other lessons have included the importance of building a common language across partners and allocating the time and resources to solicit feedback from the partners.

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

DETERMINED, RESILIENT, EMPOWERED, AIDS-FREE, MENTORED, AND SAFE (DREAMS)

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) DREAMS program is a $385 million multisectoral partnership devoted to preventing HIV transmission among adolescent girls and young women. To achieve this objective, explained Lauren Marks, she and her colleagues realized they would need to focus beyond the health system by addressing education, economic empowerment, and family planning. By broadening the scope beyond health, DREAMS has engaged a broader group of stakeholders who may not have had a primary interest in joining a partnership focused on HIV/AIDS.

DREAMS’s approach is to layer services to prevent HIV infection, explained Marks. Its core package of interventions includes empowering girls to reduce their risk for HIV and violence; identifying the “typical” sexual partners of adolescent girls and young women in order to target highly effective HIV interventions; strengthening families economically and in terms of their ability to parent positively; and educating girls, young women, and young men and mobilizing communities. DREAMS began in 10 sub-Saharan East African nations and later added 5 more countries.

The five partners in DREAMS are the Bill & Melinda Gates Foundation; Girl Effect; Johnson & Johnson; Gilead; and ViiV Healthcare, and each provides a unique contribution to the partnership. Girl Effect is launching a culture brand to reach the most vulnerable girls and boys with DREAMS messaging. In addition to informing programming and amplifying messaging, Johnson & Johnson listens to and brings girls’ voices to life to tell success stories and helps the project understand who these girls’ influences are, what their family life is like, and who their sexual partners are to enable human-centered design of the interventions. The Gates Foundation has taken the lead in and funds implementation research and impact evaluation, and Gilead is providing a financial contribution to purchase pre-exposure prophylaxis, or PrEP. ViiV Healthcare provides grants to community-based organizations to provide capacity building.

The partnership began with the development and signing of a nonbinding MOU. The MOU, said Marks, serves to hold the partners accountable to their commitments to the partnership. “When people have to quantify, write down, and sign a document that says these are our roles, responsibilities, and contributions . . . it adds a level of formality to the partnership,” she explained. “It is also where we lay out the framework for some of our governance.”

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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One of the hardest steps the partnership had to take in its early meetings, said Marks, was naming the initiative; crafting an acronym that conveys a sense of hope and positive thinking while taking political sensitivities into account was a challenge. Then, the partners had to develop a logo. The private-sector partners were able to bring their expertise in branding and marketing to facilitate the naming and logo development process. The partners then had many discussions about the governance structure, particularly on membership, how to add new members, and how much of a financial commitment would be needed for a new member to have a seat at the table. The partners discussed whether there should be a partnership director and if the secretariat should have its own leadership, governance structure, or staff; where it would be housed; and what its role should be. The partners also established working groups, which Marks said were similar to those of AA, and developed provisions for decision making, dispute resolution, and responsibilities. One challenge was accommodating the U.S. government’s role as the largest funder and its veto power over how the partnership spent its funds. The partnership wanted some flexibility in its governance structure so it would be able to adapt to changing circumstances and add new partners and subcomponents. She noted that the partners had to agree on what success looked like so the partnership could have the proper metrics in place to measure success.

During the development phase, DREAMS held workshops in each of the 10 countries where it had initially worked to listen to the beneficiaries’ vision of what the program should provide. That engagement led the partners to take a proactive approach to identify partners who could provide unique value. Marks explained that this effort included a landscape analysis of current related initiatives.

GLOBAL HEALTH INNOVATIVE TECHNOLOGY (GHIT) FUND

The Global Health Innovative Technology (GHIT) Fund, based in Japan, grew out of a 2011 conversation between BT Slingsby and Tachi Yamada about the Japanese pharmaceutical industry’s absence from global health initiatives despite ranking third in the world in new drug development. “We were trying to create a fund to act as a catalytic entity to bring more partners from Japan to the global fight against these diseases like malaria, HIV/AIDS, tuberculosis, and many of the neglected tropical diseases,” explained Slingsby. By June 2013, Slingsby had brought together eight partners to form the GHIT Fund, a partnership with an initial endowment of $100 million. The government of Japan, working with the United Nations Development Programme, provided $50 million, with five companies and the Gates Foundation matching the amount. As

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

of June 2017, the fund had grown to 26 partners, an endowment of $350 million, and six sponsors who provide in-kind donations that lower the fund’s management costs to under 5 percent of its annual budget.

