What makes a global health partnership succeed

It has come to be a familiar statement. No one organization, actor or sector can tackle global health challenges alone. And while that’s true, the hype around partnerships must be translated into more strategic, intentional, measurable collaboration to truly drive change.

The past is littered with big announcements to eliminate this disease or promote that behavior change; many times, though, the initiatives that followed fell short of purported goals.

There are also clear examples of success — through platform organizations like the Gavi, the Vaccine Alliance, which has revolutionized the vaccine sector by bringing together a host of partners, as well as countless smaller initiatives. And there are many champions — in the public, private and nonprofit realms — who are working hard to find new ways to collaborate and reach the lofty health targets that are expected to be part of the United Nations-backed sustainable development goals come next year.

While global health is primed for partnership, it is also a sector that can prove more challenging than others, Kavita Bali, senior director of strategic partnerships and alliances at CARE, told Devex. Health-related projects are not always aligned with a company’s interests and so partnerships may happen more often with corporate foundations or corporate social responsibility departments. If a partnership is tied to a company’s philanthropic efforts, it can be more volatile and is often shorter-term, she said.

For the private sector there may be no clear business case for participation — but that doesn’t mean they won’t if proper incentives are in place.

“We need to think about incentives in a different way because these are not really commercial markets,” Adrian Thomas, head of market access and global public health at Janssen, a pharmaceutical company part of the Johnson & Johnson group, told Devex. “Research in this area is difficult, prolonged, and with poor adoption there are few incentives to pursue it.”

Leading up to the post-2015 agenda, the dialogue and practice around partnerships has steadily evolved. It’s a journey that remains far from complete, and many questions remain.

What is a true partnership, for instance, and how many of them do we need? When are partnerships most useful in addressing global health and development challenges? And what does it take for a partnership to succeed?

One tool in the toolbox

Partnerships are one approach to solving a problem and should emerge as the best option when an organization finds itself faced with a problem it cannot address alone — whether that be research, manufacturing, health systems strengthening or delivering care.

A pharmaceutical company, for example, may discover it has a drug that can be used to treat a specific disease, but without testing technology or patient access to finance, they may be unable to get it in the hands of those in need. A nongovernmental organization may discover it needs help reaching customers in the last mile that a logistics company may possess. And a government may discover that it needs better training for ministry health workers and needs partners to help empower and educate them.

In each situation, it’s important first to identify the problem, and then determine the right strategy to get there and not pursue partnerships because they are the method du jour.

For Janssen, the shift to partnerships has come in part out of necessity.

Janssen discovered that while it has a drug to treat multidrug-resistant tuberculosis, it still needs what Thomas calls an adjacent technology in the form of easier testing to determine which patients need the medication and which partners can help with distribution.

“We’ve learned we have to understand and move towards an impact-based approach in global health,” Thomas said. “We can’t be all things to all people, we need like-minded partners who have an interest and execute against certain diseases.”

Partnerships are an effective tool for pharmaceutical companies in helping understand disease prevalence and ensuring manufacturing capabilities.

Janssen does not produce high-volume, low-cost medications, so it must find manufacturing partners who can handle demands.

Measuring the impacts of an individual partnership is possible, and sometimes not that difficult. What is more difficult to measure precisely is whether a partnership is a more effective tool than any other for tackling a specific challenge. As the use of partnerships is evaluated and organizations work to determine when and how to use them, more data that compare outcomes of different approaches to the same challenges can be the key to success.

Evolution of partnership strategies

What may have started out as hesitant first steps and tentative forays into partnership led to slow-building trust and is changing the way organizations — from NGOs to companies — are working together to achieve health goals. What has evolved from conversations and tests has led to new strategies, new business models, stronger leadership and changing views about collaboration.

Even as the dialogue about partnerships has increased, the concept itself is not new, and there are some skeptics who argue that there are a limited number of examples of true collaboration beyond a contractual relationship.

CARE is moving beyond a weariness and lack of trust of the private sector in particular, and is working more closely with partners to develop projects together, according to Bali.

“It’s really important to spend as much time as needed to ensure there is a shared vision, not just a one-year commitment but an opportunity to grow and leverage the skills each partner is uniquely positioned to bring to the table,” she said.

CARE is more strategic now than in the past about how to engage and develop relationships with potential partners, Bali explained. The process is ongoing, but the organization has found that different types of partnerships — including those that do not involve cash contributions but instead involved partners donating staff time or other resources — have been quite helpful both for CARE’s operations and the projects it runs.

“Gone are the days of a lot of bilateral partnerships,” she said. “We strive to have partnerships that are either multisector or multi-industry partnerships because communities don’t have health problems in isolation of other things.”

CARE and a growing number of international NGOs are working with corporate partners on how to link strategies together, she suggested.

The U.S. Agency for International Development, for one, is one of many foreign aid donors that has been thinking about partnerships more strategically in recent years. USAID has been mobilizing stakeholders around specific calls to action, Chris Jurgens, the U.S. Global Development Lab’s division chief for global partnerships, told Devex.

That shift has led generally to a more strategic approach to health partnerships, where the agency starts by analyzing the key problems surrounding a particular challenge, evaluates the possible interventions, and then brings in partners whose goals align are best positioned to carry out the programs with the most potential.

In the past, Jurgens said partnerships were seen as opportunistic projects that were not linked or integrated into a country or sector strategy, which resulted in weaker accountability and measurement mechanisms.

GlaxoSmithKline’s approach has also changed, and tackling global health challenges has moved from a largely philanthropic effort to one that is more integrated into the company’s core business, Allan Pamba, GSK’s vice president for East Africa and African government affairs, told Devex.

