The public-private partnership for the Central American handwashing initiative: reflections from a private sector perspective.

Abstract

Collaboration among the public sector, non-governmental organizations (NGOs) and commercial enterprises in the form of public–private partnerships (PPPs) to pursue health goals is not entirely new (Van der Gaag 1995). The formation of partnerships between private donors and recipient countries dates back to at least 1969 (Buse & Walt 2000). Progress towards the control of onchocerciasis (Blanks et al. 1998), trachoma (Wehrwein 1999) and lymphatic filariasis [World Health Organization (WHO) 1999a] may not have been possible without the dedicated participation of NGOs and private pharmaceutical companies. But while most governments and governmental organizations have now become comfortable with the role of private sector participants as distant donors of essential drugs (Adetokunbo 2000), this was achieved only after considerable angst, and ultimately the careful negotiation of a set of international guidelines concerning drug donations (WHO 1999b). Moreover, the increasing involvement of the private sector in health care initiatives was largely forced on the public sector. Faced with declining public resources, with the growing influence of the World Bank and other financial institutions on international health care, with ever more wealth accumulating in private sector hands and with the almost universal celebration of privatization initiatives, WHO and many of its national counterparts have been forced to accept the private sector as a necessary participant in pursuing their health care agendas. Thus, it should be expected that this apparent enthusiasm for embracing the private sector would be tempered by years of scepticism, and even suspicion, about the agenda of commercial enterprises in basic health care. Veterans at the WHO and the United Nations Children’s Fund (UNICEF) will be quick to cite the infant formula fiasco of the 1970s as an example of how private companies can co-opt local health authorities and disguise their self-interests under the cloak of enlightened public charity. Accordingly, while WHO has promoted ‘partnerships among public bodies, civil society and the private sector’ as ‘key components of the WHO Health for All policy for the 21st century’ (Kickbusch & Quick 1998), it is perhaps natural that the public stewards of health promotion will be inclined to move slowly and cautiously, to set strict rules and limits on private sector participation, to offer few if any economic incentives and to take special steps to ensure that they cannot be accused of favouritism, especially for large companies over small and foreign companies over local. The resulting context for the partnership – which prospective private sector participants perceive as an unnecessarily slow organizational pace, excess regulation, absence of government commitment and lack of competitive advantage – can be completely antithetical to the opportunistic environment in which the private sector thrives. The public–private partnership for the Central American Handwashing Initiative (CAHI) illustrates some of the areas of friction between public and private sector participants in these expanded health partnerships. This editorial examines some of these areas from the perspective of the private sector. Its purpose is to help illustrate the private sector preferences and identify options that may minimize some of the obstacles that these alliances face in their organization and long-term sustainability. Tropical Medicine and International Health