In August 2011, the eight founding partners met and formed a launch committee that, over the course of 1 year through biweekly meetings, developed the fund’s articles of incorporation, bylaws, iterative processes, and governance structure, including committees, councils, and boards. The launch committee also established the fund’s investment scope and mechanism and access policy, as well as a launch strategy. Today, the fund has invested in more than 60 global partnerships, each of which includes a Japanese entity and a non-Japanese entity. As of November 2017, these partnerships have started six clinical trials in South America and Africa.

The fundamental purpose of the fund is to act as a catalyst for engaging Japanese entities in global health initiatives, and in that respect the fund has been successful, said Slingsby. He noted that the governance structure established by the launch committee was designed to manage conflicts of interests and balance power among partners. The basic governance question the launch committee sought to answer was how to create a PPP in which the same entities that are funding the partnership can become beneficiaries of it. The answer was to create a firewall between the council and the rest of the organization. The managing council includes all corporate partners as well as the major funders, but the council is not involved in any of the decision-making processes regarding investments, strategy, scope, or portfolio decisions. As a result, the partner companies can apply for grants from the fund.

The fund’s board includes only one funder, the Japanese government, with the philanthropic partners, the Gates Foundation and Wellcome Trust, holding observer seats on the board. The Gates Foundation and Wellcome Trust sit on the selection committee that makes recommendations to the board. The governance structure includes a criterion for investment that states every funded partnership must be global, consisting of at least one partner from Japan and one from outside of Japan.

Slingsby described some persistent governance challenges for GHIT. The diversity of partners and their participation at different levels of the governance structure necessitates active awareness raising among the partners on the overall governance structure and process. Members serving on governing bodies volunteer their time, and sustained leadership and engagement from high-level experts require thoughtful management. GHIT is a public Japanese entity with a global mission and international partners that, at times, requires aligning differing legal standards.

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

AFRICAN COMPREHENSIVE HIV/AIDS PARTNERSHIPS (ACHAP)

When ACHAP3 was established in 2000, some two-thirds of HIV-positive individuals lived in Africa, and very few had access to treatment. Jeffrey L. Sturchio, who was involved in ACHAP’s development and now serves on its board, noted that in Botswana, HIV/AIDS had become an existential crisis. Life expectancy, which reached almost 70 years of age in the 1990s, had plummeted to the low 30s.

At the time, Uganda had been experiencing success in addressing its HIV/AIDS epidemic using a prevention strategy, but no initiative had tried to deal with the entire spectrum of prevention, treatment, and care and build a health system infrastructure to manage the epidemic in a country like Botswana. ACHAP was founded to test whether it was possible to tackle HIV/AIDS on that scale and to ascertain if involving the private sector to help organize and manage projects would increase the impact. Merck & Co., Inc., began looking for partners in this effort, and the government of Botswana and the Bill & Melinda Gates Foundation joined Merck and the Merck Company Foundation to create ACHAP. Structured as an NGO in Botswana, the board included two members from the Gates Foundation, two from Merck, and an independent expert well known to key stakeholders in Botswana.

ACHAP’s goal, said Sturchio, was to address the threat of the epidemic through an integrated, country-led approach to prevention, treatment, and care. During its first few years, the drop in life expectancy reversed through the partnership’s support of a broad-based national treatment program.4 An important element for success was the president of Botswana’s strong public support for the country’s efforts to control the HIV/AIDS epidemic. This was exemplified by his direct involvement in establishing routine testing for HIV throughout the country. “It helped individuals feel more comfortable about getting a test and then becoming eligible for and enrolling in treatment,” said Sturchio. He added that the opt-out testing procedure that Botswana pioneered was soon adopted by the World Health Organization, Joint United Nations Programme on HIV/AIDS (UNAIDS), and the U.S. Centers for Disease Control and Prevention as the worldwide standard for HIV/AIDS testing.

