Public –Private Partnerships for Health
SCOTT C.RATZAN
The twenty-first century heralds most health and social
services predominately provided and financed directly by government.In
recent years given the fact that health commands an ever-growing proportion
of the GDP, however, governments and other stakeholders have looked to
share the administrative, financial, and implementation burden.Moreover, the
challenges to deliver health services at a high level of efficiency
and quality place the current systems at risk. Globally, as well as in
many countries, governments are turning to the private sector to ‘‘partner
’’in the development of innovative solutions for the advancement
of health.
This idea of a public –private partnership (PPP or
P3)is an approach in which the resources of interested stakeholders
from the public and private sector (e.g., governmental authorities,
nongovernmental organizations, and private entities)are combined to
advance research, develop products, or provide services to attain a
mutually agreed-upon goal.
In November 2002 the World Health Oganization further
weighed in, suggesting
the way to improve health in developing countries could be with such
‘‘partnerships
among communities, civil societies, the private sector and government.’’While
this idea
is not new, it nonetheless has grown in application in recent years.The
Initiative on
Public –Private Partnerships for Health has identified 90 PPPs
in health from 1974 to
2003.Yet, before 1990, the term ‘‘public –private partnership
’’rarely appeared in articles
abstracted by PubMed;the number currently is projected to be more than
30 per year.
Many of the most visible PPPs are globally designed, with
different partners to
address public health challenges.Some have developed into the largest
organizations
on their own such as The Global Fund to Fight AIDS, Tuberculosis &Malaria, a
Geneva-based UN-connected organization, established in 2002 to dramatically
upscale global financing of interventions against the three pandemics.The
Global
Alliance for Vaccines and Immunization (GAVI)is three-quarters financed
by the
Bill and Melinda Gates Foundation.The Drugs for Neglected Disease Initiative
was founded in 2003 by Me ´decins Sans Frontie`res and five public-sector
research
organizations —Kenya Medical Research Institute, Indian Council
of Medical
Research, Malaysian Ministry of Health, Oswaldo Cruz Foundation in Brazil, and
France ’s Institut Pasteur.
Other development agencies have catalyzed the formation
of PPPs.For example,
USAID supported PPPs that promote handwashing with soap and implement
large-
scale handwashing interventions and use lessons to promote the approach
at a global level.In addition to USAID support designed to reduce the
incidence of diarrheal
diseases in poor communities through handwashing, other organizations
that
contribute to the partnership include the World Bank, the Water and Sanitation
Program, the London School of Hygiene and Tropical Medicine, and Colgate-
Palmolive, Unilever and Proctor &Gamble in collaboration with UNICEF
and
the Bank-Netherlands Water Partnership.Partnerships have been established
in
Ghana, Nepal, Peru, and Senegal.
To accelerate the discovery, development, and accessibility
of safe and effective
microbicides for HIV, Johnson &Johnson (J&J)provided a royalty-free
license to
the International Partnership for Microbicides (IPM)to develop, manufacture,
and distribute a J&J developed microbicide called TMC120 in resource
poor countries.J&J will continue to bear the cost of the compound
through Phase II testing,
remaining active as a scientific advisor.The IPM subsequently has been
successful in
attracting the donation of intellectual property with promising compounds
from
three other major companies, Glaxo Smith Kline, Merck, and Bristol Meyers-
Squibb, and also garnered millions in support from countries and foundations.
The U.K.Department for International Development (DFID)and
the Royal
Netherlands Embassy supported a project in Tanzania aimed at addressing
malaria
through mass promotion campaigns and supporting rapid development of
a commercial distribution system for insecticide-treated nets.
Many of these programs are relatively new, with magnanimous
goals in challenging areas.It will be some time until all of these are
evaluated, with the distillation
of the critical factors for success and the promotion of such practices
for development of future activities.Nonetheless, the challenges we face
with an aging popu-
lation in a resource-constrained world continue to suggest the opportunity
for
conditions to support the creation and application of PPPs.New partnerships
to
build healthier societies and address threats such as bioterrorism and
flu pandemics
require PPPs with public authorities to develop effective responses.Other
PPPs also
could foster the knowledge diffusion from the mapping of the human genome
and
other scientific advances, along with the rapid development of new technologies
to
support drug discovery, development, and delivery from the bench to the
bedside.
In today ’s complex world, development of PPPs of
varying types with participatory governance structures, communication
with engagement of the people the project is designed to benefit, and
financing structures that can support sustainable
impact, should be a part of a comprehensive approach to advance health.
_____
Scott C. Ratzan MD, MPA, MA is Editor-in-Chief of the Journal of
Health Communication: International Perspectives. He also serves
as Vice President, Pharmaceuticals and Global Heath for Johnson &
Johnson.
