Global Health Needs More Strange Bedfellows, Unorthodox Partnerships

t used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.
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In Tanzania, motorcycle taxi drivers learn about road safety and HIV prevention in a public-private partnership involving the private sector, local police and health officials, civil society and government.

In Tanzania, the non-profit group IntraHealth International works with a cotton gin to provide circumcision services to their male employees and collaborates with local police to bring together 400 motorcycle taxi drivers to learn about road safety and HIV prevention. Both projects are funded by the U.S. Centers for Disease Control and Prevention.

The African Christian Health Associations Platform, based in Kenya, is working with Novo Nordisk and Johnson & Johnson that provide Christian health associations in several countries with technical support, training and drugs to combat diseases like diabetes, HIV and opportunistic infections.

Those are examples of an increasingly common approach to development. It used to be that a donor would sit down with the ministry of health to work out the design and implementation of a new global health initiative, with no significant input or involvement of other stakeholders. Those days, thankfully, are long gone.

Nowadays, it's widely recognized that more stakeholders need to be consulted, both in the design and the execution of an intervention. Does this make the process more messy and complicated? It sure does, but this messiness is essential to take global health to the next level.

We've made a lot of progress over the last dozen years. We are on the brink of eradicating polio. Thirty-nine countries have decreased their HIV incidence by 26% or more between 2001 and 2011. And we've seen falling rates for infant and maternal mortality. The U.S. Agency for International Development has just announced that it is realigning $2.9 billion of its resources to save up to half a million children from preventable deaths by the end of 2015.

But we need to up our game. And to do that, we need all hands on deck -- the private sector, faith-based organizations, universities, research institutions, youth, women and community-based organizations. We need strange bedfellows engaging in unorthodox collaborations.

Too often, global development professionals are distrustful of these new partners and don't invite them to the table. Or they invite them to the table but don't listen to them. Or they listen to them but don't act on their concerns.

At the World Health Assembly in 2011, World Health Organizations Director-General Margaret Chan announced that WHO had been totally exonerated from charges that it had fabricated the 2009 H1N1 influenza pandemic in order to benefit the pharmaceutical industry. Many people in global health are still wary of companies that want to tackle non-communicable disease.

That was three years ago but many of these biases persist. At the 2014 World Health Assembly, a hotly debated resolution was on how WHO should engage with non-state actors, including NGOs and the private sector. "We're not doing this for the money," said Dr. Chan earlier this year, in reference to WHO's collaboration with for-profit companies. But suspicions remain.

Similarly, some global health professionals have a certain wariness about the role of faith-based organizations (FBOs) in global health, especially those that work in sexual health, like HIV and family planning. Yet I know for a fact that many FBOs are actively promoting family planning, and could do even more if given the resources.

This spring, I attended a most unusual conference, called SwitchPoint, in the small former mill town of Saxapahaw, North Carolina. SwitchPoint is, in some ways, the antithesis of this pandemic of collaboration suspicion. It's trying to tear down walls and silos and bring together unlikely partners in global development.

The speakers were a mix of entrepreneurs, implementers and philanthropists. I attended one session entitled "Vaccines and Microbrews," featuring a biochemist and a couple of microbrewers talking about the commonalities of vaccine development and making a better brew.

Ken Banks, author of The Rise of the Reluctant Innovator, is all about disruption and creative collaboration. In his talk at SwitchPoint, he was dismissive of traditional aid ("In 60 years, we have spent $3 trillion on traditional aid. Do you think we had had value for that money if you look at where things are today?") and celebrated what he calls the Lone Rangers, hackers, fixers and disruptive social entrepreneurs and reluctant innovators of the world.

"The people who are working outside the system -- the health care workers, the farmer's cooperatives, the human rights activists -- they're just getting on and doing stuff," Banks said. "I love people like that. There's no reason why you can't just get on and do stuff."

Public-private partnerships (PPPs) are one increasingly common manifestation of this collaboration. A PPP is a government service or private business venture that is funded and operated through a partnership of government and one or more private sector companies. A survey cited in a recent PSI blog reported that 85% of respondents said PPPs will be important to the development of more effective health interventions in the next 5-10 years.

Michael Bzdak, director of corporate contributions at Johnson & Johnson, is a huge fan of PPPs, but also sounded a note of caution. "If there's one thing I want you to remember, it's to be cautious about entering into a partnership. Make sure your voice is heard, that your issues are on the table and that everything is not being directed by someone else, like a funder."

"Shared value" is a sometimes criticized component, originally penned by Michael E. Porter and Mark R. Kramer in the Harvard Business Review to describe the relationship between businesses and societies. "For these partnerships to work," said Bzdak, who also has written about the concept, "you really have to start not with shared value, but shared values."

IntraHealth President Pape Gaye agrees. "All of our outside-the-box partnerships start by looking at what we value as an organization, and finding individuals and communities of people who get it."

Getting together a bunch of strange bedfellow to tackle the biggest health and development challenges of our day? "Shared values" seems like a good way to start the conversation.

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