“It’s really about moving toward partnerships that have strategic alignment with where the business is moving,” he said. “Such partnerships have energy, longevity and sustainability.”

This shift has required visionary leadership to change strategies — which include moving priorities from being purely profit-driven to including volume or access to GSK products. The company now commits 20 percent of its profits generated in least developed countries back into projects that strengthen those countries’ health care infrastructure through partnerships with Amref Africa, CARE and Save the Children.

“We’re finding we have to think beyond the boundaries of our own business,” Pamba said. “With all this reorientation, what we’re beginning to see is every stakeholder in this space examining themselves.”

Marc Mitchell, a lecturer on global health at the Harvard School of Public Health and founder and president of D-tree International, is skeptical of the hype about partnerships.

“Partnerships are all the rage [but] they are not new, and I don’t think they’re substantially all that different than they have been,” he told Devex. “What’s different is that people are talking about them.”

Mitchell said that there are few “true” partnerships, ones where there is risk shared by all parties. Most others, he suggested, essentially involves some form of contractual service one party pays another for.

There are many examples of partnerships that have worked and could not have achieved their outcomes without the unique mix of actors involved, according to Mitchell. But while governments and other actors are recognizing the need to work more closely with the private sector, that doesn’t always constitute a partnership, he stressed.

New or unusual partners

There are a number of actors who are obvious partners on global health challenges: pharmaceutical companies, medical device companies and health departments. But as aid groups and companies look for new ways solutions and struggle to fill funding gaps, they are increasingly looking to what may appear to be unlikely allies.

New partners include logistics companies, fast-moving consumer goods businesses, software giants, mobile network operators and more. Still, there are some who are sometimes left out, like the informal sector, local businesses and communities themselves, which could all play a larger role in partnerships in the future.

“The importance of nontraditional actors [and] partnerships involving them is crucial,” Mario Ottiglio, the director of public affairs and global health policy for the International Federation of Pharmaceutical Manufacturers & Associations, told Devex

IFPMA has been exploring new partners itself, mainly by working with the International Telecommunications Union on “Be He@lthy, Be Mobile,” an mHealth initiative directed at preventing noncommunicable diseases and with the International Federation of Red Cross and Red Crescent Societies to study the role of better workplaces in helping people live healthier lives.

The pharmaceutical industry group and platform organizations like Gavi or the Global Fund to Fight AIDS, Tuberculosis and Malaria can serve as testing grounds for new partnerships and also play a critical role as conveners. Whether more platforms like Gavi or the Global Fund will pop up, or even if that would be useful remains unknown but the need for organizations that coordinate global health work will persist. Their ability to aggregate and create economies of scale has made dramatic impacts on costs and improved efficiency.

For platform organizations, bringing in new partners can help them solve logistical and operational challenges. The Global Fund recently launched an innovation hub to bring in new partners, especially those from the private sector to do just that. If successful innovations are identified they can be scaled quickly through the Global Fund’s networks — allowing the organization to be more efficient and giving its partners the opportunity for broader impact.

While many partnerships have focused on bringing together international organizations and multinational corporations, local companies in developing countries are another source of untapped potential. Some are growing rapidly and interested in working with others on health problems, especially those that affect their employees and communities. However, Pamba said they often lack the knowledge necessary to know how to engage and governments can play an important stewardship role in involving them.

Informal economies and informal businesses have not often been included in partnerships but they could be leveraged for distribution and education efforts, said Jeffrey Rowland, director of innovative finance and private sector partnerships at Gavi.  Gavi is exploring how to better tap into the informal sector especially to reach last-mile destinations, he added.

Local communities should also be considered as partners because when given a sense of ownership they can help projects succeed, or hinder those that do not, Ottiglio said.

Changes needed moving forward

There are still barriers to successful collaboration — from a lack of understanding between partners, to competition among actors, to poor measurement of outcomes and barriers to scaling.

“I think we need to examine the barriers to collaboration a little bit more,” Bali said, adding that she has seen competition between companies, especially those in the same sector, and competition among NGOs for resources hinder partnerships.

In cases where there may be less of a business case for tackling a health problem, incentives can help encourage and make possible corporate participation. A key hurdle that remains, according to Thomas, is determining and properly designing incentives so that it doesn’t take a tragedy like Ebola to mobilize broad efforts against any particular disease.

Trust also remains a key barrier, Pamba said. Organizations sometimes still come together in “partnerships” that are more like monetary transactions. But those who recognize that there may be disagreement and agree to be transparent about those issues often move forward in a deeper, more productive way.

A further problem that partnership professionals are tackling is how to measure results, ensure stronger accountability and develop best practices.

The monitoring and evaluation of partnerships has traditionally focused on inputs, as has the measurement of many other development projects. As the field becomes more sophisticated, there is a greater attention to measuring outcomes, which is also a more expensive process. The industry needs to commit to doing proper measurement and find ways to fund it, possibly through partnerships with foundations, educational institutions and donors.

Policymakers can also help provide a venue to develop better monitoring and evaluation and governance mechanisms, Ottiglio said. While a formal accountability standards may prove challenging, creating more structure around how partnerships are designed and implemented can lead to better outcomes.

The Millenium Development Goals were born in an era where collaboration was happening sporadically, according to the IFPMA official, and there was little trust of the private sector, especially in global health. The MDGs fostered collaboration by rallying actors behind specific goals. Platform organizations and frameworks were developed that brought together organizations and sectors that hadn’t historically worked together. So if the MDGs were about learning how to talk to one another, the next few years as the sustainable development goals are finalized will help determine how to push that talk to action.

If the past 15 years were about accepting and embracing the need to work together, the next may be about how to do so more quickly, more nimbly and more effectively.

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Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.