Academic journal article Bulletin of the World Health Organization

Global Public-Private Partnerships: Part I -- a New Development in Health?

Academic journal article Bulletin of the World Health Organization

Global Public-Private Partnerships: Part I -- a New Development in Health?

Article excerpt

Voir page 558 le resume en francais. En la pagina 559 figura un resumen en espanol.

Introduction

The latter half of the 1990s witnessed a burgeoning number of initiatives involving collaboration between the corporate and public sectors with the purpose of overcoming market and public "failures" of international public health, using global public-private partnerships for health development. One example of such a partnership is provided by the International AIDS Vaccine Initiative, incorporating a range of public and private interests which have undertaken to share the risks, costs and benefits of research into an effective vaccine against human immunodeficiency virus (HIV). While such partnerships bring major resources into the international public health arena and have the potential to benefit large populations, they also blur the traditional distinctions between the public and private sector's aims and responsibilities.

This is the first of two articles in which we explore global public-private partnerships. In part I we review the concept of partnership and delineate what we mean by global public-private partnerships (GPPPs) for health development. We then turn to the context from which these partnerships are emerging, focusing particularly on changes confronting the United Nations and the corporate community during the 1990s. Part II, which is scheduled to appear in the next issue of the Bulletin, discusses a conceptual framework for understanding the different forms of global public-private partnership in the health sector, and explores the implications of GPPPs for the 21st century, looking at issues of governance and equity.

What are GPPPs for health development?

The notion of partnerships for development cooperation is not new. As early as 1969, the Pearson Commission on International Development considered the nature of partnership between donors and recipient countries. The Commission suggested that the formation of a partnership requires the specification of reciprocal rights and obligations, and the establishment of clear objectives that are beneficial to both parties (1). Subsequently, numerous definitions have been proposed to characterize what partnership means, focusing on objectives, responsibilities and gains. The essence of partnership is "a relationship based upon agreement, reflecting mutual responsibilities in furtherance of shared interests" (2). In the health sector, WHO describes partnership as a means to "bring together a set of actors for the common goal of improving the health of populations based on mutually agreed roles and principles" (3). In this definition, agreement on key principles is thought to be crucial, as well as the maintenance of a balance of power between the parties, to enable each to retain its core values and identities. WHO proposes that these core ethical principles should include the following: beneficence (should lead to public health gain); non-maleficence (must not lead to ill-health); autonomy (should not undermine each partner's autonomy); and equity (benefits should be distributed to those most in need) (4).

Some definitions add an operational element by envisioning a partnership as "a collaborative relationship between entities to work toward shared objectives through a mutually agreed division of labour" (5). This type of partnership may also include "a mechanism to assess success and make adjustments" (5); or "an agreement to work together to fulfil an obligation or undertake a specific task by committing resources and sharing the risks as well as the benefits" (6).

However, although partnership is often defined as having some or all of the above features, the term suffers from a lack of specificity. Although donor-recipient relations remain the dominant partnership focus, for many aid agencies the basis of these relations has today moved away from geopolitical or historical relations towards more selective recipient-partner commitments, longer time horizons, responsiveness to recipient priorities and equality, as expressed through sector-wide approaches (5, 7, 8). …

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