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Developing Public-Private Partnerships to fight HIV/AIDS, Tuberculosis and Malaria A practical guideline for private companies


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DEVELOPING PUBLIC-PRIVATE PARTNERSHIPS TO FIGHT HIV/AIDS, TUBERCULOSIS AND MALARIA A practical guideline for private companies

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The framework and contents of the guideline are illustrated below.

Preliminary step

Other options

Is setting up a PPP the right form of engagement for my company?

No

- Donor - Contributor - Partner

Yes Step 1 Problem analysis: What is the impact on my company?

Step 6 Evaluation and scale up or exit

Step 2 Thorough feasibility study

Step 5 Implementation of the PPP structure

Step 3 Appointment of a driver

Step 4 Design of the PPP structure

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MANAGEMENT SUMMARY In recent years, the number of Public Private Partnerships

process involved. If much has been written about the

(PPPs) addressing public health concerns and particularly

contents of PPP programs in the past, less attention has

the three communicable diseases of HIV, Tuberculosis

been paid to the PPP development process. This innovative

and Malaria in resource-poor settings has increased

guideline aims to address this gap by focusing on the PPP

exponentially. The past years have witnessed the growing

structure.

involvement of the private sector in the public health arena mainly as a result of the development of the

In view of the increasingly central role played by the private

Corporate Social Responsibility (CSR) concept. In a parallel

sector in initiating public health PPPs, this publication is

fashion and partly through realizing their limitations in

dedicated to providing private organizations with the right

an increasingly pressuring context, public actors have

tools to set up PPPs while ensuring they can realize their

become more and more open to partnering with private

full benefits.

actors by supporting corporate initiatives contributing to development issues.

This guideline will firstly assist private organizations willing to set up PPPs to address HIV/AIDS, TB and Malaria

PPPs can greatly contribute to addressing development

by providing a quick scan assessment tool to evaluate

issues and to supporting a private organisation’s

whether setting up a partnership is indeed the right

engagement. Through mutual contributions in knowledge,

decision. The guideline will also open the way for other

know-how and financial resources, PPPs reallocate risks

forms of engagement if the development of a PPP is not

and rewards as well as responsibilities and ownership

found to be appropriate.

among partners and, when successful, a well thought-out PPP can help a company roll out its CSR Health Plan while

Secondly, and if identified as the best vehicle for your

resulting in multiple benefits such as raising the company’s

company, the guideline will provide you with practical

reputation and among others, mitigating financial risks.

tools and real-life examples to guide you through the PPP lifecycle and assist you in identifying the best

PPPs are not a magic potion and experience has shown

suited collaborators and partners every step of the way.

that their success greatly depends on a multitude of

Identifying and establishing collaboration with the right

factors linked to the development process and structure

external parties is an essential factor to the success of any

of the PPP. If some examples constitute major successes,

public private partnership and this is all the more relevant

others turned out to be costly and time-consuming and

when it comes to those addressing public health issues.

eventually failed either because a PPP was not the right instrument to achieve the company’s goal or because the

Through the use of real-life cases, the authors of

implementation strategy followed was not appropriate.

this guideline will demonstrate how their experience and competencies can support private organisations

Setting up a successful PPP requires careful consideration

throughout the PPP lifecycle.

and a thorough understanding of the complexity of the

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Table of contents Acronyms and abbreviations

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Acknowledgements

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Introduction

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12 Setting the scene 12 Public-private partnerships, a definition 13 Background in which PPPs emerged 16 17 18 21

Considerations before setting-up a PPP

The company’s internal situation

Enabling environment

Preliminary step

How? Major steps in the PPP development process

Step 1: Problem analysis: What is the impact on my company?

Step 2: Thorough feasibility study

Step 3: Appointment of a driver

Step 4: Design of the PPP structure

Step 5: Implementation of the PPP program

Step 6: Evaluation and scale up or exit

Cases

Case 1 - Congolaise industrielle des bois (CIB)/Danida - the Republic of Congo

Case 2 - Chambre des mines de Guinée - Guinea

Case 3 - Groupement de la filière bois du Cameroun - Cameroon

Case 4 - Bophelo! – Namibia

Case 5 - North Star Alliance

Case 6 - Heineken Brarudi – Burundi

Case 7 - Health Insurance Fund

How can partners play a role?

PharmAccess’ assistance to private and public sectors in developing PPPs

Partners Against AIDS (PCS) and SIDA-ENTREPRISES

24 25 25 26 27 29 30 34 35 36 37 38 39 40 41 42 42 44

Bibliography

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Annex 1: Directory of Multilateral and Bilateral Agencies

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Annex 2: Case Studies

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ACRONYMS AND ABBREVIATIONS AIDS

Acquired Immune Deficiency Syndrome

ARV

Antiretrovirals

CMG

Guinea Chamber of Mines

CSR

Corporate Social Responsibility

FSC

Forest Stewardship Council

GFATM

Global Fund to fight AIDS Tuberculosis and Malaria

GFBC

Association of the Timber Industry of Cameroon

GIZ

German Society for International Cooperation

HIV

Human Immunodeficiency Virus

HIF

Health Insurance Fund

M&E

Monitoring and Evaluation

MDG

Millennium Development Goals

MOU

Memorandum of Understanding

NGO

Non-governmental organization

North Star

North Star Alliance

PAI

PharmAccess Foundation

PCS

Partenaires Contre le SIDA/Partners Against AIDS

PEP

Post Exposure Prophylaxis

PHC

Primary Healthcare

PLWHA

People Living With HIV/AIDS

PMTCT

Prevention of Mother to Child Transmission of HIV

PPP

Public-Private Partnership

SEP/CNLS

Secrétariat Exécutif Permanent/ Conseil National de Lutte contre le SIDA

STI

Sexually Transmitted Infections

TB

Tuberculosis

VCT

Voluntary Counselling and Testing (for HIV)

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ACKNOWLEDGMENTS We would like to thank the following companies and partners for their contributions to this guideline: •

Chambre des Mines de Guinée

Congolaise Industrielle des Bois

Groupement de la Filière Bois du Cameroun

Heineken Africa Foundation and Heineken’s subsidiary in Burundi, Brarudi

North Star Alliance

GIZ

SIDA-ENTERPRISES

A special acknowledgment goes to PharmAccess Namibia and the Health Insurance Fund for reviewing contents.

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INTRODUCTION The past decade has seen many developments in the

clear that none of these stakeholders have the capacities

response to HIV/AIDS, Tuberculosis and Malaria. Although

or the resources required to solve global health problems

many breakthroughs have been achieved and international

on their own.

focus is now gradually shifting to addressing other public health issues, these diseases remain a major concern and

In such a context, pooling together resources,

still heavily contribute to the global burden of health issues

competencies and expertise from all three sectors can be

especially in low-income countries.

an effective way to respond to the challenge in the mutual interest of all parties involved.

As well as representing major public health issues, infectious diseases such as HIV /AIDS, Tuberculosis and

As a result, many kinds of Public-Private Partnerships (PPPs)

Malaria negatively impact the bottom lines of companies

have emerged worldwide in recent years to advance the

operating in Sub-Saharan Africa through the direct impact

health-related Millennium Development Goals (MDG),

they have on their workforce and customer base.

notably the fight against HIV/AIDS and other major public health diseases in Sub-Saharan Africa (MDG 6).

Private organizations alone cannot respond to the threat these diseases represent for them. Similarly, the public

PPPs can therefore play an innovative role by providing an

sector is facing a major challenge in scaling-up the scope

effective and sustainable strategy for dealing with complex

of its response to the same issues while the civil society’s

diseases.

efforts remain insufficient to fill the gap. It is therefore

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OBJECTIVES The purpose of this guideline developed by PharmAccess

of this guideline are proud to be involved in.

Foundation (PharmAccess) and Partners Against AIDS (PCS) is first and foremost to help companies identify whether

Other selection criteria for these partnerships were:

entering into a partnership with the public sector and other potential partners is the most appropriate way to

halt and ultimately reverse the adverse impact of HIV/AIDS,

Their health-related nature with special attention to HIV/AIDS, TB and Malaria;

TB and Malaria on their bottom line.

Their provision of both preventive and curative interventions;

Secondly, and if identified as the most suited instrument,

this guideline aims to provide decision makers and senior

The involvement of public and private partners as well as third parties such as NGOs;

executives with a lean and mean step by step approach for

setting up a successful public-private partnership.

Workforce-based partnerships expanded to broader communities;

Economic-sector diversity.

SCOPE OF THE GUIDELINE The focus of this guideline is placed on health driven

Therefore, we are pleased to feature case studies of the

Public Private Partnerships in Sub-Saharan Africa, and

following PPPs:

more specifically those addressing the three communicable diseases of HIV /AIDS, TB and Malaria.

This guideline is supported by numerous case studies

Chambre des Mines de Guinée (Guinea)

which have the common characteristic of offering a

Groupement de la Filière Bois du Cameroun

Congolaise Industrielle des Bois/Danida (the Republic of Congo)

comprehensive response to the health issues they aim

(Cameroon)

to address. Experience has shown that conducting both

Bophelo! (Namibia)

preventive and curative interventions has proven to be the

North Star Alliance (across Africa)

most effective way to address complex health issues such

Heineken Brarudi (Burundi)

as HIV/AIDS, TB and Malaria.

Health Insurance Fund (Nigeria-Tanzania-Kenya)

SETUP OF THE GUIDELINE Based on existing best practices, the guideline will firstly define the PPP concept and its nurturing context. Secondly, the guideline will highlight the elements private organizations should take into consideration before making the decision to embark on a PPP. Lastly, the guideline will take the reader through a step by step approach to the successful initiation and implementation of a PPP while identifying potential challenges and providing practical tips to respond to them. A number of public private partnerships will be used to illustrate the various elements developed throughout this guideline. While these partnerships have been selected according to a set of specific criteria, they first and foremost constitute true success stories which the authors

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SETTING THE SCENE PUBLIC-PRIVATE PARTNERSHIPS, A DEFINITION

In this guideline, a Publish Private Partnership is defined as

A Public-Private Partnership refers to a collaboration

and the civil society where risks, responsibilities, resources

involving at least a public and a private party while civil

and competences are shared to implement a specific task

society actors often act as an important third party in the

for the common goal of addressing the public health

collaboration (see Box 1).

concerns that are HIV, TB and Malaria.

the cooperation of the private sector with the public sector

Through mutual contributions in knowledge, know-how and financial resources, the partnership reallocates risks

Box 1. PPP PARTIES

and rewards as well as responsibilities and ownership

Private sector refers to for-profit business entities

among partners.

of all sizes (multinational or national companies including small and medium enterprises) and their

PPPs can take many forms and have a diverse range of

CSR departments and/or philanthropic foundations.

purposes, set-up, duration, scale or economic sectors of

Public sector refers to national and local

the private partner (see Box 2).

governments as well as to international multilateral What then makes a PPP different from other

and bilateral organizations. Civil society encompasses not-for-profit non-

forms of collaboration?

governmental organizations and knowledge centres.

Public-private interactions diverge according to the type of relationship and the partners’ level of involvement. The

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BOX 2. THE VARIETY OF PPPs FOR HEALTH Purpose: PPPs can have very different purposes: health service delivery; human resources; information; medicines and technologies; financing and leadership and governance. For instance some public-private alliances focus on pharmaceutical product development while others implement HIV/AIDS healthcare services or distribute mosquito nets. Distribution of roles: Parties can take on various responsibilities within the relationship, including financing, service provision and technical support. Actors can also play different roles at diverse stages of the relationship e.g. promoting a partnership towards new partners or monitoring and evaluating service provision along the course of the project. Geographic scale: spanning from global health alliances such as the Global Fund to Fight AIDS, Tuberculosis and Malaria to national, regional or local initiatives. Duration of the collaboration: Private and public organizations may work together on the short-term – e.g. for a time-bound clearly defined project - or on a longer term e.g. for multi-year programs.

most accomplished form of interaction between partners

resulted in stronger external pressure on companies to

is defined as a partnership and implies a high level of

play a role in the well-being of their workforce and, where

involvement and the according investment. In some cases,

required, in healthcare delivery (see Box 3).

shared ownership and the creation of a distinct legal entity lead to a so-called “full-blown partnership”.

