Exploring Partnership Governance in Global Health Proceedings of a Workshop (2018) / Chapter Skim
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2 Global Health and Governance of PublicPrivate Partnerships in the Current Context
2 Global Health and Governance of PublicPrivate Partnerships in the Current Context
Pages 5-16
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From page 5... ...
Chan School of Public Health on the core roles of transparency and accountability in the governance of global health PPPs and was followed by a panel discussion on the challenges in PPP governance in global health. The four anelists -- Steve Davis from PATH, p Mark Dybul from the eorgetown University Center for Global Health G and Quality, Muhammad Pate from Big Win Philanthropy, and Tachi Yamada from Frazier Healthcare Partners -- iscussed transparency and d accountability as well as additional dimensions of PPP governance, board structure, terminology, power dynamics and equity, and the management of real and perceived conflicts of interest.
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From page 6... ...
A key point here, he said, is that PPPs involve a wide range of actors, stakeholders, and types of partnerships, and that different types of partnerships may require different governance structures, processes, and practices. Partnerships, said Reich, can be domestic or global, be informal and sealed with a handshake or formal and finalized with a signed document, use existing structures in a contractual joint venture or create a new special purpose entity, and be for profit or nonprofit (see Figure 2-1)
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From page 7... ...
Some might claim, for instance, that participation should be considered as a third variable of governance, although Reich said that he preferred to view participation as a means to achieving transparency and accountability. Reich therefore decided to propose a simple twodimensional model in order to help improve conceptual clarity about PPP governance and to provide a model that could lead to concrete options for planning, assessing, and changing PPP governance.
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From page 8... ...
Accountability: General public Limited number PPP webpage, Low Party A (PPP) of metrics public hearings Beneficiaries A few metrics Ombudsman Low on outputs and complaints, using public pressure and reputation Core partners Detailed metrics Annual reviews High on inputs, of key staff, processes, with firing or outputs bonus, and of key partners NOTES: Contents include inputs, processes, and outputs.
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From page 9... ...
"It is those relationships of trust that are underappreciated in the field of public health and their role both in policy making and in making organizations work well," said Reich. In closing, Reich said he hoped that his paper helps clarify what governance means for partnerships and that the matrix of transparency and accountability as two core dimensions would prove useful in helping partnerships organize their governance structures and strategies.
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From page 10... ...
These partnerships are not intended to have sustained continuous life cycles that characterize some of the largest partnerships for global health; however, they still require effective governance structures. Based on his observations and experience engaging in these partnerships from the social-sector side,2 Davis made an appeal for the global health field to stop using the term public–private partnership.
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From page 11... ...
Mark Dybul began his remarks by agreeing with Davis that the term PPP is outdated in the current global context. From a philosophical perspective, he said, it is important to examine the 2002 Monterrey Consensus,3 which set the path for the two largest partnerships in global health -- the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund)
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From page 12... ...
" Moving from the institutional governance of the Global Fund, Dybul emphasized that in many respects, the in-country mechanisms of a partnership are more important than its global structure. The country coordinating mechanisms that were developed as part of the Global Fund have not worked well in many countries because of government dominance and difficulty engaging civil society at the country level, he suggested.
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From page 13... ...
When he joined the Bill & Melinda Gates Foundation, he encountered partnerships and other entities with boards composed primarily of largely self-interested individuals with no sense of accountability for the overall welfare of the organization. In addition, many boards were too big to make substantial and wise decisions on behalf of the entities they represented.
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From page 14... ...
DISCUSSION Rabinovich asked the panelists to address a governance issue that the PPP Forum members often encounter: managing conflict of interest when it involves industry partners. Yamada responded that in general, conflicts are acceptable as long as they are declared.
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From page 15... ...
Davis said there is a need to work on multidimensional engagement models that help get rid of the presumptions about how each sector behaves, such as assumptions that the NGO sector can be inefficient, the public sector can be lazy, and the private sector can be greedy. He suggested building a cohort of individuals with experience in all three sectors who could bridge the various sectors and help reduce, although not eliminate, asymmetry and help structure governance to deal with inherent power imbalances.
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From page 16... ...
He recommended against renaming these organizations as "multisectoral partnerships." A more useful term might be "hybrid partnerships," because there is literature on hybrid organizations that addresses social enterprise. Reich appreciated Dybul's point on the difficulty of changing a system of rules once it is in place, noting that institutional arrangements are "sticky." According to the concept of path dependency, positive feedback loops frequently develop, which makes changing an institution or a policy once it is established difficult.
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