Public-Private Partnerships in Global Health: Addressing Issues of Public Accountability, Risk Management and Governance
2012; SPAEF; Volume: 36; Issue: 2 Linguagem: Inglês
ISSN
2327-4433
Autores Tópico(s)Community Development and Social Impact
ResumoINTRODUCTION Collaboration between organizations in different sectors of the economy is not a new development, but it has become increasingly dominant in the discourse on public sector reform (Wettenhall 2003). Partnerships between government and organizations in other sectors of the economy are now accepted as a promising way of generating new opportunities to leverage financial, human, and technological resources that will not be available if government goes it alone (Bovaird 2004, Savas 2000, O'Looney 1992, Linder 1999, Rosenau 2000). Globalization and advances in technology require and enable governments to adapt to changing realities through innovative types of initiatives in the form of partnerships (Kinnock 1998, Bovaird 2004, Halachmi 2010b). Public-private partnerships (PPPs) have often been touted not only for their ability to increase efficiency and quality, but also for enhancing effectiveness, transferring or sharing risk, promoting coordination, and expanding resources for the attainment of goals that are in the public interest (Wettenhall 2003, Linder 1999; Halachmi 2010a). While PPPs hold much promise, they are not without their challenges (Hodge and Greve 2005). Issues surrounding public accountability, risk management, and governance must be considered before passing judgment on the success of any given project that is implemented as PPPs. Understanding the nuances of PPPs requires mobilization of theoretical frameworks and models from several disciplines. Some of those are likely to address issues such as management practices, organizational structures, strategic planning or governance. Others are more likely to be closely related to the substantive nature of the PPPs, e.g., development of a transportation infrastructure, water system, health-related projects, etc. With growing demands for health services and stagnation, if not deterioration, in the availability of resources, it is not surprising that increased attention has been focused on PPPs. Yet, it seems that most researchers have elected to use insights and conceptual frameworks common in public health and few have incorporated theoretical frameworks from the social sciences. The purpose of this paper is to contribute to the needed effort to address this gap in the literature on PPPs in global health. Such a contribution, in turn, would be expanding our understanding of PPPs in general and bridging the divide between theory and practice in the fields of global health and public administration. The paper starts with a brief review of the literature on public private partnerships in global health, followed by an exploration of the relevance of PPPs in that context. The promise, potential and challenges associated with PPPs are illustrated through examples of partnerships in global health, where particular emphasis is placed on strategies for public accountability, risk management, and governance. The paper concludes by suggesting a possible direction for future research on PPPs. THE ROLE OF PUBLIC-PRIVATE PARTNERSHIPS IN GLOBAL HEALTH In the United States, thousands of partnerships have developed around health, fueled by investments of hundreds of millions of dollars from both governmental and non-governmental sources (Lasker, Weiss and Miller 2001: 179). According to the Initiative on Public-Private Partnerships for Health (2011) there has been an expansion of PPPs in global health since the mid-1990s. The current estimate is that there are around eighty such partnerships operating at the international level. Arguably, PPPs have become an essential part of the global health landscape (Reich 2002, Buse and Walt 2000a, Buse and Harmer 2004 and 2007, Brown et al. 2006). There is a growing recognition that today's complex health challenges cannot be tackled by a single sector of the economy be it the public, private, or non-profit (Reich 2002). The attractiveness of PPPs is its promise, as a strategy, to leverage the advantages of each sector in order to achieve a better end result (Rosenau 2000). …
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