Global Perspective on PPPs (Public-Private Partnerships) in Health Promotion

By Angelina Wilson & Emily Fisher,

Contributions by Peter Delobelle and Marie Grimm

Background:

Partnership in Health Promotion “Partnership”, “alliance”, “coalition” and “collaboration” are known as key ingredients in Health Promotion initiatives across the globe. Since the Ottawa charter publication in 1986, there has been a growing interest in the need to focus on wider social determinants of health which behavioral and psychological theories could not account for (1). The immense influence of these social and environmental determinants of health has made partnership a necessary tool in addressing inequities and promoting health across and within nations.  In addition, key international documents, such as the Bangkok charter, have emphasized the importance of partnership at all levels in order to ensure sustenance of health (2).

One important type of partnership is the type of partnership fostered between the public and private sectors, known as Public Private Partnerships (PPPs). The Nairobi conference (3) emphasized the need for partnership between private and public sectors in order to promote the effectiveness of health promotion in the 21st century: this type of partnership is especially vital for Health Promotion efforts as the public and private sectors often have different resources to contribute. Although both may have different styles of contributing, when brought together properly, PPPs can bring about a sort of synergy that was not previously evident.  Synergy created from partnership is the extent to which the contribution of partners enables each of them to be creative and accountable, while simultaneously meeting the needs of stakeholders and obtaining community support (4).  Synergy creation also means that more resulted from the partnership than if each partner had worked individually. Researchers that have focused on collaborations by exploring the relationship between partnership synergy and partnership, found that partnership synergy was actually necessary for certain aspects of continued partnership functioning (5).  

Apart from sharing ideas and resources, the diversity of factors affecting health has made partnership inevitable; however, it is recognized that “inevitable” does not mean “easily implemented”, especially in the case of partnerships. Few articles have been published on the process necessary for synergy in PPPs; however, Corbin & Mittelmark (6) in their case study of the Global Programme for Health Promotion Effectiveness (GPHPE) discovered elements within this partnership process that impacted their full potential for synergy. It is therefore important to explore the factors necessary for partnership synergy to maximize our global resources for the sustenance of health systems. The focus of this article is to provide a global perspective and illustrate some practical examples on the experience of and feasibility for PPP’s.

Global Perspectives on Public-Private Partnerships:    Our first example of partnership was highlighted in the “Health Promotion Around the World” article at the beginning of this issue of Health Promotion Connection: the Voluntary Health Association of India (VHAI). VHAI and the IUHPE previously collaborated on the development of a sustainable health care system with government, public and private partnership that would be effective in today’s political, social and economic context (http://www.iuhpe.org/?page=505&lang=en). Since that project was presented in 2006, VHAI has further grown and made great strides at all levels: from community-based initiatives up to health policy decisions. Their path to success, however, has not been easy. Through their work, they have had to challenge traditional mindsets about participation: NGOs and those they serve are not simply recipients, but should be actively a part of these initiatives. Governments may not be prepared to work in concert with their communities, so facilitating this relationship is difficult, especially when the top-down approach has been preferred historically. Creating systems of accountability has also been recognized as integral to effective partnerships, but this is something not easily implemented, especially in dynamic contexts. VHAI recognizes that there is still sometimes a lack of clarity about how to best coordinate this.

Another promising initiative illustrates the efforts undertaken by the European Union to combat NCD: it is the European Partnership for Action Against Cancer (EPAAC- http://www.ecpc-online.org/health-in-eu/cancer-partnership.html). It was initiated by the EU Commission in September 2009 with the support of over 300 stakeholders. EPAAC includes various professional and multi-level stakeholders by bringing together different European Member States and their Ministries of Health, patient organisations, health professionals, scientists, private industry and civil society. EPAAC works to coordinate all areas of cancer research in the EU, from all funding sources, to identify discrepancies, obstacles and research gaps and avoid duplicating research. From the beginning, they have highlighted the importance of putting a face to the challenge and including those most affected by cancer: the patients themselves. While this is a huge undertaking, by working together on a common cause and including a diverse set of stakeholders, we are hopeful that the partnership goal of enabling effective planning and monitoring of cancer strategies throughout Europe will be achieved.  As the partnership was formally initiated in 2009, and they are a fairly recent partnership, we look forward to updates around their process and results. 