The moral and social responsibility deriving from companies’ economic activities is an important factor in

Before deciding to embark in a PPP, it is crucial to carefully

their commitment to participate in the global health crisis

evaluate if partnering with public and other partners is the

response. The emergence of the CSR concept has been a

best instrument to respond to the issue(s) the company

major push factor for companies to enter into partnerships

aims to address. This guideline provides a model that will

to tackle public health issues.

guide companies in deciding whether a PPP really is the most opportune form of involvement to achieve their goals.

BOX 3. Developments in International Health

While the implementation of health programs - the

Increasing life expectancy, changes in disease

PPP contents - has been extensively treated in the

patterns and the double burden of disease caused

international literature, this guideline aims to follow a

by both communicable and non-communicable

different approach and will focus on the structural and

diseases have resulted in a significant increase

organizational aspects of PPPs. While the contents of PPPs

of healthcare costs. As a result, alternative

will be partly discussed in the context of this guideline,

funding sources – e.g. private sector - have been

here, they will be referred to as “PPP program”.

sought to compensate the growing expenses for healthcare. The decrease in and the lack of

BACKGROUND IN WHICH PPPs EMERGED

predictability of international aid have also led

The last two decades have seen the emergence of a

the private sector to become more involved in

number of driving factors – including both push and pull

development issues. Furthermore, the financial

factors - which have led to an exponential increase of

contribution of businesses to healthcare systems

health driven PPPs. This section provides an overview of

in their countries of operation constitutes a more

these factors

sustainable financing mechanism than traditional donor funding which remains limited in time,

Push factors

unpredictable and sometimes far from the national

The growing concern for Corporate Social Responsibility

needs.

(CSR) and developments in international health have

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In some cases, the private sector’s commitment to health

allow risk sharing through the reallocation of resources,

issues is clearly related to its health and socio-economic

they minimize risks for all partners. For companies,

impact on the milieu. The transportation industry started

collaboration with partners such as governments,

acting against the spread of STIs and HIV after realizing the

multinational and bilateral organizations as well as NGOs

role it plays as a transmission vector of these diseases (see

mobilizes additional resources - e.g. funding, expertise,

North Star Alliance case study).

social networks, equipment and premises - and creates added value (see CMG case study).

Similarly, and in order to counter the socio-economic HIV transmission risk factors resulting from its economic

Such pooling of skills and resources is crucial when

activity, the timber company Congolaise Industrielle des

addressing HIV/AIDS, TB and Malaria. These diseases

Bois implemented a HIV/AIDS program for its employees

raise complex challenges - for instance stigma and

and the populations living in its concessions (see CIB case

discrimination - that require specific expertise. As such

study).

expertise is usually not available in-house, companies are often unable to implement such programs on their own.

As is the case in many sub-Saharan African countries,

Moreover, the medical skills and constant monitoring and

companies often operate within dysfunctional public

evaluation that are crucial for quality healthcare provision

health systems - both in terms of expertise and financial

are often lacking to companies.

means. Consequently, healthcare needs related to specific diseases such as HIV/AIDS or specific groups (notably the

Collaborating with external actors – notably with health

poor) are unmet. This has led many private organizations

experts - can benefit companies in effectively addressing

to assume healthcare provision for their immediate

these issues. In return, companies can contribute, for

stakeholders - most directly involving their employees.

instance, their supply chain and operational expertise or their infrastructure and human resources to the partnership.

Developments in international health in the last 20 years have also resulted in increased pressure on private organizations demanding a more prominent role in

These push and pull factors have led international

healthcare financing and delivery from them (see Box 3).

health institutions such as the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM) to assign increasing

Pull factors

program responsibility to the private sector (see Box 4).

The potential advantages derived from health-driven PPPs constitute an important pull factor by nature particularly when it comes to resources and risk sharing. As PPPs

BOX 4. The role of the private sector in the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM) PPPs are a fast developing mechanism through which the private sector is playing an increasing role in GFATM. This is particularly visible when considering the number of private parties involved in GFTAM Country Coordinating Mechanisms as well as the increasing number of private parties involved in the submission of GFTAM proposals and subsequently appointed as principal recipients of GFTAM Grants. A broad range of partners from the private sector have supported initiatives with the GFATM that are among the most innovative and producing impressive results. Through their knowledge of the local needs and situation of the countries within which they operate, private actors have proven that they can play a leading coordination role in rolling out GFTAM funded initiatives. PPPs have therefore become an instrument for improving the management and accountability of programs whilst improving the overall sustainability of development assistance. Thus, PPPs present an opportunity for both the private sector and GFATM to successfully achieve Health MDGs.

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The responsibility of transporters towards disease transmission: the North Star Alliance case Both the vulnerability of transporters to and their role in the spread of HIV and other communicable diseases pose two main challenges to the transport industry and those who depend on it for commercial, public and humanitarian purposes: •

Human resources: Many transporters are losing skilled employees to AIDS faster than they can train new employees; a direct threat to business sustainability. In the most severely hit regions of Africa, truck drivers would have a working life span of no longer than 5 years.

Social responsibility: In the process of delivering goods, people or aid in many settings, transporters are faced with the unpleasant reality that they risk introducing HIV and other diseases to recipient communities.

In response to this issue, the international express and mail delivery company TNT and the UN agency World Food Programme established a public-private initiative in 2006 to promote the health and well-being of long-distance truck drivers and other transport-related workers through a network of basic healthcare clinics located along the main transport corridors and hotspots of sub-Saharan Africa.

The HIV/AIDS program of the Congolaise Industrielle des Bois (CIB) The presence of the timber company CIB in remote Congolese concessions has direct consequences on the local population’s vulnerability to HIV/AIDS through the following factors: •

The presence of key population groups vulnerable to HIV (migrants and mobile workers; sex workers and clients; indigenous people);

CIB’s economic and commercial activities (men with money in remote and poor area);

The limited access to HIV prevention, testing, care and treatment services.

The combination of these three socio-economic risks factors has resulted in relatively high prevalence in the CIB concessions - in comparison to national HIV prevalence. In order to counter its impact on the population living on the concessions, CIB implemented a HIV/AIDS program for its employees and the communities living on the company’s concessions. The HIV/AIDS program was made possible by the creation of a PPP between CIB, the Danish Government (DANIDA) and the Congolese Government and with technical support from the Dutch NGO PharmAccess Foundation.

Chambre Des Mines De Guinée (CMG) CMG, a mining business coalition in Guinea, has been engaged in a health PPP with the German development agency GIZ and PCS since 2007. In the context of this PPP, GIZ and PCS provide technical assistance to CMG in improving the healthcare delivery structure and services across 7 mining sites. GIZ’s and PCS’s assistance allows companies to translate their involvement into a tangible HIV prevention program for their employees and surrounding communities, thus conciliating their business interests with the country’s public health interests.

By bringing together the technical expertise and financial resources of the partners and companies affiliated to the CMG, program activities have gradually been scaled up.

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CONSIDERATIONS BEFORE SETTING-UP A PPP THE COMPANY’S INTERNAL SITUATION Preliminary step Is setting up a PPP the right form of engagement

No

WILLINGNESS AND MIDDLE TO LONG-TERM

Other

COMMITMENT

options

for my company?

The motives for embarking on a PPP are not often explicated. Experience and literature however demonstrate that motives dictate the willingness to invest on a longer term.

Yes

The willingness to invest refers to the reasons for Step 1 Problem analysis: What is the impact on my company?

companies to contribute to advancing public health goals. Step 2 Thorough feasibility study

These reasons can range from broad CSR motives to risk reduction and ultimately to a strong business case (see Box 5). The various degrees of willingness to invest can be represented on a continuum ranging from the weakest to the strongest motives that will support the success and continuity of a PPP.

Setting up a PPP can be an opportune way to reach your company’s public health goal when two major factors are

As a general rule, it can be said that the stronger the link

present. These factors are namely the company’s internal

between the motives for embarking on a PPP and the

situation and an enabling environment.

company’s core business, the more appropriate form of

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engagement the PPP will be.

- e.g. human, technical and financial - are available internally. Besides, a PPP is more likely to be effective if the

In addition to the company’s motives, senior

resources and skills needed to implement the partnership

management’s willingness to engage in a PPP is another

are closely linked to the company’s core business.

important factor especially when it comes to driving the initiative internally. However, this factor alone will be

In conclusion, while companies can have several underlying

insufficient to sustain the partnership on the medium

motives - both altruistic and utilitarian - for embarking in a

to long-term as changes that might occur within the

PPP, these need to be clearly stated to ensure an informed

senior management team will influence the level of

decision-making process. From a public perspective, it

willingness and commitment of its members. Therefore, a

is fundamental for public stakeholders to understand

company’s willingness to engage in a PPP must consist of

the motivations of their potential private partner for

a combination of top management executives’ personal

engaging in a PPP and to ensure that these are aligned

commitment and solid business motives.

with the general purpose of the PPP as well as with public interests. Experience has shown that the overall success of

Willingness alone might however be insufficient to embark

a PPP is highly determined by the complementarity of all

on a longer term complex relationship.

stakeholders’ motives to participate in the PPP (see GFBC example).

Available resources and skills In addition to the company’s willingness, the in-house

All the while, companies should estimate the extent to

presence of the skills and resources required for the PPP is

which existing in-house internal resources and skills can be

a determining success factor. After assessing the skills and

mobilized for the PPP.

resources required to meet the partnership’s objectives, the company should consider what its contribution to

The checklist on the following page will assist you in

the partnership can be and what the limitations of this

identifying whether the internal situation of your company

contribution are. It is essential to assess what resources

is favourable for engaging in a PPP.

box 5. BUSINESS MOTIVES FOR INVESTING •

Corporate Social Responsibility motives range from promoting public relations and company branding, window dressing and altruistic/philanthropic interest from top management.

Risk reduction refers to the necessity or obligation for a company to invest in the public interest in order to counter its business impact – environmental and/or socioeconomic.

Business case refers to the economic advantages of investing in health such as supporting a healthy workforce (reducing absenteeism, retaining experienced workers), decreasing health costs, accessing new markets (e.g. mosquito nets distribution), new product development (drugs, vaccines, health insurance packages), expansion of distribution channels and strengthened relationships with governmental decision makers...

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Stakeholders’ motives for participating in the

Checklist: “Is the company’s internal situation

GFBC PPP

favourable for engaging in a PPP?”

The relatively high HIV prevalence rate (9%) in Cameroon’s forestry sector coupled with its economic and

What are the motives for engaging in a PPP?

organizational impact and the FSC certification standards

Are these motives shared by the company’s

were strong motives for the Cameroon timber industry

senior management team?

(GFBC) to engage in a PPP to fight HIV/AIDS. Gradually, an increase in senior management’s awareness combined

Is the senior management team willing

with competitiveness elements in the sector convinced

to commit to and support the PPP on the

additional companies to embark in the process.

medium to long-term? •

Is there an individual or a team capable of driving the partnership within the company?

Is the company able to mobilise the resources required e.g. financial, human, in-kind, technical etc.?

Is there an understanding of the required resources and skills that are lacking within the company?

