How to leverage the private sector to sustain health programs: A case study from Ghana

The post-2015 development agenda is focused squarely on sustainability, transitioning from simply achieving specific targets to sustaining progress and impact in health and development. Two key elements in attaining sustainability include reducing donor dependency and increasing country ownership. By looking beyond traditional sources, public sector leaders are increasingly able to diversify health funding, reducing reliance on any one donor or investor. Many private sector actors recognize engagement with the public sector has business value and promotes social benefits. Improving population health can have further positive effects for employees and consumers: A healthier population generally has stronger purchasing power. Public-private partnerships have been lauded as a way to increase country ownership, as well as diversify funding sources for health programming. However, mobilizing private sector investment for public programs is not easy. The private sector and public sector often operate in distinct ecosystems and have different characteristics; alignment of their varied objectives is challenging. Key differences include: ● Accountability. The private sector is accountable to shareholders; the public sector is accountable to citizens. ● Interests. Public sector interests are achieving health and development targets; private sector advances business interests, aligning CSR investment to commercial opportunities. ● Organizational cultures. The public sector adheres to government norms, which may be viewed as cumbersome and bureaucratic; private sector has more opportunity for innovation and timeframes for impact are generally shorter. Innovative engagement with the private sector can drive sustainable public health programming. But how do we align the interest and capacities of the public sector and the private sector to realize this mutual benefit and public good? Through USAID-funded End NTDs in Africa program, we are supporting Ghana’s health service and USAID’s Neglected Tropical Disease Program in the country to mobilize resources from private sources, reducing their reliance on donor funding and sustaining programs to control and eliminate NTDs. Our experience in Ghana and other countries has offered significant lessons to enable PPPs for health. What the public sector can do to attract and enable private sector investment The public sector has an opportunity to be in the driver’s seat, identifying potential stakeholders and partners based on specific principles: 1. Know who the potential investors are. Stakeholder mapping can help clarify the landscape of stakeholders and identify players who may be interested in supporting public programs. In Ghana, we worked with the NTDP to identify diverse stakeholders and mapped out the level of influence and impact of each. This helped prioritize a list of potential investors to the NTDP. 2. Understand the interests of the potential investor. Once a prioritized list of stakeholders was established, we worked with the NTDP to develop stakeholder profiles that outlined the beliefs, attitudes, and needs of the stakeholder. The purpose was to understand the business and social interests of the potential investor and answer: Why would they invest in the NTD program? 3. Develop a message that aligns with stakeholder interests. We then helped the NTDP to develop a business case using data and detailed contextual information to “make the case” of why the stakeholder should invest, and what return they could anticipate. The business case justification helped the team hone the message or the “ask” so that it aligns to stakeholder interests. 4. Develop a proposal. Pulling the business case justification into a proposal provides an opportunity to demonstrate that the requesting agency, in this case the NTDP, has the right performance, the right management structure and the right staff to deliver program results, manage resources and achieve impact. Public sector organizations benefit from targeted capacity building to prepare for PPP opportunities. Working directly with the NTDP, we provided mentoring and capacity support to identify stakeholders, develop business cases, facilitate introductions to private sector players, and strengthen internal controls so that private sector actors can trust that funds will be managed effectively and results will be achieved. What the private sector needs The private sector has considerable opportunity to advance business objectives, while simultaneously providing a social good. But for the private sector to invest, several variables must be aligned: 1. The linkage between business/social investment interests and programs must be clear. A business case using familiar terminology is critical. In programs such as NTD, the highly technical and jargon terms can alienate a private sector investor. 2. Impact measurement needs to be relevant. NTD program monitoring is not the same as business investment monitoring. Therefore, the business case needs to articulate not only the return of the investment, but also how that investment will be measured and who will be measuring it. For example, what would be the return on investment for investing in the NTDP in terms of market expansion or brand recognition? 3. Time parameters for achieving results must be clear. Private sector stakeholders often operate in a quicker time frame than public health programs, expecting results expeditiously. 4. Trust for effective fund management must be established. Investors expect that the funds will go to their intended purpose within the NTDP. What are the risk management considerations built into the proposal? 5. Who is leading the effort. Establishing relationships and trust is critical to any investment. The private sector wants to know who is responsible and trust that that individual will enable impact with the funds. Although theoretically a “win-win” opportunity, PPPs are complex. In a separate paper, “The Roadmap toward Effective Strategic Social Partnership”, we provide a detailed roadmap how to achieve the full benefits PPPs, following five key steps from inception through implementation and even “sun-setting”. While this is just a beginning for PPPs in managing the NTD burden in Ghana, we believe that in this decade, leading companies in most industries will be using such strategies and investments to change the way they relate to their markets and customers. Building the capacity of health sector authorities today to identify and promote such PPPs will position these countries toward a sustainable health sector in the future. Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans. 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.