Exploring Partnership Governance in Global Health Proceedings of a Workshop (2018) / Chapter Skim
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Appendix A: Commissioned Paper: The Core Roles of Transparency and Accountability in the Governance of Global Health PPPs
Appendix A: Commissioned Paper: The Core Roles of Transparency and Accountability in the Governance of Global Health PPPs
Pages 59-80
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From page 59... ...
Within this sphere, the question of "governance" of PPPs remains an important topic for additional analysis and discussion. This paper was prepared as background for the National Academies workshop to examine "the evolution and trends in the governance of global health PPPs," and provide "reflections on significant issues and current challenges with these governance structures, processes, and practices."1 The PPP Forum staff suggested that I draw on my own work in considering the trends and challenges for PPP governance.
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From page 60... ...
Diverse engagements with PPPs in global health over many years have highlighted for me the importance of transparency and accountability in partnership governance. In this paper, I first briefly review the literature on PPP governance.
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From page 61... ...
FIGURE A-1 Graph of usage of "governance" in Google Books, 1940–2008.
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From page 62... ...
One report10 provides "five characteristics of successful PPPs."a Another publication -- based on a review of the "governance structures" of 100 global health partnerships -- identifies the "seven habits of highly effective global public–private health partnerships,"11 specifying seven contributions and seven unhealthy habits, followed by seven actions to improve their habits.b Another article concludes that the governance structure of a partnership is a key determinant of success, according to an analysis of the voting rights of different parties in organizational boards.12 My initial impression of the literature on PPP governance, based on this review, was of a field characterized by a plethora of recommendations and an ambiguity of actions. The number of publications about PPP governance has undoubtedly grown, but it was difficult for me to identify any evolution or trends in the literature.
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From page 63... ...
Following this initial review, the National Academies research center conducted a more detailed literature scan on partnership governance of three databases (OVID, Scopus, and Web of Science) for materials published since 2000.14 The search included the terms partnerships and global health and transparency, accountability, and governance in various combinations.
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From page 64... ...
As Jonathan Fox notes, "a wide range of actors agree that transparency and accountability are key to all manner of ‘good governance.'"16 These two concepts also appeared as common themes in the NASEM literature scan on PPP governance.9,14 Many analyses of organizational governance consider transparency and accountability as part of the same category.16,17 For example, the authors of an analysis of the Medicines Transparency Alliance wrote, "Transparency is a necessary but not sufficient condition of accountability."18 In this paper, I take a different approach. Instead of seeing one concept as a condition of the other, one inside the other, or one leading to the other, I consider transparency and accountability as orthogonal (and independent)
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From page 65... ...
is sometimes proposed as a separate aspect of governance.19 I prefer, instead, to see participation as a mechanism for expanding transparency and/or assuring accountability.d For the purposes of thinking about PPP governance, however, I suggest that these two dimensions provide improved conceptual clarity and operational implications. In addition, and most importantly, improved transparency and improved accountability may lead to improved performance by the partnership in achieving its organizational and societal goals.
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From page 66... ...
of transparency and accountability, the ways to measure high and low levels for both concepts, different institutional mechanisms that can change the levels of transparency or accountability, and, eventually, how these two dimensions i nfluence the performance of a partnership. In short, this simplified model is intended to create conceptual clarity about the purposes of PPP governance and also lead to concrete options for action to promote ethical and effective governance of PPPs in global health.
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From page 67... ...
Outcomes would specify the ultimate performance objectives in terms of improved health status, client satisfaction, or financial risk protection.21 In their analysis of four partnerships in the Netherlands, Reynaers and Grimmelikhuijsen found that there was limited attention given to inputs and processes, and that most of the attention focused on outputs, but that the output targets were not always clearly specified and thereby created problems.20 The quality and scope of information is also often decided by the partner hip. For instance, monitoring information on outputs produced s by the PPP is often published in an annual report and made available to the general public.
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From page 68... ...
can require the reporting of certain information to the funders and the founders and of other information to the public as a condition of receiving financial support. Members of the board of directors may have exceptional access to internal information through regular meetings; these members can include the core partners, noncore partners, and others, depending on how broadly board representation is decided by the partnership.
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From page 69... ...
Decisions about transparency shape the positive and negative information and images that exist in the public sphere about a partnership. PPPs may decide not to disclose information that could be viewed as harmful or negative, as part of their public relations strategies, or they may use positive information to boost the partnership's public image and reputation.
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From page 70... ...
For example, accountability may be exercised through specific sanctions for nonperformance related to an agreed-upon metric, but it may also occur through public criticism and conflict that damage a PPP's reputation and thereby negatively affect the partnership's ability to operate. What does this mean for PPPs in global health?
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From page 71... ...
also have strong interest in asserting accountability for a PPP, including the intended beneficiaries, related civil society organizations, and relevant governmental or international agencies. National regulatory bodies in the countries where the PPP operates also have a relationship with the PPP that can be expressed through accountability.
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From page 72... ...
Insiders may focus on staff performance metrics for deciding on both sanctions and incentives, and thereby influence partnership production of both outputs and outcomes. Insiders, for example, could use "management by objectives" and "key performance indicators" to hold executives or groups or projects responsible for specific targets, with sanctions and rewards depending on performance.
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From page 73... ...
But such public meetings can also be designed to avoid serious questions and consequences, thereby avoiding accountability. In some cases, a partnership may sign contracts with key stakeholders (core partners or beneficiaries)
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From page 74... ...
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 for Transparency includes inputs, processes, and outputs; Contents for Accountability includes inputs, processes, and outputs; for Mechanisms for Transparency and Accountability, see discussion above.
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From page 75... ...
and (2) the mechanisms for assuring that the performance standards are met by the organization (accountability through public information on a webpage, accountability through reports provided to beneficiaries, or accountability through performance reviews of key PPP staff, followed by sanctions or rewards depending on performance)
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From page 76... ...
National regulatory agencies and national law could address (as currently happens for charitable organizations, for example) the governance requirements of PPPs, specifying the levels and mechanisms of transparency and accountability required.
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From page 77... ...
They state: "We argue that GHPs [Global Health Partnerships] skew national priorities of recipient countries by imposing those of donor partners; deprive specific stakeholders a voice in decision-making; demonstrate inadequate use of critical governance proce dures; fail to compare the costs and benefits of public versus private approaches; fail to be sufficiently resourced to implement activities and pay for alliance costs; waste resources through inadequate use of country systems and poor harmonisation; and do not adequately manage human resources for partnering approaches." See ref.
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From page 78... ...
"Partnership Governance in Global Health, Annotated Bibliography of Selected Resources." Prepared as an initial reference document for the Workshop on Exploring Partnership Governance in Global Health Planning Committee. Washington, DC: NASEM, 2017.
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From page 79... ...
Harmer. "Seven Habits of Highly Effective Global Public Private Health Partnerships: Practice and Potential." Social Science & Medicine 64: 259-271, 2007.
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