Public-private partnerships (PPPs) in health refer to collaborative relationships that transcend national boundaries and bring parties together to achieve a shared health-creating goal on the basis of a mutually agreed division of labor (Richter, 2004). These latter elements – a shared goal and mutually agreed division of labor – are important foundations for such partnerships, but all too often not the reality. PPP`s or “collaborative” partnerships seem to be ridden with conflict in what might be termed a “senior partnership” arrangement.
The various partners of a PPP– governments, corporations, and philanthropic organizations – each come to the table with their own agenda. Take, for example Uniting to Combat Neglected Tropical Diseases, a partnership between the Gates Foundation, pharmaceutical companies, and the governments of the US, the UK and the United Arab Emirates (Joseph, 2012). These partners have very different goals and priorities. Pharmaceutical companies keep an eye on profits, the Bill and Melinda Gates Foundation may prioritize technological solutions, and non-profit donors might emphasize direct care and training to front-line staff. These different goals can cause conflict and challenging partnership dynamics (Joseph, 2012). In a multi-stakeholder organization, trust between partners is essential; when it is eroded, the aims and impacts of the PPP are undermined (Omobowale et al., 2010).
With different goals vying for prominence, a stronger partner may overshadow the goals and interests of a weaker one. In particular, powerful transnational corporations may gain unfair advantage as they exert their influence. Buse and Walt (2000) point out the many benefits that the private sector can incur in these partnerships: corporate influence in global policy-making, direct financial gain, indirect financial benefits through image promotion, and enhanced corporate authority through association with the UN and other bodies. Partnerships between the WHO and the pharmaceutical industry are in need of particular scrutiny. According to Richter (2004), many PPP’s that are focused on drug donation reflect the industry’s desire to influence policy debates, particularly those on the World Trade Organization’s intellectual property agreement, and on drug pricing.
A look at three PPPs can exemplify how these differing agendas can play out. GAVI (Global Alliance for Vaccines and Immunization) and GAIN (Global Alliance for Improved Nutrition) were both initiated by the Gates Foundation. These PPPs are bound by agreements that the private sector has decision-making power on the governing bodies of the initiative at international and national levels. Furthermore, both health alliances focus on technology driven health interventions: GAVI on vaccines, and GAIN on micronutrient provision (Richter, 2004). This focus is clearly related to the Gates agenda. The third PPP, the Global Fund to Fight AIDS, TB and Malaria (the Global Fund) was set up by the UN Secretary-General in 2001. Although its funding comes primarily from public sources, an industry representative has voting rights on the board, but WHO has none (Richter, 2004).
While PPPs wield huge budgets and research power, they will inevitably need to grapple with issues related to conflict of interest. Recognizing and managing these conflicts is essential for a PPP to achieve its mission.
Buse, K., & Walt, G. (2000). Global public-private partnerships: part II- what are the health issues for global governance? Bulletin of the World Health Organization, 78 (5), 699-709.
Joseph, A. (2012). Public-private partnerships: A double-edged sword. Retrieved from formin.finland.fi/public/download.aspx?ID=12360&GUID=%7B3556FE5F-6CBC-4000-86F3-99EBFD2778FC%7D
Omobowale, E.B., Kuziw, M., Treurnicht, M., Daar, A., & Singer, P. (2010). Addressing conflicts of interest in public private partnerships. BMC International Health and Human Rights, 10 (19), 108.
Richter, J. (2004). Public-private partnerships and international health policy-making. Retrieved from http://formin.finland.fi/public/download.aspx?ID=12360&GUID=%7B3556FE5F-6CBC-4000-86F3-99EBFD2778FC%7D