ENABLING ENVIRONMENT Before going for a PPP, it is important to evaluate if the environment in which the company operates is favourable. A favourable environment will be characterized by the

1 Political stability 6 Opportunities for sustainability

2 Potential partners

Enabling Environment 5 Legislative environment

3 Public sector’s participation

4 External pressure

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following factors:

The impact of political instability on the development of the CMG PPP

1. Political stability and enabling overall context: it goes without saying that one of the first requirements

In Guinea, political instability has impeded the formation

for the establishment of a PPP is a stable political context

and start of a PPP involving a mining business coalition

(see CMG case study);

(CMG), the German development agency GIZ, the French NGO Partners Against AIDS and the Guinean health

2. Potential partners offering the complementary

authorities.

skills and resources lacking within the company -

Political turmoil led to a one-year delay in the

contacts, assets and skills:

establishment of the partnership and to limited

Existing business response to the health issue in the

participation of the major public stakeholders up until

country, private sector coalition, other companies

early 2011.

interested in partnering and investing in the PPP; •

As a result of the unstable political climate, the public

Existing government response to the public health

sector’s capacities to assume ARV provision remain very

issue as well as availability of capacity and skills; •

limited. The private partners therefore found themselves

Community participation in the partnership:

in the obligation to take on this responsibility.

involvement of beneficiaries at all stages of the PPP for demand-based healthcare services, better ownership and sustainability of the project (see the example of Heineken in Burundi);

Heineken in Burundi: building of a health centre together with the local community and

3. Public sector’s participation:

the Government

Willingness and capacity of the public sector to collaborate

This PPP was initiated by the Bugendana community in

with the private sector;

the Gitega province (Burundi) in 2010 and brings together the financial and in kind contribution of the community,

4. External pressure:

the financial and in kind contribution of Heineken (which

External pressure on companies for greater social

operates a brewery in the Gitega province) and the

responsibility from the media, consumer associations and

human resources and technical expertise of the Ministry

international organizations among others: general public

of Health.

interest towards a particular health issue can contribute to promoting the initiative towards potential partners and to

Within, this partnership, the local community organized

accessing additional support and resources;

as an association, is responsible for the coordination of the project and is involved in all phases, from the project

5. Legislative requirements for health:

design to the operations and maintenance of the health

Are companies obliged to pay for their employees’ health

centre.

costs in their country of operation? Are companies required to play a role in addressing public health issues? 6. Opportunities for sustainability (exit strategy): it is easier for companies to commit when the duration of their involvement is limited in time - for instance when there are options for handing over the project to other partners on the long term. A supportive environment will offer a maximum of these enabling factors. The more enabling factors present in the environment, the more likely the PPP will succeed. As illustrated in Figure 1, an enabling environment can also be represented as a continuum where the presence of supportive factors can

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influence the success of the PPP.

in assessing the extent to which the environment your company operates in can support a potential PPP initiative.

In order to evaluate the willingness of public partners to collaborate with the private sector, it is important for companies to understand the public perspective (see Box 6). The checklist on the next page will assist you

Existence of a HIV/AIDS Business Coalition willing to share expertise and to invest in the PPP

Possibility to hand the project over to the Government

Public interest and media coverage of the partnership initiative

Government willingness to collaborate + Presence of focal point within the Ministry of Health

The Government has skills and resources – including money - to contribute to the partnership

Target Group organized into an association involved in needs assessment and project definition and implementation

Figure 1 - Enabling environment

Box 6. The public partners’ perspective: What do public partners usually consider before engaging in a PPP with the private sector? In order to evaluate the strength of a company’s commitment, public partners will assess two factors: •

The company’s willingness to invest on medium to long-term

The potential impact of the PPP on the public health agenda. The duration of a company’s commitment to a PPP will depend on the strength of its motives as well as the supportive nature of its environment (figure 1).

Some legal and economic frameworks can stimulate sustained private contribution to development issues. For instance, the Forest Stewardship Council (FSC) certification plays an important role in strengthening corporate social responsibility within the timber industry. Another aspect usually considered by public partners is the reach of the services offered through the PPP. Public partners often require a broader reach than the mere target groups of employees and their families - considered to be the companies’ responsibility. Surrounding communities and supply chain workers are examples of target groups that can benefit from the services offered through the PPP.

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Checklist: “Are the enabling factors present in the company’s environment for supporting its involvement in the PPP?” •

Have such partnerships ever been developed in the country?

What is the national program/body dedicated to the health issue (National HIV/AIDS program, Malaria control program…)?

Is there a Government department/focal point for partnerships with the private sector? Are there strategies to guide collaboration with the private sector the company can benefit from?

Is the Government inclined to establishing collaboration with companies? Has the government ever worked with companies on public health issues? Does the government have the capacity to partner with the private sector? What resources can the Government contribute?

Are there potential partners interested in collaborating to address the health issue (other companies, business coalitions, local and international NGOs, universities etc.)? What are their fields of competencies? What resources could they mobilize?

Is the target group of beneficiaries organized as an association? Are there knowledgeable persons who can be consulted? Could the community play a role in the implementation and the operations of the partnership program?

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how successful the collaboration with potential private partners will be.

Preliminary step Is setting up a PPP the right form of

No

engagement for my

1. DONOR/ CONTRACT

Other

The company’s motivation is limited to performing a good

options

deed and the enabling environment is under-developed.

company?

A PPP is therefore an inappropriate vehicle as it requires a strong investment in terms of time and resources. In this situation, company donations are preferable.

After having assessed your company’s internal and external

2. INITIATOR/ LEADER

situation, you will be able to identify whether setting up

This is a situation where the business case is strong but

a PPP is the right form of engagement for your company.

there are few enabling factors – e.g. no skilled partner

If it is, the following part of this guideline will take you

available or government reluctant to collaborate. The

through the major steps of a PPP lifecycle while providing

company therefore takes the lead and sets up the initiative

you with practical guidance and best practices.

on its own. This requires a higher investment but gives exclusive ownership to the company. The success of the

In the event where this role is not identified as the most

initiative fully relies on the company’s ability to mobilize

suitable, other options are available. Your company’s form

the internal skills and resources needed in view of the

of engagement can differ according to both its internal

limited external resources available. Experience has shown

situation and the environment in which it operates.

that such company initiatives can progressively evolve into successful partnerships.

There are four roles a company can play in its engagement for health. A conceptual model (see Figure 2) was

3. CONTRIBUTOR/CONSULTANT

developed to help you reflect on the role your company

If there is a well-developed enabling environment that will

can play according to its internal situation as well as the

likely put more pressure on companies to participate but

external context in which it operates. This model is of

the business interest to invest in the initiative is low, a PPP

equal relevance to public decision-makers in estimating

is not recommended. Instead, companies can consider

Strong internal situation

4. Partner in a PPP - Strong company’s commitment & resources and skills availability - Strong enabling environment

2. Initiator/Leader - Strong business case - But few external enabling factors

Poor supportive context

Strong supportive context

Enabling external context

1. Donor/Contract - Company’s willingness to perform a good deed - But lack of external supporting factors

3. Contributor/Consultant - Well-developed enabling environment - But low busines interest to invest

Company’s internal situation Figure 2 - Roles to be taken by the private sector

Weak internal situation

22


short-term contributions (e.g. by sharing information, capacity building of the partnership staff through training and time-bound consultancy). This type of involvement requires a little more investment than mere donations but on the other hand has the advantage of supporting CSR goals. 4. Partner If the company operates in a country where the government is experienced in partnering with the private sector and can mobilize time and other resources, where partners with complementary skills and resources are available and where an exit strategy can be foreseen, the company will naturally take on a partner role and will share risks and rewards with other stakeholders in the partnership. Roles can evolve over time due to changes in the external context and in the internal situation of the respective partners. It is therefore important to integrate room for flexibility in order to adjust roles and responsibilities accordingly in due course. Although the second part of this guideline mainly addresses companies that will take a leading role in designing and setting up PPPs, it remains of significant relevance to any organization involved in a PPP, whatever its role.

23


HOW? MAJOR STEPS IN THE PPP DEVELOPMENT PROCESS Step 1 Problem analysis: What is the impact on my company?

Step 6 Evaluation and scale up or exit - Hand over - Program scale up with entry of new partners - Closure of the PPP program

Step 5 Implementation of the PPP program

Step 2 Thorough feasibility study - Resources and skills capacity - Enabling external environment

Major steps in the PPP lifecycle

Step 4 Design of the PPP structure - Objectives and goals - Roles and responsibilities - Organization and accountability - Program contents - Exit strategy - Partnership formalization

24

Step 3 Appointment of a driver


Should the first assessment of the internal and external

Situation analysis of the timber industry in

factors indicate that a PPP is a good option, the step-

Cameroon: the economic impact of HIV/AIDS

by-step approach provided in this chapter will guide you through the process of setting up and implementing a

The interest of the Cameroon timber industry in engaging

successful PPP.

into a PPP to address the HIV/AIDS issue stemmed from a strong business case. The adverse impact of HIV/ AIDS on the timber companies’ workforce led the GFBC

Step 1 Problem analyis: What is the impact on my company?

to conduct a study which demonstrated that, with an average prevalence rate of 9% among the timber industry‘s workforce, the costs of the disease average

The first step in setting up a PPP will be to conduct an

83 million CFA (USD 126.500) per year for the industry

in-depth analysis of the health issue your company wants

while this impact can be halted within 4 years with an

to address in order to evaluate its impact on your business

investment of 23 million CFA (USD 35.000) per year in an

by, for instance, looking at how HIV/AIDS affects your

HIV/AIDS prevention and care and treatment program. On

workforce, supply chain or consumer base (see GFBC case

the longer term, such a program will help sharply reverse

study in Cameroon).

Cameroon’s rising HIV prevalence within the timber industry.

At this stage, resorting to external technical assistance to conduct a thorough needs assessment may be required. Every activity should be based on a full understanding of the needs and demands of the PPP program’s beneficiaries (see the North Star case study on the right and the Health Insurance Fund case study on page 27). For this purpose, various specialized approaches and tools can be used. Collaborating with organizations experienced in designing and implementing such action-research methods will ensure the collection of high quality reliable data in a cost-

North Star Alliance: Wellness Surveys

effective way. As conducting a situation analysis is an important requirement for program scale-up, North Star Alliance

This thorough needs assessment must be performed

often requests the assistance of external experts such as

during the development phase of the PPP in order to

PharmAccess to conduct initial “Wellness Surveys” to

provide baseline information that will guide the design of

assess the health situation, needs and demands of the

the PPP program and will allow for the monitoring and

target groups in each and every site before setting up

evaluation of its progress.

their Wellness Centres. Step 2 Thorough feasibility study

ANALYSIS OF AVAILABLE INTERNAL RESOURCES: WHAT DO WE HAVE TO ADDRESS THE PROBLEM? The health issue to be addressed should also be analysed in relation to your company’s core business. When examining the impact of HIV/AIDS on your workforce, supply chain or consumer market, you should also ask yourself what type of interventions are within your field of expertise and operations.

25


You should also assess your company’s internal capacity

Mining companies in Guinea

to mobilize the financial, social resources and technical

In 2008, PCS conducted an initial evaluation of the

skills required e.g. in terms of management, Monitoring &

healthcare services provided by mining companies in

Evaluation, communication, IT and logistical skills; contacts

Guinea and assessed their capacity to implement a HIV

with employees, supply chains, business partners, the

program run by CMG in remote mining areas.

government, customers; funding, equipment, services and products, in-house healthcare infrastructure etc…. This

This study allowed CMG to identify the most suitable

internal resources and skills mapping exercise will help

technical partners and to design and subsequently

evaluate in detail what your company can invest and what

implement a comprehensive action plan.

the gaps to be addressed by other partners are. After completion of this analysis, you should have a clear

Heineken Brarudi – Burundi

overview of the benefits your company will yield from its involvement in the partnership. This step will also allow

During the project’s development phase and before

you to set a commitment timeframe.

engaging in its implementation, the partners conducted an initial evaluation of potential partners and local

ExTERNAL SITUATION ANALYSIS OF POTENTIAL PARTNERS AND INTERVENTIONS

healthcare service providers in order to assess their

Before engaging in a partnership, you will need to

evaluation allowed for a prompt and smooth start of

assess the scope of the potential partners’ respective

operations when the health centre opened.

capacity to deliver timely and quality services. This initial

contributions. This will help identify the extent of available skills and resources from potential partners and to ensure they are equipped with the relevant knowledge and

Driving the GFBC PPP

expertise to effectively contribute to the partnership. In addition to the assessment of the main partners,

At the launch of its program, the GFBC tested an external

the situation analysis can also focus on the capacity of

organisational set up for two years before deciding

identified service providers to ensure quality and timely

to in-source its operational team therefore taking full

service delivery (see examples in the CMG and Brarudi case

responsibility for the coordination and management

studies).

of the program. This decision streamlined the communication process between the companies, GFBC and its partners and allowed for better relations between

Step 3 Appointment of a driver

the partners and the operational team. The latter is under the direct supervision of a GFBC representative and must report on its activities to all partners involved (GFBC,

Experience and literature demonstrate that appointing a

companies, GIZ, PCS). This strategic decision allowed

driver is a prerequisite in the success of a PPP. From the

GFBC and its affiliated companies to gain in leadership

onset of the PPP, partners should identify and agree on a

and visibility.

party responsible for initiating, brokering and promoting the initiative. This role can be taken on by your company or by another partner with the appropriate skills to perform this assignment: e.g. social skills, communication skills, flexibility, negotiation skills, motivation, charisma to name but a few (see GFBC example). In some cases, a distinct legal entity can be created to manage the PPP program. Such was the case for North Star Alliance and the Health Insurance Fund (see example on page 27). This driving role will be of particular

26


importance in advocating the partnership to potential

Creation of an independent entity to drive the

partners, in facilitating initial discussions and in bridging

partnership: The North Star and HIF examples

potential cultural gaps between the partners.

