Why haven’t we achieved health for all yet? Forty years ago, the global health community committed to achieving primary health care for all by 2000. But today, about half of the world’s population still does not have full access to essential health services.
Could public-private partnerships finally get us there? Last month at the Africa Health Business Symposium (AHBS) in Johannesburg, an annual event we helped sponsor, hundreds of health ministers, government officials, business representatives and health-sector stakeholders and investors from across Africa came together to discuss this.
But I left chewing on a different question: How do we move from small- and mid-scale pilot partnerships between the public and private sectors to big, collaborative impact on global health?
In Johannesburg, Dr. Aaron Motsoaledi, minister of health in South Africa, explained there’s no medical school textbook that teaches students one treatment protocol for rich people and another for poor people. Yet, in practice, due to inequities in reach and service quality, this is what happens. It was true in 1978, it was true when we set the Millennium Development Goals (MDGs) and it’s true today, as we work toward the Sustainable Development Goals (SDGs).
So, why are we chasing a future that never comes? Our global agendas have led to fantastic progress since the 1978 Alma-Ata Declaration, yes, but the idea that our grandchildren might sit here 40 years from now and have this same conversation is unacceptable. We need to continue planning for the future. But we also need positive, on-the-ground disruption to accelerate progress today. Can the private sector offer that disruption?
For the past 40 years, we’ve tried to reach our health goals mostly by advancing in our own sectors or trying out partnerships on a project-by-project basis. At IntraHealth International, we’ve worked with the Novartis Foundation and corporations in Dakar to combat hypertension. In Kenya, the Afya Elimu student loan mechanism is a great example of sustainable, cross-sector collaboration that is keeping health worker trainees in school.
But where are the efficient, productive, large-scale solutions to public health in Africa that public-private partnerships could offer? Two things are stopping us: risk and trust.
Risk And Trust
The public and private sectors eye each other as risky bedfellows. In Johannesburg, both sides spoke frankly about their concerns and hopes.
On the public side, there’s an aversion to the idea that companies should profit on the health of people, particularly on the health of poor people. Will private companies ruthlessly put revenue above all else, including quality and social equity? Will those who can afford them continue getting high-end services while those who can’t are left farther behind? Will wealthy corporations wield too much power? And what about the time and resources it takes simply to vet and select the partnerships that could succeed and scale?
On the private side, we heard about how slow and bureaucratic the public sector can be, how it can stifle innovation, reward incompetence and even harbor corruption. While the public sector might dangle promises of scale, it is also known for challenges that can reduce profitability — politics, evolving regulatory environments, financing mechanisms and so on. Any given election can turn a once favorable environment for collaboration into a hostile one.
We talk a lot about how the two sectors are different and what we have to lose. But we don’t talk much about our common ground and how we can manage and mitigate risks to select and nurture the “right” partnerships. In fact, we don’t spend enough time talking to each other at all.
There is a burgeoning body of research already shedding light on risk mitigation and facilitating environments for partnerships in the health sector in low- and middle-income countries. Partnerships can be set up to pool risks and meet the needs of all parties.
With the right due diligence and dialogue, we can design partnerships that level the playing field between those who have the money and resources and those who have the reach.
Who’s In The Driver’s Seat?
One thing I heard over and over from health ministers and others at AHBS is that country governments need contextualized solutions. They aren’t looking to implement the global agenda or a company’s latest innovation, they’re looking to meet the health needs of their citizens. They also want the global community to learn from their experiences — in fact, they are a bit tired of what they perceive as the persistent one-way flow of information. They want to drive.
And from private-sector companies, I heard a lot of enthusiasm and know-how. They want to invest and start moving. They are impatient with bureaucracy and know how to get things done. They want to drive.
NGOs: The Catalyst For Better Dialogue And More Action
There’s a role here for local, regional and international NGOs to be the catalyst for better dialogue and more action between the public and private sectors. We know public health sectors. We know the stakeholders to engage. We also know how to evaluate and engage private partners. We can help busy governments evaluate potential partnerships. We can be part of the risk mitigation strategies governments employ to ensure the balance of power doesn’t always shift to the partner who brings the most money, or that if a private-sector solution fails, we learn from it and move on. And if it works, it moves forward faster.
I’m hoping that at next year’s AHBS, we’re not still talking about potential risks, but rather learning from the collaborations and investments that were seeded last month in Johannesburg. And after the global community descended on Astana for the Global Primary Health Care Conference in October, I hope multilateral agencies, donors, private-sector actors, government representatives and country-level voices can continue the honest dialogue that builds the trust we need to succeed.