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Partnerships – Working Together to Achieve Health for All Chapter 2

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Partnerships – Working Together to Achieve Health for All Chapter 2 Chapter 2 Partnerships – working together to achieve health for all Equality (Boniface Nzimy) Key points ■ Improving the health of the people, including health security, is dependent on good partnerships between communities, providers, organizations carrying out interventions, governments, technical agencies and international partners. ■ The number of initiatives and the multiplicity of actors involved in health development in the Region have increased, leading to a bigger share of external resources in total health expenditure. ■ Countries have been setting compacts (negotiated and signed time-bound agreements in which partners commit to implement and uphold the priorities defined in a country health strategy), which has optimized the gains from health partnerships. ■ An increasing number of initiatives aggregate around issues, themes or diseases rather than on more comprehensive approaches to health, such as health systems development. 2. Partnerships – working together to achieve health for all Good health is a complex state and achieving it requires much more than just one or two simple interventions, but an integrated range of preventive strate- gies; environmental changes; therapies and technology to diagnose and treat ill health; and provision of opportunities for those who need health care to access it. Making this happen effectively is dependent on good partnerships between communities, providers, organizations carrying out interventions, governments, technical agencies and international partners. Given the substan- tive proportion of external resources on health as a percentage of total health expenditures (Fig. 2.1), the number of initiatives and the multiplicity of actors involved in health development in the Region, coordination and harmonization of effort is essential to avoid waste and target real needs. This chapter looks at partnerships that operate in the Region to answer the question “what works?” Few successful health initiatives now depend on a single organization and, as a result, partnerships functioning in the Region have multiplied. A variety of names used to describe them have sprung up, for example “partnership”, “alliance”, “network”, “programme”, “project collaboration”, “joint (advocacy) campaign” and “task force” all describe partnerships of one form or another. The term “partnership” is often – and misleadingly – used to describe a vari- ety of relationships such as sponsor or international partner relationships and the traditional exchange of goods or services for money. In this chapter we use a more narrow definition of “partnership”, using it to describe the relation- ship between individuals or groups characterized by mutual cooperation and responsibility towards achievement of a specified health-related goal. Partnerships in the health sector encompass a wide range of organizational structures, relationships and collaborative arrangements, from formal, legally incorporated entities to more informal collaborations without independ- ent governance arrangements. The nature of the participating partners also varies, but they are usually intergovernmental organizations (e.g. Economic Community Of West African States [ECOWAS], Southern African Develop- 19 The health of the people: what works Fig. 2.1. External resources on health as a percentage of total health expenditure in the WHO African Region, 2012 < 20% 20–40% > 40% No data Cabo Verde Comoros Mauritius Sao Tome and Principe Seychelles Source: adapted from World health statistics 2014. Geneva: World Health Organization; 2014. ment Community [SADC], Economic Commis- The existing partnerships work on different sion for Africa [ECA], bilateral (e.g. Department aspects of the health sector using varied modes for International Development [DFID], Japan of intervention. Some of them are targeted at International Cooperation Agency [JICA], specific diseases, such as AIDS, tuberculosis, United States Agency for International Develop- malaria and immunization, as well as mater- ment [USAID], Norwegian Agency for Interna- nal and child health. Others are working on tional Development [NORAD]) and multilateral different aspects of health systems, for exam- institutions (e.g. United Nations agencies, the ple health information systems, drug supply, African Development Bank [AfDB], the World human resources, etc. With regard to the mode Bank), public sector entities, nongovernmen- of intervention used by partnerships, there are tal organizations, foundations (e.g. the Bill & funding partnerships, technical cooperation, Melinda Gates Foundation), academic and/or policy and strategic dialogue partnerships, research institutions, the commercial sector and advocacy and joint ventures. Some partner- civil society. Sometimes certain United Nations ships have been initiated at global level while agencies create joint programmes, which may or others have been established at the regional or may not involve other stakeholders. country level. 20 Chapter 2 Partnerships – working together to achieve health for all In the last decade, global health partner- neglect. However, the proliferation of such part- ships – the biggest being the Global Alliance for nerships (there are an estimated 75–100 global Genomics and Health (Global Alliance) and the health partnerships) has led to greater complex- Global Fund to Fight AIDS, Tuberculosis and ity and significant transactional costs, such as Malaria (Global Fund) – have provided substan- an increased reporting burden for health staff at tial funding to support health programmes in both national and district level. Africa (Table 2.1). Global health partnerships To address these challenges, several mecha- have mobilized important new resources for nisms and initiatives have been put in place at major health threats, and brought much needed global and regional levels and some of them aim political and technical focus to priority diseases to change and reform existing institutions for and interventions. They have injected new energy more effective partnerships. They include: into the aid architecture by supporting the pri- ■ United Nations Reform. Since the late vate sector and civil society to play a more prom- 1990s, the United Nations System has been inent role in the matters of health development. implementing reforms to work in a more However, there are concerns that the increas- unified manner and deliver more effec- ing number of initiatives aggregate around issues, tively at country level in the Delivering as themes or diseases rather than on more compre- One initiative. The Region is fully involved hensive approaches to health, such as health sys- in the Delivering as One initiative, which tems development. This has increasingly become initially included four pilot countries very difficult for countries to manage and fur- (Cabo Verde, Mozambique, Rwanda and ther complicates international partners’ harmo- the United Republic of Tanzania) that have nization efforts at the global level and alignment now been joined by an increasing number with national systems and priorities. of countries in the Region. The United In particular, there is a risk that global Nations Development Assistance Frame- health partnerships may intensify the financ- work is recognized as the main instrument ing of vertical programmes by focusing large for United Nations reform at country level amounts of new funding on specific, relatively and all countries of the Region are fully narrow programmes and interventions, leaving involved in the roll out or implementation national governments little flexibility to real- of the Framework. locate funds according to their priorities or to ■ Focus on MDGs. Along with the launch boost health systems’ capacity. Beyond the inter- of the United Nations Secretary-General’s national partners’ priorities, some of the most MDG Africa Initiative to mobilize financ- significant challenges facing partnerships in the ing and accelerate achievement of the Region include legislative frameworks, policies MDGs, Focus on MDGs has created a plat- and operational strategies, and sustainability. form to engage, at the country level, with Legislation that governs public–private partner- government entities and local stakeholders. ships is often absent and as a result partnerships ■ The Paris Declaration on Aid Effective- may work in isolation. Some partnerships do ness (2005) and the Accra Agenda for not appropriately ensure that partners are held Action (2008). These mechanisms aim to accountable for the delivery of efficient, effective achieve sustainable development by focus- and equitable services. Furthermore, the ques- ing on five principles: country ownership; tion of national capacity-building and long-term alignment; harmonization; management for sustainability is often ignored. results; and mutual accountability. The original purpose was to simplify the aid ■ Harmonization for Health in Africa architecture, focusing aid on areas of perceived (HHA), formally established in 2006, is 21 The health of the people: what works Table 2.1. Examples of global partnerships and initiatives actively involved in health programmes in the WHO African Region Partnership Purpose Global Fund to Fight AIDS, Tuberculosis Established in 2002, the Global Fund is an international public–private financing and Malaria (Global Fund) mechanism rather than an implementing agency. However, the Global Fund part- ners with countries and implementing agencies to improve health outcomes. For example, in 2005, the Global Fund joined other partners
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