One of the lessons learned from ACHAP is the critical importance of political will and commitment that was evident in Botswana by the presi-

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3 For additional background on the origins and early years of ACHAP, see Distlerath et al., 2004; Hilts, 2005; Ramiah and Reich, 2005, 2006.

4 For more information on this program, see http://apps.who.int/iris/bitstream/handle/10665/43065/9241592400.pdf;jsessionid=3382DEDC60C338C50F221DF6CB3BDE64?sequence=1 (accessed April 4, 2018).

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

dent leading the charge. At the same time, said Sturchio, it was important for the Gates Foundation and Merck to realize that they were working in a different organizational and national culture, which had a critical impact on the partnership. Country ownership was also fundamental, he said, as ACHAP was integrated into national strategies and priorities. Building local capacity and engaging effected communities were also key elements of the strategy. ACHAP’s governance structure included clearly identified objectives, roles, and responsibilities, as well as an effective mechanism for communicating among stakeholders and agreed-upon metrics. Among the key metrics, said Sturchio, were the number of individuals treated and the mortality rate.

To promote alignment, transparency, and accountability, ACHAP worked closely with the National AIDS Coordinating Agency, participated in the national forum of development partners, and established the Madikwe Forum5 for the ACHAP board and permanent secretaries of all government departments involved in the AIDS response to meet regularly to identify and work through bottlenecks. The permanent secretaries would assign specific ministries to tackle those bottlenecks and report back at the next meeting of the forum.

The ACHAP board, said Sturchio, had its own processes for ensuring that the two funding partners were able to work closely with management on critical issues. In addition, an international advisory group provided information and counsel about the global response and what was working elsewhere on preventing and treating HIV/AIDS. The ACHAP board also decided to invest in monitoring, evaluation, and dissemination of the results with partners and other audiences.

From ACHAP’s inception, the founding members were concerned about sustainability, but it was not a primary issue in the board’s planning in its early years, as the focus was on coping with a crisis situation. In time, however, there was discussion and planning to move from dealing solely with HIV/AIDS to a broader emphasis on population health in the country. The resulting sustainability plan involved building on ACHAP’s core capabilities in program management and implementation and on diversifying sponsors. The formal partnership ended in 2014 (although Merck continued to donate its antiretroviral medicines to Botswana until 2016), but ACHAP still operates in Botswana. It has worked with PEPFAR and the U.S. Centers for Disease Control and Prevention and has also become the first private-sector principal recipient of the Global Fund in

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5 For more information on the Madikwe Forum, see George, G., C. Reardon, J. Gunthorp, T. Moeti, I. Chingombe, L. Busang, and G. Musuka. 2012. The Madikwe Forum: A comprehensive partnership for supporting governance of Botswana’s HIV and AIDS response. African Journal of AIDS Research 11(1):27–35.

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

Botswana. ACHAP is also working with the World Bank and has begun a project with 10 members of the Southern African Development Community on various health challenges, such as tuberculosis among mine workers.

Regarding ACHAP’s impact, Botswana went from having the highest adult prevalence of HIV infection to becoming the first country to achieve universal antiretroviral therapy coverage and the first African country to reach UNAIDS’s 90-90-90 targets.6 Life expectancy had rebounded to 66 years of age by 2015, and adult HIV prevalence had fallen from nearly 40 percent to 22.2 percent in 2015. ACHAP also supported Botswana’s introduction of universal coverage for prevention of mother-to-child transmission, which cut the percentage of HIV-positive infants from 40 percent to under 4 percent. With ACHAP’s collaboration and financial support, Botswana also built a national network of HIV clinics; developed national counseling and testing infrastructure and services; developed a cadre of physicians, nurses, and community health workers to build the national response; implemented and scaled up safe voluntary male circumcision and behavior change programs for prevention; and developed local capacity to address TB/HIV co-infection. The important factors that led to these successes, said Sturchio, were that ACHAP focused on alignment with government and all partners, on being adaptable as circumstances changed, on learning by doing, and on being willing to change priorities if it became clear that an activity was not going to have the desired impact.

