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Abstract
The growth of global public-private partnerships for health has opened up new spaces for civil society participation in global health governance. Such participation is often justified by the claim that civil society organizations, because of their independence and links to communities, can help address democratic deficits in global-level decision-making processes. This article examines the notion of ‘civil society engagement’ within major public–private partnerships for health, where civil society is often said to play a particularly important role in mediating between public and private spheres. How do major global health partnerships actually define ‘civil society’, who represents civil society within their global-level decision-making bodies, and what formal power do civil society representatives hold relative to other public and private-sector partners? Based on a structured analysis of publicly available documents of 18 of the largest global public–private partnerships for health, we show that many of them make laudatory claims about the value of their ‘civil society engagement’. Most use the term ‘civil society’ to refer to non-governmental organizations and communities affected by particular health issues, and state that they expect these actors to represent the needs and interests of specific populations in global-level decisions about strategies, funding models and policies. Yet, such civil society actors have a relatively low level of representation within the partnerships’ boards and steering committees, especially compared with private-sector actors (10.3 vs 23.7%). Moreover, there is little evidence of civil society representatives’ direct and substantial influence within the partnerships’ global-level governing bodies, where many decisions affecting country-level programmes are made. Rather, their main role within these partnerships seems to be to implement projects and advocate and raise funds, despite common discourses that emphasise civil society's watchdog function and transformative power. The findings suggest the need for in-depth research into the formal and informal power of civil society within global health governance processes.
Highlights
The growth of governance beyond the nation state has been described as ‘one of the most distinct political developments of the past half-century’ (Bexell et al, 2010, p. 81)
Almost all of the 18 partnerships surveyed refer to the term ‘civil society’ on their websites and in official documents, and all of them describe some level of engagement outside the strictly public or for-profit private sectors
Only the Global Fund explicitly defines the term ‘civil society,’ specifying that it designates all those stakeholders who are neither government bodies nor private sector enterprises: groups such as non-governmental organisations, advocacy groups, faith-based organisations, networks of people living with the diseases, and so on (Global Fund, 2017a)
Summary
The growth of governance beyond the nation state has been described as ‘one of the most distinct political developments of the past half-century’ (Bexell et al, 2010, p. 81). There is a long history of philanthropic and civil society involvement in health (Birn, 2014), the role of non-state actors including private philanthropy, corporations, and civil society organizations has accelerated and expanded since the late 1990s Such actors operate alongside or as part of a dizzying array of public–private partnerships that address specific global health challenges through joint decision-making among multiple partners from the public and for-profit and nonprofit private sectors (Buse and Harmer, 2007). Global public–private partnerships for health have gained traction over the past two decades, enabled by the rising influence of private philanthropic power (notably the Bill & Melinda Gates Foundation) and the incursion of a business-oriented ethos throughout the field of global health (Birn, 2009) Today, these partnerships address global public health challenges ranging from HIV/AIDS to road traffic accidents, malnutrition and lack of access to vaccines and other health commodities. In the early years of partnerships like the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, Buse and Harmer (2004, p. 49) noted that:
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