A role for publicprivate partnerships in controlling neglected diseases?
Robert G. Ridley1
Publicprivate partnerships mean different things to different people, depending on the values of the individuals and organizations concerned. They raise numerous political, social, public health, economic and commercial issues. Partnerships formed to promote product research, development and access, however, can only work effectively if the collaborating organizations have a common goal, however their values may differ.
In developed economies, members of the public and private sectors are continually discussing shared concerns, often through well-defined structures. Despite tension, a modus operandi has emerged whereby legislative, market and societal forces can operate to accommodate the needs of both sectors. This can result in a sustainable balance of power and flow of resources and rewards while generating wealth that leads to progress in health.
In many developing economies, however, a sustainable balance of this kind does not exist. It is widely believed that in addition to national inputs, external resources will be required if health is to be improved. External resources can come through donor governments, international organizations, philanthropic foundations, nongovernmental organizations and the private for-profit sector. The underlying question about investment for health in developing countries is: who has what responsibilities and obligations? Closely related is the issue of the power of developing countries in relation to that of other stakeholders in defining the goals, values and mechanisms of the partnerships.
The situation today is perhaps more promising than ever before in terms of the political will to mobilize resources to reduce global health inequities. Publicprivate partnerships are increasingly being explored as a mechanism to meet the needs involved, and this has given rise to much debate. In addition to the general questions above, the following more specific ones arise. First, regarding appropriateness: when, if at all, are publicprivate partnerships necessary and desirable? Second, regarding trust: can goals be clearly distinguished from values as an aid to dialogue? Should differences in values ever preclude cooperation or partnership? How best can trust be generated when potential stakeholders differ sharply on values? Third, regarding risks and benefits: what are they for each party involved in a public private partnership? What operational value can each contribute to such a partnership? What special role can it play?