“We have to realize that partnerships like this are a process, not just an event,” said Sturchio in concluding his remarks. “When you create it, that is just the beginning. As ACHAP’s experience clearly shows, a focus on adaptability and learning is really critical to long-term success.” He noted that while today’s ACHAP looks nothing like ACHAP in 2000, it continues to make an important contribution both to progress against the HIV/AIDS epidemic in Botswana and, more broadly now, to population health in southern Africa.

THE AVAHAN EXPERIENCE

The Avahan program, which operated between 2004 and 2014, was implemented in two phases in the six Indian states that accounted for 70 percent of those infected with HIV in the country at the time. Sonal Metha

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6 By 2020, 90 percent of all people living with HIV will know their HIV status. By 2020, 90 percent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. By 2020, 90 percent of all people receiving antiretroviral therapy will have viral suppression (http://www.unaids.org/en/resources/documents/2017/90-90-90 [accessed January 29, 2018]).

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

explained that the first phase of Avahan focused primarily on controlling HIV through scaled prevention response; the second phase focused on the sustainability of Avahan’s achievements during the transition from external funding to local government ownership. Mehta emphasized that a significant change between the phases was the strong focus on community engagement in the latter phase. Partnerships were formed with 46 government clinics working in rural areas, and the program trained hundreds of outreach workers.

Prior to Avahan, the Indian government’s health system focused solely on HIV/AIDS treatment rather than prevention, said Mehta. Much of Avahan’s work, she said, was with female sex workers in rural areas, and between 2007 and 2010, the number of female sex workers accessing services at the partnership clinics increased from 1,627 to more than 15,000 (Kokku et al., 2014). “It is relatively easy to talk about HIV and sexually transmitted diseases in urban centers, but to talk about that in rural areas is . . . much more difficult,” said Mehta, “and to involve government clinics was even more difficult.” However, opinion surveys found that most female sex workers accessing services at the partnership clinics expressed confidence that they would continue to receive effective services from the government facilities even if the program ended, which Mehta observed was one sign that the program was successful. Another measure of success, she said, was the extent to which the HIV epidemic has been reduced significantly in the southern states where Avahan worked.

Avahan had five levels in its governance structure: organizational governance focused on processes and systems, donor oversight to regularly review progress, partner meetings for ongoing coordination and mutual accountability, government oversight to monitor role clarity and expectations, and the community advisory group. Mehta commented that the community advisory group was the most effective governance mechanism for increasing accountability across the partners; the community advisory group was also more effective at demanding that the government be accountable for meeting its responsibilities than Avahan would have been by itself.

One of the most important lessons Mehta learned from this project was that each actor had to have a clear responsibility and role and that it was important that each actor understand its stake in the success of the project. Another lesson was learning the importance of involving the individuals most affected by the work. Real advocacy, said Mehta, came from the targets of the interventions. It was also important to set realistic expectations and clear boundaries for the partners. She also noted the importance of respect and ideological agreement.

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

DISCUSSION

Clarion Johnson opened the discussion with a question for the panelists: When they began putting their programs together, did they decide at what point they would consider their efforts a failure and stop their programs? Mehta replied that her program had a few small failures. Early on, the program came to a point where the Gates Foundation was not happy with Avahan’s formation of community-based organizations (CBOs). “We had decided that if they really take a stand, ‘no CBO formation, only HIV control,’ then we would withdraw from the program,” she said. Marks said that the DREAMS partnership set a 2-year deadline for reducing HIV incidence by 40 percent, with the 2-year window ending in December 2017. Sturchio said that while ACHAP was having “tremendous success” with treatment, HIV incidence was not declining at the desired rate, particularly among young people. As a result, ACHAP started focusing on prevention and behavior change, using insights from social marketing, behavioral economics, and learning from previous work on health promotion and prevention.