In these two partnerships, an independent legal entity was created to fund and manage the partnership

Step 4 Design of the PPP structure

programs. In each partnership, the partners’ roles and responsibilities are clearly defined within the partnership structure and all partners and stakeholders

After completion of the feasibility study and on the basis

are represented at Board level to ensure that all interests

of its outcomes, the partnership structure will need to be

are taken into account in the implementation of the

outlined. To guarantee an effective partnership, a number

programs.

of key elements should be incorporated in its structure and in the design of its program: the roles that all partners are expected to play. In some Objectives and goals: Expose each partner’s agenda

cases, defining terms of reference for the main partners

and expectations towards the PPP. This will result in clearly

involved can help guide the PPP stakeholders in regard to

formulated purpose and objectives of the partnership

the role they are expected to play (see page 29).

agreed upon by all partners. Accountability procedures: In order to ensure PPP organization: The PPP should be structured in

transparency and timely reporting to partners and

a way that ensures good governance, transparency

stakeholders, it is essential to set up procedures when

and relationship equity between all partners. Room

designing the partnership. Accountable persons should be

for participation of the program beneficiaries in the

designated for reporting on decisions made and actions

partnership should already be created. The case of

taken.

Heineken in Burundi gives an example of community participation as a primary partner of the PPP (see

Activity content and quality: The PPP program activities

Involvement of the local stakeholders example on p 28).

should be developed in relation to the program objectives. The situation analysis conducted in step 2 will have

Roles and responsibilities: When designing the

provided a good understanding of the needs and demands

partnership and to ensure a quick start and smooth

of the target groups, which will help define the content of

implementation of the program, it is important to clarify

the activities.

The Health Insurance Fund Within the set-up of the Health Insurance Fund, assessments of the local healthcare providers’ network and of the customers’ needs and demands are a pre-requisite to design and assess the feasibility of new schemes before their implementation. These assessments are part of extensive operational research conducted by PharmAccess, the Amsterdam Institute for International Development (AIID) and the Centre for Poverty Related Communicable Diseases (CPCD). In this context, various tools are used including standardized tools to assess the quality of healthcare provision, household surveys, focus group discussions, in-depth research etc.

27


Ensuring the highest level of quality will strengthen the

than not, the need for such a system is omitted in the

reach and impact of the PPP program interventions.

development phase and becomes visible at a later stage of

Therefore, it is essential to design the content of the

implementation. Such a situation makes the activities more

activities in consideration with national and international

difficult to develop, implement, monitor and evaluate.

health programs and guidelines. An efficient M&E system should be based on the objectives In view of the complexity of health issues such as HIV/

laid out in the action plan and should take the output,

AIDS, TB and Malaria, a comprehensive response, involving

outcome and impact of each program activity into

both the preventive and curative components, is required.

consideration.

You should therefore resort to expert organizations for the A strong M&E system will allow for constant evaluation

design and implementation of comprehensive programs.

and re-assessment of program activities by drawing on Budget: From the onset of the partnership, it is crucial to

experience and fresh knowledge acquired over time.

define the respective contributions of the partners to the

Therefore, the M&E system should include a daily follow-

design and implementation of the activities laid out in the

up of the program activities and regular assessments of

action plan.

overall achievements and results. From the beginning, it is also critical to set a timeline to regularly review results and

This includes staffing, equipment, financing, premises etc.

re-adjust the program contents accordingly.

Any unclearness in the action plan can lead to a biased budget and slow down the start of activities. If financial

M&E enables companies to identify potential issues early

resources are found to be insufficient to carry out the

on and to consequently adjust the program to address

activities laid out in the action plan, partners should

them. A strong M&E system also ensures the efficient use

consider mobilizing additional funds.

of resources and strengthens accountability.

Monitoring & Evaluation (M&E) system:

In view of the importance of the M&E system,

A performance monitoring framework should be

collaboration with external organizations or consultants

elaborated during the PPP development phase in order

experienced in developing and implementing such systems

to ensure the quality of the activities and to measure

will therefore be required.

the progress of the program going forward. More often

Involvement of the local stakeholders The Bugendana population, represented by the association the Natives of Bugendana (Les Natifs de Bugendana), has been involved in the health centre project from the onset of the initiative: •

Initial request from the Bugendana community to Heineken and the Burundian Government;

•

Involvement at project development (needs assessment, fund raising) and implementation stages (financial contribution and community work – e.g. raw material collection, labor contribution) as well as in the operation and maintenance phase (accountancy, stock management, maintenance).

As a result, the Bugendana community has developed strong ownership of and important participation in the project.

28


Sustainability of the PPP - Exit strategy or scale-up:

Distribution of roles between partners - GFBC

From the start of the PPP, partners should anticipate and outline the opportunities for exiting the partnership or

Within this PPP, the three partners share governance

prospects for program scale-up, taking into consideration

responsibility for the partnership through a coordination

the timeframe they are willing to commit for.

and management committee which meets on regular basis. As for the operational elements, as instigator of

Partnership formalization: It might be necessary to

the program, GFBC is responsible for supervising the

formalize the partnership. The types of formalization,

operational team while each timber company makes

ranging from Memorandums of Understanding to

its own staff, logistical capacities and facilities available

contracts, will depend on the complexity of the partnership

during the missions and activities held on its concessions

and on the partners involved. In some cases, donors might

sites. From their side, GIZ and PCS have been focusing

ask for a formal contract as a preliminary requirement for

their contribution on the provision of technical assistance

entry into the partnership (see GFBC example).

(providing advice for program management, medical activities) and capacity building over the past three years.

Step 5 Implementation of the PPP program

Formalization of the GFBC PPP In order to ensure a smooth and effective program

The partnership is formalized through a joint MOU

implementation process, the following conditions should

between GFBC, GIZ and PCS. This document includes all

be fulfilled:

operational elements such as the action plan, timeline, M&E framework and budget detailing the respective

Regular visits to the program site(s): All partners

contributions and responsibilities of each partner. Each

should visit the program site(s) regularly to ensure a close

partner (GIZ, PCS) has its own contract with GFBC

follow-up of the activities. Seeing the program in action

governing and aligning administrative procedures.

will allow the partners to gain a good understanding of the actual context within which activities take place and of the difficulties and challenges that may arise. These

North Star in the Democratic Republic of the

visits will also present the opportunity for all stakeholders

Congo

to meet and will provide a platform to discuss attention points on the spot while facilitating communication

North Star began its activities in the Democratic Republic

between partners (see North Star in DRC).

of the Congo in 2010 with the introduction of its first Roadside Wellness Centre on the most developed,

Ongoing dialogue: Clear and flowing communication

reachable, closest and busiest transport corridor of the

is an essential requirement for a successful partnership.

country. By starting with a feasible location, this pilot is

In order to facilitate the communication process, regular

expected to rapidly demonstrate visible results. In practice,

meetings of the Management Committee should be

this also means that the site can be visited by the PPP

organised to discuss the progress of the program activities

partners, donors as well as potential new actors. Initiating

and, as previously mentioned, regular visits to the program

operations with the most feasible activity is a way to

site(s) should gather all partners/stakeholders.

sustain the commitment of partners as well as to convince others to join in the PPP.

Transparent communication within the partnership will ensure that all partners and stakeholders remain engaged in the implementation process and will create an attractive and trustworthy environment for potential new partners. Moreover, a consultative approach will foster participation of all stakeholders – including beneficiaries - in developing and operating the PPP (see Box 7).

29


Flexibility and continuous readjustment of the

Step 6 Evaluation and scale up or exit

partnership: The partnership’s ability to demonstrate flexibility and to adapt to a changing environment (both internal and external) will determine its sustainability. For instance, the partnership’s long-term objective may

A PPP is not an end in itself but an instrument employed

be challenging to reach or the initial situation analysis

to address a specific public health issue that could not be

might reveal that one or several readjustments need to be

solved by a single party. PPPs are often not meant to last

made. There should also be room for flexibility during the

forever though their programs might continue over time if

implementation phase of the program in order to bring

the health needs are still present. All sustainability options

further required adjustments (see CMG example page 31).

should therefore be considered when setting up the PPP. The section below provides an overview of these options.

As achieving long-lasting results takes time, the early stage as these will be an efficient way to demonstrate

Program scale-up with entry of new partners in the PPP

immediate results and will therefore prove the feasibility of

This is a situation where additional partners enter and

the project. This will be the opportunity to set the stage

inject additional resources and skills into the PPP. A

for a fully fledged intervention by gaining the early

common example is when a government that could not

commitment of local stakeholders.

contribute to the partnership at its onset, improves its

partnership should consider achieving quick wins at an

skills and the availability of its resources over the course of time and can eventually engage in the PPP as a primary partner. In this scenario, the company remains involved in the partnership but its role shifts from initiatior and direct implementor to supervisor and steering committee member of the PPP program.

BOx 7. THE CONSULTATION PROCESS IN A PPP LIFECYCLE Establishing and maintaining a PPP requires a participative approach involving all stakeholders: •

A management committee representing all the stakeholders should be appointed and should meet regularly to guarantee transparent and flowing communication of programrelated information.

A coordination team should be responsible for reporting on the program to the management committee and for coordinating management committee meetings. This process will allow all partners to identify and address early on any potential issues that may arise in the implementation of the program.

Additionally, representatives of the program beneficiaries should be involved in the consultation process as their critical input will help evaluate the reach of the program and, if and when required, to adjust it accordingly.

30


In this situation, the PPP usually evolves towards a more

Flexibility of the CMG PPP’s structure

consolidated and institutional partnership while the program extends to wider groups of beneficiaries and/or

This PPP is run by a management committee representing

to a broader scope of activities (see Bophelo example page

all stakeholders and its activities are implemented by a

32).

coordination team originally composed of a coordinator, two medical technical assistants and several administrative

Hand-over of the PPP program responsibilities to another party

staff members.

An ideal scenario is when the activities implemented

program scale-up, the partnership will need to adapt

under the PPP can be handed over to another party (the

and strengthen its coordination team in order to comply

government or other parties, see HIF example page 32).

with the GFATM’s implementation and monitoring and

The partnership can then be closed and the company’s

evaluation rules.

Following its GFATM Round 10 award and subsequent

contribution consequently comes to an end. This scenario implies that new parties with strong resources and skills have emerged or that the capacities of the public healthcare system have increased and it is therefore able to take over the former PPP activities. This can also mean that the government is able to fully finance the program. In this situation, a transition period might be necessary to ensure a smooth and progressive hand-over of the PPP program. During this period, the company will gradually decrease its contribution to the partnership while providing remote technical support to the new party.

Program closure If the partners are unable to sustain their commitment to the partnership and there is no external party to take over the activities, the partnership must come to an end and its program must therefore be concluded. Another reason for closing down the PPP program might be that the initial health problem has become less of an issue over time and that the health needs of the target group can be addressed by the public healthcare system alone.

31


The BOPHELO! scale-up scenario: From mobile wellness screening to mobile primary healthcare services In 2009, BOPHELO! was created to conduct mobile multidisease screening at public and private workplaces. BOPHELO! was a private-private partnership composed of the Namibia Business Coalition on AIDS (marketing and workplace program support) and PharmAccess (service delivery). The initiative was funded by international donors (USAID, Global Funds, Dutch organizations) as well as by companies contracting for the mobile screening services. At that time, the contribution of the Namibian Government (Ministry of Health and Social Services) was limited to enabling the partnership’s operation by licensing the mobile testing facilities. The follow up from BOPHELO! is a full blown PPP providing primary healthcare services to communities located in remote areas. The alliance of public and private partners allows leveraging private sector resources to support public health. Operations are implemented by a private not-for-profit provider with international public and private funding and where the government contributes to the program by providing medication. The PPP is financed through employers paying for their employees & their dependents (pre-formal insurance) as well as Heineken Africa Foundation and USAID.

