[José Cerezo is student at the ISGlobal-UB Master of Global Health]
The term “Private-Public Partnership” was popularized during the 1970s as a result of the rise of neoliberalism
Although interactions between the public and the private sector have been around for millennia, the term “Private-Public Partnership” (PPPs) was popularized during the 1970s as a result of the rise of neoliberalism. Nevertheless, it was not until the late 1990s, with the impetus of economic globalization, when they began to be used in the United Nations system after the reform carried out by Kofi Annan.
As far as the WHO is concerned, the years of the Gro Harlem Brundtland administration (1998-2003) meant a flourishing of PPPs and Product Development Partnership (PDPs) in the organization and in other international health initiatives. The lack of credibility along with the economic problems encountered by the WHO, were the main drivers of this process. It was at this time that PPPs such as the Roll Back Malaria Partnership or The Global Alliance for Vaccines and Immunizations (GAVI) emerged, among many others initiatives.
Despite the outstanding achievements during the last two decades, including the millions of lives saved, remarkable drawbacks have been brought to the table when PPPs have been subjected to scrutiny.
PPPs contribute to skew the health priorities of the recipient country
In first place, they contribute to skew the health priorities of the recipient country since the PPP objectives are frequently prioritized, undermining the country´s capacity and motivation to set its own health agenda. PPPs rely on vertical programmes focused on specific diseases or groups of patients and on short-term results, frequently overlooking more significant needs which demand a more comprehensive, long-term response. Moreover, the poor harmonization and the lack of coordination between the different PPPs lead to duplication and waste of resources and to the establishment of parallel donor-driven health systems. This creates an overwhelming situation where weak national health systems can’t compete with PPPs, discouraging them to take responsibility towards their citizens. This situation is intolerable since it doesn´t contribute to the self-sufficiency of the developing countries.
Another hazard of the PPPs is the conflict of interests in which they may incur since commercial and public interests are not always aligned
Another hazard of the PPPs is the conflict of interests in which they may incur since commercial and public interests are not always aligned. This is evident when it comes to the Pharmaceutical or the Food industry. In the case of the PDPs, problems like lack of transparency of the Pharma setting prices, or the patentability of the products developed under them, have arisen. Given the enormous problem of access to medicines that the world is facing, allocating public resources to promoting alternatives to the current R&D system such as the “Global Framework of Research and Development” instead of reinforcing the role of the pharmaceutical industry, seems more ambitious from a global health perspective.
Besides, many authors have expressed serious concerns about the lack of accountability and transparency, and have denounced poor governance mechanisms within the PPPs. In addition, some studies highlight that claiming that PPPs reduce costs and are more efficient in delivering services, is more based in ideology than in scientific evidence.
The progressive transfer of public funds towards the private sector under the PPPs, has undermined democracy, jeopardized the sovereignty of the international community and compromised the credibility of the WHO; it has legitimized the corporate sector to shape the global health agenda participating in the priority setting. This has been by far the worst legacy that two decades of PPPs´s hegemony have left us.
The ambitious Sustainable Development Agenda ahead us regarding health requires a strong, empowered, well-founded, independent and committed WHO acting as a global health leader. The focus should be on strengthening health systems enabling countries to the Universal Health Coverage achievement. Moreover, there´s a need for the establishment of regulatory frameworks to prevent human beings from the negative effects that climate change, unhealthy food and alcohol have in our health. Taking into account the nature of these challenges, PPPs are not the most suitable vehicle to carry out this task, being necessary to find other ways to confront them based on the empowerment of the civil society, states and the international community.