Scott Ratzan from the Anheuser-Busch InBev Foundation noted that many of the programs discussed over the course of the day focused on infectious diseases and, for the most part, delivering effective treatments. He asked the panelists if there were lessons to learn from their efforts that could be applied when there is not an easy product, such as a drug or vaccine, available as the answer to the global health challenge being addressed. Marks replied that a multidisciplinary approach, one that engages doctors, engineers, anthropologists, and representatives of a variety of industries, will enable lessons from these programs to be applied to public health to change behavior and bring a focus on wellness and prevention to PPPs. “I think it is going to take some creativity and doing things differently and not talking to the same public health people, but really looking outside of our usual orbits,” said Marks.

Rollmann remarked that industry alone will not be able to drive solutions, which is why AA is engaging with the World Bank and NGOs. She said that she and her colleagues have heard from individuals they work with that the demand for efforts on noncommunicable diseases is increasing, and they are looking for the right partners to advance this conversation. As far as forming new partnerships to address noncommunicable diseases, Sturchio said that governments need to be more proactive about approaches that use existing instruments and tools, including laws and regulations, to engage more systematically with the private sector. He suggested that if there are more individuals who can work comfortably across sectors, who know how to translate what government thinks into

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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the way that private industry and civil society think, and vice versa, progress could be facilitated.

Regina Rabinovich asked the panelists if any of them had established mechanisms for dealing with disagreements among partners. Sturchio answered that the Madikwe Forum was established in part for that purpose. While there were not many disputes, the forum proved to be an effective mechanism for addressing and resolving disputes by having the right people around the table and a clear process for identifying the issue, fact-finding, brainstorming for potential solutions, and following up on implementation. Marks shared an example of how data served to solve a disagreement. The U.S. Department of State was adamant that it wanted the DREAMS program to work with adolescent girls ages 15 to 24, but one partner wanted to work with younger girls. The solution was to commission some research that showed the importance of working with younger girls, and so the U.S. Department of State changed its policy and DREAMS now reaches those younger girls. Slingsby said that formally, GHIT addresses disagreements through the committees, the board, the selection committee, or the council. However, there have not been many disagreements, and in his opinion soft diplomacy within the organization to align partners behind closed doors is the key.

Robert Bollinger from the Johns Hopkins University School of Medicine asked the panelists how they define sustainability or scale. Mehta said that in India, most states have transitioned successfully from Avahan support to government support. Her concern, though, is that technical knowledge can be lost during such transitions.

Jo Ivey Boufford then asked if any programs had been supportive of or resistant to transitioning from a disease-specific program to using the same infrastructure for broader care. Sturchio said that when ACHAP facilitated and financially supported building a network of clinics, the clinics were initially intended to serve as infectious disease control centers but ultimately served as an investment in building health care infrastructure for delivering a range of primary care interventions. He also noted that when the newly elected president of Botswana had different priorities, ACHAP adapted to that reality and discovered that its capabilities in program design and implementation were transferable to other areas and to countries outside of Botswana. Moreover, those capabilities were sought out by new funders, and ACHAP is now a major implementer of the work on voluntary male circumcision that PEPFAR has been supporting in Botswana, and it is working with the Global Fund in other countries.

Rollmann said that one of the goals of AA’s pilots with the World Bank was to explore how existing infrastructure can be used for additional purposes. She noted that building a health system infrastructure

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

can address one of the barriers to appropriate care in general in these countries. In addition, AA is looking for ways to extend the impact of the programs companies already have in order to give a greater benefit to patients in the countries in which its partners work. In Mehta’s opinion, the services her program delivered had to be specific to context and population and would not have worked if those facilities were delivering general health care.