Handing over the Health Insurance Fund to the local governor in Kwara State - Nigeria Three insurance schemes funded by the Dutch Government through the HIF are currently operational in Nigeria: a scheme for Market Women in Lagos, 40.000 market women and their dependents (Lagos Scheme) and two schemes for farmers in Kwara State, for the Shonga and Bacita communities (Kwara Central, 70.000 farmers and their dependents) and for Afon and its surrounding communities (Kwara North, 75.000 farmers and their dependents). Encouraged by the success of the Health Insurance Fund scheme in Kwara State, The Kwara State Government agreed to fund 20% of the premium after the first year and to completely take over the scheme after four years. Moreover, the Kwara State Government agreed to co-finance the expansion of the program to the Afon community in Kwara Central: an agreement was signed between the Kwara State government and the Health Insurance Fund in April 2009.

32


33


IV. CASES This chapter provides an overview of the nature,

The seven PPPs listed below were therefore chosen:

objectives, success factors and results achieved through the seven selected partnerships. The selection criteria for

Workplace expanded programs:

choosing these particular cases are listed below and are

followed by an overview of the seven cases divided into

Congolaise Industrielle des Bois/Danida – the Republic of Congo

three categories. For a more detailed study of each case,

Chambre des Mines de Guinée - Guinea

please refer to Annex 2.

Groupement de la Filière Bois du Cameroun Cameroon

The case studies analysed in this guideline

Bophelo! - Namibia

were selected according to the following criteria: •

Supply chain programs

Their health-related nature with a special emphasis on

North Star Alliance

Heineken Brarudi - Burundi

HIV/AIDS, TB and Malaria; • •

Their provision of both preventive and curative

Other

interventions;

The involvement of public and private partners as well as third parties such as NGOs;

Workforce-based partnerships expanded to broader communities;

Economic-sector diversity.

34

Health Insurance Fund - Nigeria, Tanzania, Kenya


CASE 1 - CONGOLAISE INDUSTRIELLE DES BOIS (CIB)/DANIDA – THE REPUBLIC OF CONGO Strengthening and EXTENDING the CIB HIV/AIDS Workplace Program to the local community

The partnership

Driving factors

• Partnership formed in 2009 between the company Congolaise Industrielle des Bois (CIB), the Danish cooperation agency Danida, PharmAccess Foundation and Congolese health institutions

• Business case: Impact of HIV/AIDS on the company’s workforce and compliance with Forest Stewardship Council (FSC)’s International certification standards • The company did not have sufficient capacities to address the issue on its own and sought out technical and financial support from partners

Objective

• Strengthening and expanding the HIV/AIDS prevention, care and treatment workplace program for the benefit of workers, dependents and communities living in CIB concessions

Results

• Up to date peer education and mass prevention programs up and running • Increased VCT uptake: >3,000 people tested in 2009-2010 • >100 HIV patients on ARV therapy: 40% CIB workers and dependents / 60% community members • Increasing involvement of the government through quality control, ARVs and HIV tests provision • Embedment in local network: technical support from HIV/AIDS care, treatment and prevention NGOs

Success

• Company’s commitment to mitigating the impact of HIV

factors

• Additional financial resources (DANIDA) • External expertise for designing and implementing the HIV program • Government’s willingness to collaborate and to provide ARVs • Importance of shared ownership between partners

35


CASE 2 – CHAMBRE DES MINES DE GUINEE - GUINEA Strengthening HIV/AIDS prevention and care and treatment in the mining sector

The

• Partnership formed between Chambre des Mines de Guinée (CMG) - a business coalition made up

partnership

of 66 local and international companies operating in the mining sector in Guinea -, the German cooperation agency GIZ and PCS

Driving factors

• Business case: High HIV prevalence in the mining sector, higher than the national prevalence rate, high adverse impact on the mining sector’s workforce which is by far a major commercial sector in the Guinean economy • Shortcomings of the national health system in free ARV provision • CMG affiliated companies have inequal capacities to address HIV/AIDS and therefore, require external support

Objective

• To strengthen access to HIV/AIDS prevention and care and treatment for the mining sector’s workforce, their eligible dependents and the communities they interact with

Results

• Prevention and VCT activities running at the workplace in 6 sites • Growing number of patients accessing ARV treatment among the target population • Leveraging the CMG’s capacities through the GFATM Round 10 grant award

Success

• Strong involvement of CMG affiliated companies to the project

factors

• Global Fund Round 10 Award for Guinea: the CMG earned a USD13 million grant towards the coordination of HIV/AIDS healthcare interventions in the mining sector • CMG’s leadership’s continued engagement in the fight against HIV/AIDS

36


CASE 3 - GROUPEMENT DE LA FILIERE BOIS DU CAMEROUN – CAMEROON Improving access to HIV/AIDS prevention, care and treatment in the timber concessions in Cameroon

The partnership

• Partnership formed in 2007 between Groupement de la Filière Bois du Cameroun (a forestry sector business coalition in Cameroon - GFBC)/ the German International Cooperation GIZ/ the NGO Partners Against Aids and local and regional healthcare institutions in Cameroon. • Originally starting with 6 GFBC-affiliated companies, the partnership included 10 companies in 2010 • Coverage of 6,700 workers, 26,900 family members and a catchment area of around 77,500 inhabitants

Driving factors

• Business case : high HIV prevalence rate in the forestry sector (9%) and compliance with the Code of Labor in Cameroon and the FSC (Forest Stewardship Council) certification standards • Low access to healthcare facilities for the workers and their families in remote forest concessions • Lack of capacity among GFBC - affiliated companies to solve the issue on their own: external financial support and technical expertise are required.

Objective

• To reinforce the provision of HIV/AIDS prevention and care and treatment services to employees, their families and the surrounding communities

Results

• Increased number of companies involved in the project • As of 2010: 14,800 people attended awareness sessions, 8,500 people were tested and counselled, 517 PLWHA were treated and monitored, 31 people were on ARV treatment. • Peer education program implemented in workforce and community: 298 peer educators trained and 32 HIV committees created. • Network of 42 public and private facilities for the referral system. 5 private facilities provide HIV/ AIDS care and treatment services • Options for sustainability are being studied, for instance the implementation of a private medical scheme. • Current extension of the program to activities addressing Malaria, Tuberculosis, clean water and general hygiene.

Success

• Strong leadership of GFBC and consistent commitment of GFBC -affiliated companies

factors

• Stimulation through the competitive environment and the FSC certification • Partnership with the government for the access to public healthcare providers (CTA, UPEC) for HIV/ AIDS care and treatment. • Sustainability options with the potential establishment of a private insurance scheme • Entrance of and continuous search for new partners (NGOs) in the PPP

37


CASE 4 – BOPHELO! - NAMIBIA Providing mobile primary healthcare to rural and remote populations in Namibia

The partnership

• Expansion of mobile multi-disease screening to primary healthcare provision for rural and remote workplaces and surrounding communities • Partnership formed in 2010 between Heineken Africa Foundation, USAID who provides funding for HIV test kits, PharmAccess Foundation Namibia, the Ministry of Health and Social Services (MOHSS) who provides vaccines • Employers paying for their employees & their dependents (pre-formal insurance) • Services provided to communities on route by private not for profit provider with public medication

Driving factors

• Namibia is a vast and sparsely populated country making access to healthcare services difficult: 2nd least densely populated country in the world (2.5 people /km2) • Primary healthcare service provision extremely challenging particularly in a country with an HIV prevalence rate of 15.3% (World Bank 2007) and where more than one in four households live in poverty (UNDP)

Objective

Results

• To provide mobile primary healthcare to remote and rural workforces and communities in Namibia

• Three months pilot phase in Otjozundjupa region in Namibia: • 3 round trips of ~500km over 12 days • 28 sites - 30 participating farmers, rural primary school, nutritional support scheme • 1.925 patients, 1.103 children / 822 adults • Logistics and costing model developed • Proposal to partners to continue and expand services

Success

• New and innovative approach leveraging private sector resources to support public health

factors

• Sustainability options including the potential establishment of a low cost insurance option, the financial contribution of employers, the involvement of Government bodies for medication provision and the high interest of the donor community • Public contribution through licensing, free immunization materials and quality insurance by: Ministry of Health and Social Services and the Namibia Institue of Pathology

38


CASE 5 – NORTH STAR ALLIANCE Building a network of basic healthcare centres for mobile populations and the communities along Sub-Saharan Africa’s transport corridors

The partnership

• Partnership formed in 2006 between TNT, the United Nations World Food Program, UNAIDS, ORTEC and the International Transport Workers’ Federation • The partnership brings together financial support from WFP, logistical expertise, network and CEO’s advocay from TNT. Later, technical assistance and financial participation from PharmAccess Foundation and technical assistance from ORTEC

Driving

• Business case in some regions of Sub-Saharan Africa: Impact of HIV/AIDS on transport sector

factors

• To counter the adverse socio-economic impact of the transport sector on HIV spreading along the transport corridors

Objective

• Buidling a network of basic healthcare and prevention “Wellness Centres” at border crossings, ports and truck stops along transport corridors in Sub-Saharan Africa for truck drivers, sex workers and the surrounding communities

Results

• As of July 2011, 22 Wellness Centres are operating in DRC, Kenya, Malawi, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe • IEC sessions: 6.000-8.000 annually/per centre • STI treatments: 2.500-3.500 annually/per centre • VCT referrals: 1.500-2.000 annually/per centre • Condom distribution: 150.000 annually/per centre • Embedment in local network of transport companies and local donors

Success factors

• Switch from foundation to alliance allowing the participation of strategic partners contributing crucial expertise • Sustained involvement of TNT’s CEO • In 2005, the first Wellness Centre implemented at the Mwanza Border - Malawi - was useful to promote the initiative to potential partners • External expertise for reviewing medical strategy

39


CASE 6 - HEINEKEN BRARUDI – BURUNDI Building of a Community Health Centre in the Bugendana District

The partnership

• Partnership formed in 2010 between the population of the Bugendana District, Brarudi (Heineken’s local subsidiary in Burundi), Heineken Africa Foundation, the Ministry of Public Health and the Ministry of Home Affairs

Driving

• Acute health needs in the Bugendana rural district located in the Gitega province

factors

• Funding shortfalls of the Ministry of Public Health • Social responsibility of Heineken in Burundi - and particularly in the Gitega province where Brarudi operates one of its breweries called Bragita

Objective

• To improve access to primary healthcare for the Bugendana community spread across three hills of the Bugendana District with a catchment area of around 25.000 inhabitants

Results

• Effective PPP between the Government, Brarudi and the Bugendana community • The community health centre is now up and running and was officially inaugurated and handed over to the Ministry of Public Health in February 2011 • The medical staff received specific training on malaria and HIV testing, care and treatment conducted by Brarudi’s chief medical officer

Success factors

• Involvement of Heineken at both local level - project initiation and coordination through its subsidiary - and international level with Heineken Africa Foundation being involved in the project funding, supervision and steering • Initial request from the Bugendana community to Heineken and the Burundian Government • Community participation in the health centre: financial contribution and community work

40


CASE 7 – HEALTH INSURANCE FUND Providing access to affordable quality healthcare to middle to low-income groups in Nigeria, Tanzania and Kenya

The partnership

• Partnership formed in 2007 through an initiative of PharmAccess Foundation and Kees Storm, former CEO of AEGON. Partners include the Dutch Ministry of Foreign Affairs, USAID, local health insurance and healthcare providers as well as the local government in Nigeria (Kwara state)

Driving

• Limited capacity of most African public health systems to provide accessible and quality healthcare

factors

• As a result, over 50% of healthcare services in Africa are delivered through the private sector and are covered out of pocket by the users resulting in often catastrophic expenditure for low income groups • Need for private voluntary risk-pooling approaches that are accessible to middle to low-income populations

Objective

• For low-income families: provide access to an affordable and quality private health insurance scheme to reduce health and health-related financial risks • For healthcare providers and insurers: provide sufficient and stable income streams, affordable financing options and quality technical assistance to reduce their financial and operational risk • For donors: provide innovative and more effective financing mechanisms • For governments: work together in an effective and sustainable partnership to build an enabling environment (including the legal framework)

Results

• The HIF in Nigeria has been operational since 2007: 3 schemes are successfully implemented by the local health insurance company Hygeia Community Health Plan for 40.000 market women in Lagos and for 145.000 farmers in Kwara State • The first target group in Kenya is the Tanykina Dairy Plant Ltd. private limited company, jointly owned by its members. Its current group size totals 20.000 people. • Two schemes operational in Tanzania: 40.000 members of the Promotion of Rural Initiatives and development Enterprises Limited and their households (Dar-es-Salaam) and 40.000 coffee farmers, members of the Kilimanjaro Native Cooperative Union and their households (Moshi region)

Success factors

• Sustainable healthcare financing model: Multi-funding strategy; predictable and affordable income streams for local healthcare providers • Improved aid effectiveness and reduced risks of crowding-out private and public resources • Using private healthcare providers for reaching public health goals • Improved healthcare provision

41


HOW CAN PARTNERS PLAY A ROLE? In this chapter, the authors of this guideline aim to demonstrate the scope of their experience and competencies and how they can support private organisations throughout the PPP lifecycle.

