Public-Private Partnerships for Health
The term public-private partnerships covers a wide variety of ventures involving a diversity of arrangements, varying with regard to participants, legal status, governance, management, policy-setting prerogatives, contributions and operational roles. They range from small, single-product collaborations with industry to large entities hosted in United Nations agencies or private not-for-profit organizations. The objectives of public-private partnerships include:
- Developing a product, e.g. the Medicines for Malaria Venture and the International AIDS Vaccine Initiative.
- Distributing a donated or subsidized product, to control a specific disease, e.g. initiatives to distribute leprosy medicines. Concerns have been expressed about these initiatives as not tackling the health problems of highest priority, as perceived locally.
- Strengthening health services, e.g. the Gates Foundation/Merck Botswana Comprehensive HIV/AIDS partnership.
- Educating the public.
- Improving product quality or regulation.
Some so-called public-private partnerships could be more accurately described as public sector programmes with private sector participation. Collaborations in this category include Roll Back Malaria, Safe Injection Global Network, and Stop TB (all of which have secretariats in WHO) and the Global Alliance for Vaccines and Immunization, which has its secretariat at UNICEF. There are also legally independent “public interest” (but actually private sector) entities such as the Global Fund to Fight HIV/AIDS, TB and Malaria.
Public-private partnerships for health should be distinguished from privatization. In the latter case, the public health policy goal and the rules under which for-profit entities operate are set and enforced solely by government agencies.
Public-private partnerships are closely scrutinized by a wide range of observers and some very different perceptions of their desirability and viability have emerged. In particular, concerns have also been raised about:
- Conflicts of interest over the role of industry partners.
- Donations in kind, such as drug donations, which often require relatively high national inputs, including costs associated with guaranteeing distribution networks, storing drugs at ports and airports, and training health workers.
- The exclusion of poor countries with large populations, unpopular governments or poor infrastructure from public-private partnership programmes.
- The circumvention of mechanisms designed to ensure that developing countries have a say in the policies that will affect their populations.
Others recognize that partnerships between public/governmental entities, private/commercial entities and civil society have a contribution to make in improving the health of the poor by combining the different skills and resources of various organizations in innovative ways. Public agencies clearly benefit from working in collaboration with the private sector in areas where the public sector lacks expertise and experience, e.g. in product development, production process development, manufacturing, marketing and distribution. However, there are areas, such as public health policy-making and regulatory approval, where the concept of partnership with for-profit enterprise is not appropriate. The purposes of partnerships should therefore be carefully considered and well articulated.