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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TABLE 4-1 Partnerships Presented at the Workshop on October 26, 2017

Overview of Partnerships Presented in Workshop Session IV: Examining Lessons Learned from the Development and Iterative Improvement of Public–Private Partnerships and Their Governance
Operating Years Target Country/Region Partners Focus
Access Accelerated 2017– Worldwide Initial Sponsors: 28
Pharmaceutical companies and associations: Almirall, Astellas, Bayer, Bristol-Myers Squibb, Celgene, Chugai, Daiichi Sankyo, Eisai, Eli Lilly and Company, GlaxoSmithKline, Johnson & Johnson, Menarini, Merck, MSD, Novartis, Pfizer, Roche, Sanofi, Shionogi, Shire, Sumitomo Dainippon Pharma, Takeda, UCB, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), BIO, EFPIA, JPMA, and PhRMA
Partners: World Bank, Union for International Cancer Control (UICC)
Moving noncommunicable disease (NCD) care forward: access to NCD prevention and care
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

Partnership Goal Governance Structure (publicly available) Documented Partnership Outcomes/Impacts
To support the United Nations Sustainable Development Goal to reduce premature deaths from NCDs by one-third by 2030 http://www.accessaccelerated.org (accessed April 16, 2018) www.accessaccelerated.org/initiatives (accessed April 16, 2018)
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Operating Years Target Country/Region Partners Focus
DREAMS 2014– Sub-Saharan Africa; Haiti

(Botswana, Cote D’Ivoire, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, Zimbabwe)
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the Bill & Melinda Gates Foundation; Girl Effect; Johnson & Johnson; Gilead Sciences; ViiV Healthcare Prevention among adolescent girls and young women
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Partnership Goal Governance Structure (publicly available) Documented Partnership Outcomes/Impacts
To reduce HIV infections by 40 percent among adolescent girls and young women in 10 sub-Saharan African countries by 2017

Country-specific targets: https://www.pepfar.gov/partnerships/ppp/dreams/c69041.htm (accessed April 16, 2018)
http://www.dreamspartnership.org (accessed April 16, 2018)

https://www.pepfar.gov/partnerships/ppp/index.htm (accessed April 16, 2018)

http://ghpro.dexisonline.com/sites/default/files/PEPFAR%20Final%20DREAMS%20Guidance%202015.pdf (2015) (accessed April 16, 2018)
https://www.pepfar.gov/documents/organization/252380.pdf (2017) (accessed April 16, 2018)

https://www.pepfar.gov/documents/organization/247602.pdf (2017) (accessed April 16, 2018)

http://www.genderhealth.org/files/uploads/change/publications/CHANGE_Dreams_Report_Updated.pdf (2016) (accessed April 16, 2018)

Innovation Challenge: http://www.dreamspartnership.org/innovation-challenge/#innovation (accessed April 16, 2018)
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Operating Years Target Country/Region Partners Focus
GHIT FUND 2013– Worldwide Full partners: Japanese Ministry of Foreign Affairs; Japanese Ministry of Health, Labour and Welfare; United Nations Development Programme (UNDP); Astellas; Daiichi Sankyo Company; Eisai Company; Shionogi & Co.; Takeda; Gates Foundation; Wellcome Trust; Chugai Pharmaceutical Co.; Eisai Co.; Fujifilm; Shionogi
Associate partners: Otsuka Pharmaceutical Co.; Sysmex
Affiliate partners: GlaxoSmithKline; Johnson & Johnson; Kyowa Kirin; Merck; Mitsubishi Tanabe Pharma; Nipro; Sumitomo Dainippon Pharma
Research; product development
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Partnership Goal Governance Structure (publicly available) Documented Partnership Outcomes/Impacts
To facilitate international partnerships that bring Japanese innovation, investment, and leadership to the global fight against infectious diseases and poverty in the developing world https://www.ghitfund.org/about/governance/leadership (accessed April 16, 2018)

https://www.forbes.com/sites/medidata/2015/04/30/investing-in-drugsthat-wont-makemoney/#1024b2c83bb6 (2015) (accessed April 16, 2018)