PharmAccess assistance to private and public sectors in developing PPPs: a comprehensive intervention package Since its inception in 2001, the Dutch not-for-profit organization PharmAccess Foundation operates at the cutting edge of health sector support in Africa, notably by harnessing the private sector to address public health

Facilitation of communication and collaboration between partners

issues like HIV/AIDS. PharmAccess works closely with the public and private health sector and companies, aiming

Technical assistance in program management

to alleviate the healthcare burden of African governments through the establishment of public-private partnerships. Training and supervision of program staff (including medical staff)

Based on various public-private collaborations spanning across several-countries - North Star Alliance, Health Insurance Fund - to in-country programs - Bophelo! Mobile clinics as well as CIB/Olam and Heineken workplace

Health financing instruments

Quality assurance of medical interventions

programs - PharmAccess has developed a unique expertise in bringing together public and private players and assisting them throughout the process of forming

42


a partnership. PharmAccess has also developed a range

efficiency and quality of care. A cross-sectoral approach

of health financing instruments which facilitate the

that combines the strengths of public and private actors is

mobilization of additional resources.

therefore crucial for durably and effectively strengthening health systems in Africa.

By understanding both public and private languages and perspectives, PharmAccess can usefully intermediate

To achieve the goal of improving health systems and

between the two sectors to structure and manage the

access to healthcare in developing countries, PharmAccess

partnership. PharmAccess can play a crucial role at

has established three innovative funds to improve the

all stages of the PPP lifecycle e.g. facilitating informal

quality of healthcare in Africa - the Health Insurance

discussions with potential partners, advising partners on

Fund, the Medical Credit Fund and the Investment Fund

how to formalize the relationship, assisting in proposal

for Health in Africa - thus contributing to stimulate both

writing and partnership program design.

the demand for and the supply side of healthcare. To do so, PharmAccess supports programs and offers services in

Throughout the development phase of the program,

the areas of medical and administrative capacity building,

PharmAccess can assist with the initial needs and demands

health insurance, medical credit funds, HIV/AIDS and

assessment and can provide expert advice on activity

healthcare workplace programs, health investments,

contents as well as for the development of a strong

development of innovative health products and services,

monitoring and evaluation framework.

and the collection of key information on health systems in developing countries.

During the program implementation phase, PharmAccess provides medical expertise and technical assistance not

As a result, PharmAccess offers its unique expertise to

only in terms of program management but also in ensuring

various types of partners and is present in different regions

the quality of healthcare activities by assessing healthcare

of Africa with local offices in Tanzania, Kenya, Namibia,

providers and supporting them in upgrading and acquiring

South Africa and Nigeria.

certification of their services. For more information, see also PharmAccess Foundation’s website: www.pharmaccess.org

Dealing with complex diseases such as HIV/AIDS, TB and Malaria implies several issues including stigma and discrimination, respect of confidentiality and fairness addressing these issues.

The Dutch Public Private Partnership Forum – Facilitating inter-partnership collaboration

Pioneering new approaches:

In 2004, PharmAccess initiated the Dutch PPP

PharmAccess vision

Forum, a working group of representatives from

of employment. PharmAccess can provide assistance in

Heineken, Shell, Air France/KLM, North Star PharmAccess Foundation (PharmAccess) is a Dutch not-

Alliance and the Dutch Ministry of Foreign Affairs.

for-profit organization dedicated to the strengthening of

The Forum members strongly believe that joint

health systems in Sub-Saharan Africa. Its ultimate goal

contribution by engaging business and tapping

is to improve access to quality basic healthcare including

private sector assets and expertise can improve

the treatment of HIV/AIDS. PharmAccess supports

the efficiency, effectiveness and sustainability of

programs and offers services in the areas of medical

government programs to fight HIV/AIDS, TB and

and administrative capacity building, health insurance,

Malaria. Representatives of the PPP Forum regularly

HIV/AIDS and healthcare workplace programs, health

share their public-private initiatives for contributing

investments and health intelligence.

to the achievement of MDG 6 in the ‘Working Hand in Hand’ booklet. Since its creation, the

Developing an optimally functioning health system

Dutch PPP Forum has released three issues of this

therefore requires an alignment of both demand and

booklet.

supply of healthcare combined with a focus on improving

43


Partners Against AIDS (PCS) and SIDAENTREPRISES: custom made assistance for companies

communication, advocating the issues and needs of the corporate world to public institutions and administrations, funding partners and NGOs.

PCS and SIDA-ENTREPRISES provide companies with custom-made assistance in defining their health policies

Working closely with UNAIDS and OIT, PCS and SE

and setting up quality and sustainable health programs.

can provide sectorial analysis and advise and facilitate

They operate at both levels for local companies/subsidiaries

discussions with all national stakeholders in order to

and Group headquarters.

incorporate the private sector into national programs (PNLS, PNLP…).

SERVICES TO OPERATIONAL SITES Based on a diversified experience of health programs with

SERVICES TO COMPANY HEADqUARTERS

companies’ headquarters in France and international/

PCS and SE offer services to headquarters and companies

national companies in Africa, PCS and SIDA-ENTREPRISES

in Africa wishing to design global health policies and to

(SE) can provide field assistance to companies, drawing

organize and monitor their implementation at the local

up quality and organizational assessments (cost efficiency

level. SE and PCS can operate in various programs against

studies, KABP surveys, best practices analysis), providing

HIV, TB, Malaria and other chronic pathologies (diabetes,

training (for project managers, doctors, nurses and peer

hypertension).

educators) and guidance to enhance, adapt or re-launch health programs.

By providing a strategic watch on medical information and best practices, organizing seminars and trainings for CSR

By partnering in two public-private partnerships beside

managers/staff involved in health policies and programs

the German cooperation (GIZ), the timber industry of

and developing custom made tools (policy, action plan,

Cameroon (GFBC) and the Guinea Chamber of Mines

monitoring & evaluation framework...), PCS and SE can

(CMG) - PCS developed a solid expertise in modelling and

build and enhance companies’ capacities to tackle health

enhancing PPPs through continuous monitoring and the

issues and to help their subsidiaries engineer the Group’s

development of M&E tools and framework.

policy.

By creating a bridge between public, private and civil

For more information, see the following websites:

stakeholders, PCS and SE act as a go-between for

www.partenairescontrelesida.org

companies in the development and implementation

www.sidaentreprises.org

of health programs: facilitating internal and external

www.canalprevention.org

Design, costing

Mobilizing stakholders & donors (companies & workers, public authorities, NGOs, communities)

& continuous adjustment

Situation analysis (Feasibility & needs assessment, KAPB study, mapping)

Monitoring & Evaluation

Group health policy & Action plan

Training

Company headquarters &

(CSR manager, health committee, doctors, nurses, peer educators)

subsidiaries

44


PARTNERS AGAINST AIDS AND SIDAENTREPRISES Partners Against AIDS (PCS) is a non-profit organization, founded in May 2006 by SIDA-ENTREPRISES and the Global Business Coalition with the financial support of the Agence Française de Développement (AFD). The association SIDA-ENTREPRISES was created in 2003 by a group of French multinational companies established in Africa who needed expertise in enhancing health programs towards employees, their families and the surrounding communities. SIDA-ENTREPRISES bridges its affiliated companies: ACCOR, ALCAN-Rio Tinto, Allianz, ASCOMA, BGI (Castel Group), BNP Paribas, Bolloré, CFAO, Club Méditerranée, Gras Savoye, Imperial Tobacco, Société Générale, SOMDIAA, OPTORG and TOTAL. Moreover, SIDA-ENTREPRISES has strong links with the national confederation of French employers (Mouvement des Entreprises de France -MEDEF) and the trading assistance council for investment in Africa (Conseil Français des Investisseurs en Afrique -CIAN). PCS and SIDA-ENTREPRISES share the same objective: to assist companies in tackling health issues at the workplace. After several years of operation in France and Africa, both organizations decided to partner in 2010, pooling together their networks, expertise and projects.

45


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ANNEX 1: DIRECTORY OF MULTILATERAL AND BILATERAL AGENCIES This section presents the various types of assistance that

improve people’s lives primarily by: financing private

the main international institutions can provide to the

sector projects in developing countries, assisting private

private sector or to PPPs.

companies in developing countries mobilize financing in international capital markets, and providing advice and

Multilateral organizations

technical assistance to businesses and governments in these countries.

Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)

In its developing member-countries IFC offers a wide

Created in 2002, the Global Fund to Fight AIDS,

range of financial products and services to companies in

Tuberculosis and Malaria is one of the principal

all major industries and sectors, including: manufacturing,

international funding mechanisms for HIV/AIDS, TB and

infrastructure, health & education, as well as financial

Malaria. As of March 2010, the Global Fund had approved

markets.

US$ 19.3 billion worth of grants to programs in 144 low - and middle - income countries. Funding is provided

To be eligible for IFC financing, projects must be profitable

to countries via the Country Coordination Mechanisms,

for investors, benefit the economy of the host country, and

country-level multi-stakeholder partnerships in charge of

comply with standard environmental and social guidelines.

grant proposal development and submission to the Global Fund. After grant approval, they oversee progress during

IFC charges market rates for its products and does not

implementation.

accept government guarantees. In addition, to ensure the participation of investors and lenders from the private

Country Coordinating Mechanisms include representatives

sector, IFC limits the total amount of the financing it will

from both the public and private sectors, including

provide for any single project to a maximum of 25% of the

governments, multilateral or bilateral agencies, non-

total estimated project costs, or, on an exceptional basis,

governmental organizations, academic institutions, private

up to 35% for small projects. IFC investments typically

businesses and people living with the diseases.

range from US$ 1m to US$100m.

For each grant, the Country Coordinating Mechanism

World Economic Forum (WEF) - Global Health

nominates one or more public or private organizations to

Initiative (GHI)

serve as Principal Recipients. The Global Fund encourages

Launched by Kofi Annan at the World Economic Forum

Country Coordination Mechanisms to include private

Annual Meeting 2002 in Davos, the Global Health

sector representatives

Initiative’s mission is to catalyse new PPPs in public health and drive existing ones in developing countries.

In the last years, there has been growing promotion of private sector applications to the GFATM funding process,

The GHI can assist member companies in their public

at all stages of the cycle: Grant proposal process, grant

health efforts by:

negotiation and implementation of the proposal. •

Acting as a catalyst and convener of partnerships,

World Bank Group:

by identifying needs, developing ideas, providing

The main World Bank Group institution primarily involved

technical advice and guidance, and launching

in private sector development is the International

partnerships

Finance Cooperation (IFC).

