A Donor Perspective

Abstract

Public-private partnerships in health have to be seen in wider economic and political contexts, usually set by domestic agendas in the West. These agendas have frequently been driven by ideology, but more recently the debate has centred on exploring new ways of funding and improving the performance of traditional public sector activities. In the UK and elsewhere, examples include partial privatization of state infrastructure such as rail transportation, private financing initiatives for the construction of hospitals, and the private management of poorly performing schools. Inevitably, similar thinking has entered the health and development field. Classically, development funding has been seen either as a public good or as a philanthropic endeavour. Support has been channelled through governments to public health systems and care, or through nongovernmental organizations that operate in a similar framework. Some of the great achievements in public health, such as the development of vaccines for polio and other diseases, have been based on public funding. Drugs developed with private funding have been made widely available as international public goods. In recent times public funding for research and development (R&D) concerned with diseases of the developing world has declined, as has overall official development assistance. Development assistance for health, however, has actually increased in real terms by as much as 3% per annum. As a response to these changes, public-private partnerships in the population and health sector have expanded in recent years. This has been partly to mobilize additional resources, and partly to build a new political framework for working with the private sector on traditional public service provision. But more important than either is the recognition that health and development are part of the globalization agenda. They now hit the radar screens of world leaders, the G8 discussions in Okinawa and Genoa being the most recent example. The three main focuses of collaboration are products, outcomes, and activities within countries. Regarding products, efforts are being made to increase investment in new drugs and vaccines, in the face of decreased emphasis on R&D for diseases of importance to the poor. Public funding, tax credits, current and advance purchase funds are among the incentives being developed. Examples include the Medicines for Malaria Venture (MMV), a partnership which brings together the pharmaceutical industry with its expertise in drug development and the public sector with its expertise in science and fieldwork. The mission MMV has set for itself is to discover, develop and commercialize antimalarial drugs at prices that are affordable to the populations worst hit by the disease, at the rate of one new product every five years. …