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70055-X/abstract (2013) (accessed April 16, 2018)

http://www.nature.com/nm/journal/v19/n12/full/nm1213-1553.html (2013) (accessed April 16, 2018)
https://ghitfund.org/impact/impact (accessed April 16, 2018)

http://5th.ghitfund.org/replenishment/en (2017) (accessed April 16, 2018)

https://www.ghitfund.org/general/annualreport (2016) (accessed April 16, 2018)
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Operating Years Target Country/Region Partners Focus
Avahan 2003– India (Andhra Pradesh, Karnataka, Maharashtra, Tamil Nadu, Manipur, Nagaland) Bill & Melinda Gates Foundation; lead implementing partners; capacity-building partners; other supporting partners; monitoring and evaluation partners; knowledge-building partners Prevention, education, and service
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Partnership Goal Governance Structure (publicly available) Documented Partnership Outcomes/Impacts
To reduce HIV transmission and lower the prevalence of sexually transmitted infections in vulnerable high-risk populations—female sex workers, men who have sex with men, transgender individuals, people who inject drugs—through prevention education and services http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136177 (2015) (accessed April 16, 2018)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287554 (2011) (accessed April 16, 2018)

http://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1027&context=spnareview (2009) (accessed April 16, 2018)

https://docs.gatesfoundation.org/documents/avahan_hivprevention.pdf (2008) (accessed April 16, 2018)
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70083-4/fulltext (2013) (accessed April 16, 2018)

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61390-1/abstract (2011) (accessed April 16, 2018)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287556 (2011) (accessed April 16, 2018)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287555 (2011) (accessed April 16, 2018)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287553 (2011) (accessed April 16, 2018)

https://docs.gatesfoundation.org/documents/avahan_hivprevention.pdf (2008) (accessed April 16, 2018)
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Operating Years Target Country/Region Partners Focus
ACHAP 2000–2014a Botswana Merck & Co., Inc.; Merck Foundation; Bill & Melinda Gates Foundation; and the Government of Botswana Prevention, care, treatment, capacity building, and systems strengthening

a The original ACHAP partnership ended in 2014. Today, ACHAP operates as an independent entity with a broader health mandate and wider geographical focus while continuing to build on and leverage its core competencies in the field of HIV/AIDS and related health conditions. Its goal is to provide comprehensive, innovative, and catalytic solutions through Public Private Community Partnerships (PPCPs) to achieve sustainable population health. More information can be found at http://www.achap.org/index.php (accessed May 25, 2018).

SOURCES: Information in table was compiled from speakers Lauren Marks, Sonal Mehta, Danielle Rollmann, BT Slingsby, and Jeffrey L. Sturchio, and distributed at the workshop as preparatory material for their respective sessions.

Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Partnership Goal Governance Structure (publicly available) Documented Partnership Outcomes/Impacts
To prevent and treat HIV/AIDS in Botswana; ACHAP, established in July 2000, supported the goals of the government of Botswana to decrease HIV incidence and significantly increase the rate of diagnosis and the treatment of the disease by rapidly advancing prevention programs, health care access, patient management, and treatment of HIV/AIDS http://web.archive.org/web/20030322045745/
http://www.achap.org:80/

http://www.fsg.org/publications/adapting-through-crisis#download-area (2014)

https://www.cgdev.org/sites/default/files/archive/doc/events/6.06.07/ACHAP_Presentation_June_6_Event.pdf (2007)

http://digitalcommons.law.yale.edu/cgi/viewcontent.cgi?article=1080&context=yjhple (2004)
http://www.fsg.org/publications/adapting-through-crisis#download-area (2014)

http://www.msdresponsibility.com/wp-content/uploads/pdfs/key-initiatives_access-to-health_africancomprehensive-hivaidspartnerships.pdf (2014)

http://www.achap.org/annual.php (2012, 2013, 2014)
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×

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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Page 46
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
Page 47
Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
×
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Suggested Citation:"4 Examining Lessons Learned from the Development and Iterative Improvement of PublicPrivate Partnerships and Their Governance." National Academies of Sciences, Engineering, and Medicine. 2018. Exploring Partnership Governance in Global Health: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25069.
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Next: 5 Evaluating and Reporting on PublicPrivate Partnerships in Global Health »
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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. However, 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 them 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.

To explore the role of governance in PPPs for global health, the Forum on Public–Private Partnerships for Global Health and Safety convened a workshop. Participants explored best practices, common challenges, and lessons learned in the varying approaches to partnership governance. They also highlighted key issues in the governance of PPPs for global health with the goal of increasing their effectiveness in improving health outcomes. This publication summarizes the presentations and discussions from the workshop.

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