Identifying appropriate partners and ensuring the ongoing presence of a driver

The IFC promotes sustainable private sector investment

in developing countries as a way to reduce poverty and

Acting as the initial driver in partnerships and, in some cases, ensuring smooth transition to a permanent

48


Bilateral organizations

driver. Through its involvement in global and regional PPPs, the GHI: •

• •

Delivers innovative workplace programs to tackle

USAID

HIV/AIDS, tuberculosis and malaria across Africa and

As part of its endeavor to fulfill the need for quality

South, East and South-East Asia.

HIV/AIDS services, the U.S.Agency for International

Strengthens the health system in sub-Saharan Africa,

Development (USAID) – in cooperation with the U.S.

starting with a pilot project in Ghana

President’s Emergency Plan for AIDS Relief (PEPFAR) –

Supports global and regional public-private

designs and enters into public-private partnerships in

partnerships, such as the Global Fund to Fight AIDS,

developing countries. The reauthorization of PEPFAR in

Tuberculosis and Malaria, the Stop TB and Roll Back

2008 brought a new focus on sustainability of services in

Malaria Partnerships, the China Health Alliance and

partner countries, which USAID works to support through

the India Business Alliance

public-private partnerships. USAID’s Global Development Alliance:

See also http://www.weforum.org/issues/global-health

www.usaid.gov/our_work/global_partnerships/gda/ UNAIDS

USAID’s Public-Private Partnerships in HIV/AIDS:

UNAIDS, the Joint United Nations Program on HIV/AIDS,

www.usaid.gov/our_work/global_health/aids/Partnerships/

brings together the efforts and resources of ten UN system

partnerships_brief.html

organizations to the global AIDS response, with the aim to help mount and support an expanded response – one

Pepfar

that engages the effort of many sectors and partners from

Recognizing that partnerships are needed to sustain

government, civil society and the private sector.

programs for the long-term, Congress authorized PEPFAR to promote public-private partnerships (PPP) as a priority

UNAIDS seeks partnerships with the private sector that can

element of U.S. strategy to combat the HIV/AIDS pandemic

help us fulfill our mission e.g. through alliances that can

and other global health crises. PEPFAR has fostered public-

provide support, directly and indirectly, to UNAIDS’ work.

private partnerships that support and complement its

UNAIDS’ alliances with the private sector can take many

prevention, care, and treatment work

forms: programmatic partnerships, advocacy, fundraising For a project to be considered a PPP, the private sector

support, or contributions-in-kind.

must contribute at least as many resources - cash and Every company can make its own contribution to the AIDS

in-kind - as PEPFAR contributes in funding. Private sector

response based on its size, type of workforce, geographical

partners include a wide range of organizations such

range, financial strength and core capabilities. While

as: foundations, U.S. and non-U.S. private businesses,

models for partnerships are practically limitless, activities

business and trade associations, unions, venture capitalists,

often fall into one of four main categories:

and social entrepreneurs.

1. HIV workplace programs;

Public-private partnerships are a tool to enhance the global

2. Advocacy;

response to HIV/AIDS, and will support the transition

3. Cash donations;

to more sustainable country programs. The PEPFAR PPP

4 In-kind contributions.

Strategy can be found at the following link: www.pepfar.gov/strategy/global_context/134290.htm Several examples presented on the website to illustrate the diversity of PEPFAR’s public-private partnerships in support of HIV/AIDS prevention, treatment and care programs: PEPFAR’s Public-Private Partnerships: http://www.pepfar. gov/ppp/index.htm Category Bilateral/Multilateral

49


Dutch Ministry of Foreign Affairs – MinBuZa

(Abstract from Publiek-Private Partnerschappen. July 2010)

Technical planning and procurement of materials and equipment for projects;

Organization and undertaking of advanced training.

Definition of PPP: “Cooperation of Government with private sector and often with third part consisting of Civil Society

The AFD and the PROPARCO

organizations – e.g. NGOs, Unions, University – where

As a financial institution, the French Agency of

risks, responsibilities, means and competences are shared

Development (AFD) is at the center of the French system of

to reach a common goal and implement a specific task..”

public help for the developing countries. Thanks to a set of financial tools, the AFD assists public institutions, private

There are three major advantages in PPPs according to the

sector and the local association networks in setting up

Dutch Ministry of Foreign Affairs

economic and social projects.

Introduce and test innovative approaches to

The society of promotion and participation for the

development issues; combine knowledge, know-how

economic cooperation (PROPARCO) is a branch of the

and resources from different worlds

AFD (held up to 66.8% by the AFD). Established in

Business-like approach, performance-based can

1977 to stimulate investments and the different markets

effectively help address development issues

while granting bank assistance in a both profitable and

Participation of the private sector in the countries

useful way, it specialized in supporting the private sector.

they operate in through PPPs can contribute in a

Alongside the strictly economic goals, PROPARCO’s aims

sustainable way to poverty reduction and more

are to promote the access to education and healthcare.

especially to mitigate the spread of infectious diseases.

Regarding healthcare, we come across the “social effects”

• •

criterion when it comes to the identification indicators The Dutch Ministry of Foreign Affairs provides financial

of the projects, gathering the impact and integration of

support to public private partnerships established to close

the set of the healthcare, education, continuous training

gaps in healthcare provision.

problems...

Deutsche Gesellschaft für Internationale

The PROPARCO financing and co-financing between 2007

Zusammenarbeit (GIZ)

and 2009 helped supporting 8000 companies in a CSR

The GIZ is an international co-operation enterprise for

process.

sustainable development, with worldwide operations. Its mission is to contribute to improving the living standards and perspectives of people in developing and transition countries on a sustainable basis. GIZ mostly undertakes technical co-operation tasks, encompassing not only the dissemination of technical knowledge, but more importantly the transfer of organizational and business-related know-how. GIZ’s services include: •

Advisory assistance to organizations, governments, or companies performing their tasks;

Project and financial management services;

Non-repayable financial contributions from the Technical Cooperation Fund such as grants, processes and disburses;

50


ANNEX 2: 7 CASE STUDIES

workforce. •

CIB - Danida public private partnership

CIB alone could not bear the financial costs of the program and sought additional financial support. The Danish International Development Agency (DANIDA)

Strengthening and expanding the HIV/AIDS prevention,

was prepared to co-fund the program, within its

care and treatment workplace program to the surrounding

Innovative Partnerships for Development Program

communities in the forest concessions of a logging

(IPD).

company The Government’s willingness to collaborate with the Background

private sector through the provision of free ARV treatment

Congolaise Industrielle des Bois (CIB), a former subsidiary

and HIV testing products, is in line with the Universal

of the Danish logging company Dalhoff Larsen &

access to ARV and HIV testing policy implemented in 2007.

Horneman (DLH), operates in remote tropical forest concessions in the north of the Republic of the Congo.

As a result, a PPP was created in 2009 to alleviate

The company’s logging activity has attracted population

the impact of HIV/AIDS on workers, dependents and

groups in areas deprived of any kind of public facilities.

communities living in the CIB concessions, bringing

As a direct consequence of the company’s presence, a

together financial support from DANIDA, financial and

number of factors contributed to an increased risk level of

in-kind resources from CIB and technical assistance from

HIV infection in the concessions:

PharmAccess.

Limited access to HIV prevention, testing, care and

Objective

treatment in a remote forest area

The PPP aims at strengthening and expanding the HIV/

Exploitation site deprived of a public health facility:

AIDS prevention, care and treatment workplace program

the nearest public hospital is a one hour and a half

for the benefit of workers, dependents and communities

boat ride away

living on CIB concessions.

Relatively high HIV prevalence in the CIB concessions – in comparison to the national HIV prevalence. This

Structure

can be attributed to the presence of HIV vulnerable

Partners involved

groups – e.g. migrants and mobile workers; sex Primary partners:

workers and clients and indigenous people – and to the economic and commercial activities created by the

company - men with money in remote and poor area.

Congolaise Industrielle des Bois (CIB), a former subsidiary of the Danish logging company Dalhoff Larsen & Horneman (DLH), Olam International (since

In addition to these, four main driving factors have

2011)

facilitated the creation of the partnership:

The Danish cooperation agency DANIDA, within the Innovative Partnerships for Development Program

• •

The company’s engagement was, up to 2010, part of

(IPD) supporting partnerships for advancing strategic

the DLH Corporate Social Responsibility program.

Corporate Social Responsibility (CSR)

The Forest Stewardship Council (FSC) certification

Congolese health institutions: National AIDS Program

had a pulling effect on the company’s engagement in

(Secrétariat Exécutif Permanent/Comité National de

combating HIV/AIDS. This international independent

Lutte contre le VIH/SIDA (SEP/CNLS)), Ministry of

label promotes responsible management of the

Health, National laboratory

world’s forests and ensures the certified companies’ Secondary partners:

access to the consumer market. One of the FSC standards is the compliance with national laws in

PharmAccess Foundation

the company’s country of operation. The companies

Congolese prevention NGO

operating in the forest industry are strongly advised

Congolese HIV care and treatment NGO and the

by the government of the Republic of the Congo to

International Red Cross (Centre de Traitement

implement HIV/AIDS prevention activities for their

51


Ambulatoire Brazzaville)

Results to date

UNICEF for prevention of mother-to-child transmission

(since 2011)

Tasks and responsibilities are well defined and shared between local management team members

Focused Prevention and Awareness activities including

Partnership organization

peer education program among the workforce and

the community implemented

Initial needs assessment “feasibility study”: Preliminary study and feasibility study conducted in 2006 and

2007. PharmAccess has played an important role in

services

initiating the partnership and bringing the various

Increased VCT uptake

partners together.

Increased number of patients on ARV treatment: 140

Proposal submitted in 2008 to DANIDA by DLH/CIB

HIV+ patients on ARV treatment: 38% CIB employees

with the support of PharmAccess Foundation. As a

and dependents / 62% community

result, DANIDA awarded the partnership a three-year •

with the local government in terms of quality control,

A local management team consisting of the

ARV treatment, HIV tests provision and trainings via the National AIDS Program

2 medical doctors

• •

Increasing involvement of and improved relationship

funding grant for the program (from 2009 to 2011). company’s human resource manager, 2 assistants and •

Increased quality of HIV/AIDS care and treatment

Close collaboration with local HIV care and treatment

Monthly local management team meetings organized

(CTA) and prevention NGOs for quality control, ARV

for project follow up

treatment, trainings on HIV testing and prevention

Technical assistance on HIV/AIDS care and treatment

Signed company policy for the prevention of HIV, the

and prevention activities provided by local NGOs

aid, and non-discrimination of employees, and the

Quarterly PharmAccess visits for quality monitoring

population living with HIV within the CIB concessions

and capacity building. Challenges Roles and responsibilities •

The local management team is responsible for the

and testing equipment): the lack of international

day to day implementation and management of the

funding could lead the government to interrupt the

program

provision of ARV drugs and testing equipment. In the

PharmAccess Foundation is responsible for the

occurrence of such an event, an alternative solution

technical support and quality assurance of the HIV/

has yet to be found to ensure treatment continuity.

AIDS program •

Fragile medical supplies provision (ARV drugs

The economic situation poses the greatest challenge

Overall monitoring of project; quarterly reporting to

to the partnership and the HIV program itself. In the

DANIDA; budget and financial coordination executed

midst of the economic crisis, the company can be

by DLH CSR coordinator based at the company’s

tempted to reduce its contribution to healthcare and

headquarters in Copenhagen.

social activities in order to reduce its expenses. •

CIB has recently been bought over by the Singaporean

Legal framework of the partnership

company, Olam International. In order to sustain

A formal contract has been signed between DANIDA

the CIB HIV/AIDS program, DANIDA has already

and DLH/CIB

expressed its interest in transferring its support to

A service provision contract has been signed with

Olam International, which has also developed a

PharmAccess

CSR strategy aiming at making meaningful social

A service provision contract has been signed with the

contributions to the communities within which

local prevention partner

it operates. However this change will require

A Memorandum of Understanding has been signed

adjustments in order not to disrupt the HIV/AIDS

between the National AIDS program and CIB

program.

