Global Public-Private Partnerships: Part II -- What Are the Health Issues for Global Governance?
Buse, K., Walt, G., Bulletin of the World Health Organization
Voir page 708 le resume francais. En la pagina 708 figura un resumen en espanol.
In Part I of this article, which appeared in the last issue of the Bulletin, we suggested that there have been a number of initiatives in which the corporate and public sectors sought collaboration in international public health through partnerships. That paper reviewed the concept of partnership and defined global public-private partnerships (GPPPs) as collaborative relationships which transcend national boundaries. Each partnership brings together at least three parties, among them a corporation (and/or industry association) and an intergovernmental organization, to achieve a shared health-creating goal on the basis of a mutually agreed division of labour. The paper described the context within which these partnerships are emerging, focusing particularly on changes confronting the United Nations and the corporate community during the 1990s.
While these partnerships are bringing major resources into international public health and have the potential to benefit large populations, they are also blurring traditional distinctions between public and private sector responsibilities and aims. The use of GPPPs in public health also raises a number of important questions of conflicts of interest, and implications for governance. This paper opens the debate on these issues, starting with a conceptual framework for understanding the different forms of global public--private partnership in the health sector, illustrated by a number of examples. It ends by exploring the implications of GPPPs for the 21st century, looking at issues of governance and equity.
What forms have GPPPs for health development taken?
There are several ways to conceptualize and categorize partnerships. One is in terms of constituent membership, for example, donor--recipient or public--private. However, this is too broad to be very helpful for understanding GPPPs. Another categorization has been proposed by Mitchell-Weaver and Manning (1), who reason that as partnerships are primarily a set of institutional relations, they should be categorized by their organizational form. They differentiate between three institutional models on the basis of the degree to which private interests "participate in the strategic-level decision-making in the public interest". The elite committee model (sometimes called a board or conference) is characterized by negotiation among relatively equal partners so as to arrive at decisions by consensus. The committee does not implement decisions, rather the individual members influence the behaviour of their respective organizations to achieve partnership goals and/or influence public policy through network associations. In the health sector, the `Global Business Council on HIV/AIDS', which involves the leaders of 15 major companies, is one example of such a model (2).
The second institutional form is the NGO model, involving nongovernmental organizations. Mitchell-Weaver and Manning suggest that the relationship between parties is essentially one of delegation. The public side provides organizational, material or financial resources to enable a private partner to carry out the public programme. The NGO model links the public with the private sector through resource transfers and is exemplified by the Sexually Transmitted Diseases Diagnostics Initiative (3).
The third is the quasi-public authority model in which a hybrid organization with both public and private characteristics is created by public sector institutions. Acting in the public interest, this type of organization provides goods and services or enables the private sector to enter a market. In effect, the quasi-public authority model creates favourable conditions for private enterprise to provide public services or goods. The Medicines for Malaria Venture (MMV) (4) and the International AIDS Vaccine Initiative (IAVI) (5) could both be said to be examples of this organizational form at the global level. …