Discussion

The examples outlined above demonstrate that PPPs are valuable, possible and can occur at every level. PPP’s are essential for ensuring extensive growth and outreach of health promotion programs. This form of partnership also ensures that areas of low resources are adequately supported. For example, in the case of VHAI, the local and hard-to-reach communities have been impacted by the collaboration with foreign public and private institutions. EPAAC ensures that those potentially marginalized by cancer are given a voice within their work and a way to be empowered through their partnership process.

Even with evidence of synergy, it is important to proceed carefully with any partnership, especially partnerships involving both public and private sectors. There are many factors that could cause wasted resources, decreased productivity, or adverse effects within PPPs. The first is conflicting values and/or goals (7). While organizations can have differing overall goals, for a successful partnership everyone needs to be in agreement about what the aims of the partnership will seek to accomplish. On a day to day level, operating styles and expectations for communication between parties also often differ: in the case of the GPHPE, this was documented as a factor that reduced synergy and impacted potential results (6). In addition, private organizations may be more interested in profit than public sectors and they are also often more focused on short-term agendas, so public sectors may suffer losses when organizations in the private sector change their business strategy (7). And finally, there needs to be a systematic form of regulation that both public and private organizations in the partnership are equally held accountable to, without adding an additional, costly burden to either party (8). It is therefore important for future PPP’s to aim for partnership synergy through choosing partners who are closely aligned in terms of ethical frameworks and to clearly outline working strategies and review these strategies throughout the partnership. One future potential tool to help health promoters align and engage these separate interests might be the implementation of a professional code of ethics for Health Promotion that members of ISECN/IUHPE have already begun to develop.

In conclusion, there is no doubt that synergistic partnership is necessary for the sustenance of health systems. For partnerships to truly benefit health systems globally, we must build a more practical understanding and systematic practice in partnerships. As health promoters, we have a responsibility to aid these efforts though studying partnerships and transparently sharing positive and negative partnership lessons across all health systems. 

 One European organization to explore further:The Federal Association for Prevention and Health Promotion (“Bundesvereinigung Prävention und Gesundheitsförderung e.V.”) currently includes 128 institutions and associations working in the field of HP and prevention. Such a linking umbrella institution is of special importance in Germany, since the country is divided into 16 federal states, each with its own administration, interests, and government. The members of the association are both public and private institutions and represent a great variety of working fields, such as oral health, mental health, health research, sickness funds, sports clubs, occupational health, etc. The Association represents its members through participation in national advisory committees, working groups for the development of national action plans, and the development and implementation of national programmes for health promotion and prevention, among others. (Website in German: http://www.bvpraevention.de/ )

References

(1.) Gillies P. Effectiveness of Alliances and Partnerships for Health Promotion. Health Promotion International. 1998 Jan 1;13(2):99 -120. (2.) WHO | The 6th Global Conference on Health Promotion [Internet]. [cited 2011 Jun 8];Available from: http://www.who.int/healthpromotion/conferences/6gchp/en/index.html (3.) WHO | 7th Global Conference on Health Promotion [Internet]. [cited 2011 Aug 23];Available from: http://www.who.int/healthpromotion/conferences/7gchp/en/index.html  (4.) Lasker RD, Weiss ES, Miller R. Partnership Synergy: A Practical Framework for Studying and Strengthening the Collaborative Advantage. The Milbank Quarterly. 2001 Jan 1;79(2):179-205. (5.) Weiss ES, Anderson RM, Lasker RD. Making the Most of Collaboration: Exploring the Relationship Between Partnership Synergy and Partnership Functioning. Health Education & Behavior. 2002 Dec 1;29(6):683 -698. (6.) Corbin JH, Mittelmark MB. Partnership lessons from the Global Programme for Health Promotion Effectiveness: a case study. HPI. 2008 Dec 1;23(4):365 -371. (7.) Mattig T. Public Private Partnerships in Health promotion. Experiences, Opportunities, Readiness [Internet]. In: workshop: the benefits and risk of public private partnerships (PPP) in public health. Geneva: IUHPE; 2010. Available from: http://www.iuhpeconference.net/downloads/en/Programme/PDFs/Broesskamp-Stone-Ursel.pps.pdf (8). Corbin, J. H. and Mittelmark, M.B. (2006). Public Private Partnerships in European Health Care. Health for the Millions, 32 (6 & 7), 23-28. (9.) Brundtland, G., Address to the fifty-fifth World Health Assembly, Geneva, 13 May 2002.

Published August 2011

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