Editorial
Public–Private Partnerships for Health
SCOTT C. RATZAN
The twenty-first century heralds most health and social services predominately pro- vided 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 implemen- tation 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 develop- ment 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
Scott C. Ratzan, MD, MPA, is Editor-in-Chief of theJournal of Health Communication:
International Perspectives. He also is Vice President, Pharmaceuticals and Global Health, Government Affairs & Policy for Johnson & Johnson.
Journal of Health Communication, 12:315–316, 2007 Copyright#Taylor & Francis Group, LLC ISSN: 1081-0730 print/1087-0415 online DOI: 10.1080/10810730701331739
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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 coun- tries. 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 com- mercial distribution system for insecticide-treated nets.
Many of these programs are relatively new, with magnanimous goals in chal- lenging 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 develop- ment 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 participa- tory governance structures, communication with engagement of the people the pro- ject is designed to benefit, and financing structures that can support sustainable impact, should be a part of a comprehensive approach to advance health.
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