• • •

52


Interesting partnership model for: Companies operating in remote areas deprived of public health facilities such as mining companies and logging companies. Companies confronted with HIV/AIDS and other infectious diseases prevalent among their workforce. For more information about this partnership, please contact: Dr. Rinse Meester (CIB): +242 06 900 12 88 rinse.meester@cibpokola.com Marie Vicart (PharmAccess): m.vicart@pharmaccess.org

53


CHAMBRE DES MINES DE GUINÉE

Structure Partners involved

Strengthening HIV/AIDS prevention, care and treatment in

the mining sector, Guinea

The Guinea Chamber of Mines (CMG), a Guinean professional organisation

The German cooperation agency, GIZ

Background

PCS

Mining is the main sector of economic activity in Guinea. It

Non contractual partners : Guinea’s Ministry of Health

largely contributes to the country’s national income (22%

and the National Plan of Fight against AIDS .

of GDP) and a large proportion of the Guinean population

depends on the sector.

Civil society organisations : PSI, CMG HIV/AIDS committee members, NGO AFEGMASSI

HIV prevalence in the mining sector (5.2%) is much higher

Partnership organization

than the national prevalence (1.5%) due to various factors

In 2008, a situation analysis was conducted by PCS.

such as the remoteness of the mines, (men far away from

The partnership was subsequently launched in 2009

their steady partners) and the long distances to the nearest

with six mining companies.

health centers.

The management committee meets three times a year for program follow up.

In response to this issue, leading mining companies such as

Management structure: A management team

Rio Tinto and SAG started developing most of the existing

consisting of a coordinator, an administrator, and 2

HIV/AIDS policies for their workers and dependents.

medical doctors. A CMG committee composed of the management team and private medical doctors from

In 2003, The Guinea Chamber of Mines (CMG), a

the mining companies.

Guinean professional organisation gathering 66 national

In 2010, the GFATM approved the round 10 grant

and international firms in the mining sector, developed

requested by Guinea. CMG was awarded as a

and implemented a HIV/AIDS program for its workers,

principal grant recipient along with CNLS. PCS has

dependents and neighbouring communities. The program

played an important advocacy role on behalf of the

includes both prevention and care and treatment activities

CMG.

and is conducted in collaboration with the National AIDS Program (PNLS) and both international (USAID, GTZ, PCS,

Roles and responsabilities

GFATM, PSI) and local partners.

CMG : Human resources contribution (coordinator) and mining companies’ medical infrastructure

Objective

provision and logistical assistance for medication and

The PPP aims at reducing the risks of HIV transmission

medical consumables’ supply.

as well as its impact on the workers, dependents and

GIZ: Temporary ARV provision, medical capacity

communities while assessing the extent of the epidemic’s

building and technical assistance for M&E and

negative impact on the mines’ productivity.

program follow-up.

Activities Prevention activities are developed by the mining companies and are held at the workplace. Voluntary, Counselling and Testing (VCT) sessions are organised for staff, dependents and the local communities. Access to HIV/AIDS care and treatment is facilitated through both national healthcare providers and companies. ARVs are provided free of charge by the Government to all program patients.

54


PCS: Technical assistance in medical and program

Challenges

management capacity building (M&E, project

Weakness of the public sector in ARV provision

management, administrative and organisational

Poor quality of public healthcare services which could lead to an overload of private health structures.

assistance). • •

PNLS/MoH: Provision of technical and medical program guidelines.

Interesting partnership model for:

Civil society organisations such as PSI, members of

Mining companies, logging companies and, generally,

the CMG committee and the NGO AFEGMASSI,

companies operating in remote areas deprived of public

provide technical advice for prevention and awareness

health facilities such as companies confronted with HIV/

activities and HIV testing at CMG health facilities.

AIDS and other infectious diseases prevalent among their workforce.

Legal framework •

Partnership agreement between CMG and GIZ.

For more information about this partnership,

Partnership agreement between CMG and PCS.

please contact:

Common logical framework and reporting adopted by

the three partners.

Mr. Chaikou Diallo (CMG):

A partnership agreement has been signed with the

chaikouyaya.diallo@cbg-guinee.com - chaikouyaya@

PNLS to incroporate six CMG private hospitals into the

yahoo.fr

National AIDS Program.

Dr Komi Ahawo (GIZ): Komi.Ahawo@giz.de

Results to date

Mr Felix de Marliave (PCS):

f.marliave@me.com

Access to ARV treatment for new patients and nearby communities

HIV/AIDS Voluntary Counseling and Testing (VCT) provided to large numbers

Increasing treatment uptake for PLWHA : 400 PLWHA currently on ARV treatment

42 CMG doctors and 33 CMG nurses received training on HIV/AIDS care and treatment

Testing materials are available, two CD4 meters are operational, three more are planned on three mining sites and two viral load meters on two private hospitals recognised as HIV/AIDS care and treatment reference centers

CMG has been selected as principal recipient of the GFATM Round 10 (R10) grant and will receive USD 13 million for the coordination of HIV/AIDS healthcare interventions in the mining sector and for monitoring the HIV/AIDS activities of several NGOs.

Success factors •

Companies’ involvement in the project

CMG’s award as principal recipient at the GFATM Round 10 Grant for Guinea which will enhance the impact and the scope of the PPP and strenghen CMG’s capacities.

CMG’s perseverance in the fight against HIV/AIDS, particularly the continuous involvement of its leaders.

55


Groupement de la filiere bois du Cameroun

The PPP aims at improving access to HIV/AIDS prevention, care and treatment for the benefit of timber industry workers, their dependents and communities living in GFBC

Improving access to HIV/AIDS prevention, care and

concessions.

treatment in timber concessions in Cameroon Activities: Background

HIV/AIDS prevention activities, including Voluntary

The Groupement de la Filière Bois du Cameroun (GFBC),

Counselling and Testing (VCT) at the workplace,

an alliance of the timber companies in Cameroon, is

in collaboration with local NGOs and public health

a federation of 12 national and international timber

facilities

companies operating in timber concessions in Cameroon.

Organization of a management body (the HIV committee) within each company to oversee the

The settlement of these concessions and their logging

program : training of management staff, medical

activities attracted migrant and mobile workers in remote

doctors and nurses, peer educators, counselors

and poor areas. This contributed to the region’s economic

Design and organization of a referral system and a

and commercial development but eventually increased the

network of health facilities at the concession level to

risks of HIV transmission in areas deprived of public health

facilitate HIV/AIDS care and treatment through both

facilities.

public (CTA & UPEC) and private health facilities.

Three main driving factors facilitated the implementation of

Structure

the partnership.

Partners involved

Primary partners

The code of Labor in Cameroon obliges companies to guarantee the health and safety of their workers and

families. •

The Groupement de la Filière Bois du Cameroun (GFBC), an alliance of timber companies in Cameroon

The certification standards regarding health and social

The German International Cooperation, GIZ

responsibility required by the Forest Stewardship

Partners Against AIDS (PCS)

Council (FSC) coupled with the competitive climate in

Non contractual partners: Cameroonian health

the sector urged the timber companies to address the

institutions: National AIDS Program (Comité National

HIV/AIDS issue.

de Lutte contre le VIH/SIDA – CNLS and PNLS),

In May 2006, GFBC assessed the HIV prevalence

Ministry of Health (MoH), CENAME.

among the timber sector’s workforce at 9% - which is higher than the national prevalence of 5.5% - and

Potential partners

understood the danger that HIV/AIDS constitutes for

IRD, ACMS, PNLP, ESTHER (C2D), International and

its workforce and productivity. This study eventually

Cameroonian Red Cross

convinced timber companies to implement HIV/AIDS Partnership organization

programs for their employees and their dependents.

In 2006, GFBC requested GIZ’s assistance in

Lacking the financial resources and technical expertise to

conducting an initial needs assessment and situation

develop the program on their own, the GFBC along with

analysis on the impact of HIV/AIDS on the timber

6 affiliated companies set up a PPP with GIZ (German

companies’ workforce,

International Cooperation) and the Cameroonian

Government in 2007. Partners Against AIDS joined the

GFBC and GIZ launched the partnership with 6 affiliated companies. An external consultant was

partnership in 2008.

recruited for the implementation of the activities. •

In 2007, GFBC requested the assistance of PCS who joined the PPP in 2008.

• Objective

A steering and management committee was established for the project follow up and capacity

56


building. All partners and stakeholders meet quarterly.

Results to date

An organizational and quality assessment of the PPP

program was conducted in 2009. As a result, GFBC,

project (from 6 in 2007 to 10 in 2011).

GIZ and PCS decided to give GFBC full responsibility

6,700 workers, 26,900 dependents with a catchment

program.

area of 77,500 inhabitants have access to the

Local management team consisting of 3 permanent

program. •

assistant. The team reports to all partners involved. Roles and responsibilities All three partners have shared governance

Peer education program among workforce and

responsibility through the steering & management

community implemented: 298 peer educators trained

committee with quarterly meetings and regular visits

and 32 HIV committees established. •

Creation of a network of 42 public and private

GFBC is the program leader, supervising the local

healthcare facilities. 5 of the private facilities provide

management team.

HIV/AIDS care and treatment services

Each timber company makes its staff, logistics and

facilities available for activities held on its concessions

Options for sustainability are being studied, for instance the implementation of a private medical

and industrial sites. •

517 PLWHA treated and monitored, 31 of them are on ARV treatment.

to program sites

14,800 people attended awareness sessions, 8,500 people were tested and counselled,

Coverage: 34 logging concessions. An estimated

for the coordination and management of the

employees: a coordinator, a medical doctor and an

Increasing number of companies involved in the

scheme.

Over the past 3 years, GIZ and PCS focused their

Current extension of the program to activities

contribution on expertise needs such as:

addressing Malaria, Tuberculosis, clean water &

»» Program coordination, administration-

general hygiene.

accountancy and communication: capacity building on reporting, monitoring, evaluation and

Success factors

communication processes.

»» Medical expertise for all health related activities:

Strong leadership of the GFBC and consistent commitment of the GFBC affiliated companies to

awareness campaigns and testing and counselling

continue the program and to look for new partners

of employees and families. Responsibility for

(NGOs)

these activities is gradually being handed over

Stimulation of the competitive environment in a

to the companies, once their autonomy level is

context where the labor law in Cameroon and the

sufficient.

social standards required by the FSC certification

»» Training of companies’ staff, i.e. HIV committee

regarding healthcare oblige the timber companies

members, company medical doctors and nurses,

to provide their workers and dependents with HIV

peer educators, peer educators trainers, medical

prevention and to cover their healthcare.

counsellors.

Partnerships with the government for the access to public healthcare providers (CTA, UPEC) for HIV/AIDS

Legal framework

care and treatment. A MOU with the MOH could be

discussed in 2011.

A Memorandum of Understanding between GIZ, GFBC and PCS with a common logical framework, indicators, action plan and budget

A contractual agreement between the GFBC and GIZ

A contractual agreement between the GFBC and PCS

Interesting partnership model for:

Logical framework and common reporting

Logging companies and mining companies and generally,

There is no national agreement with the public sector

companies operating in remote areas deprived of public

for this program but local contractual agreements

health facilities such as companies confronted with HIV/

exist at the concessions level between companies and

AIDS and other infectious diseases prevalent among their

CTA or UPEC.

workforce.

57


For more information about this partnership, please contact: Ms. Jeanne Nsoga (GFBC): pppvihsidagfbc@yahoo.fr Ms. Sonia Sheikh & Dr. Gerd Eppel (GIZ) : +237 22 23 93 11 - Sonia.sheikh@giz.de Ms. Agnes Joyeux (PCS) : agnes.joyeux@yahoo.fr

58


Bophelo ! Mobile PHC services Namibia

The follow up from Bophelo! is a full blown PPP providing primary healthcare services to communities located in

Providing mobile primary healthcare to rural and remote

remote areas.

populations in Namibia *AEA wages survey 2010 and Statistics, MAWRD 2005 Background The agriculture sector is one of the most important

Objective

economic sectors in Namibia, with the commercial farming

The objective of this partnership is to provide regular

sector alone employing around 40,000 individuals with

mobile primary healthcare to remote and rural workplaces

around 80,000 dependents living on commercial farms*.

and communities in Namibia.

A 2007 PharmAccess study revealed that people living in

Structure

rural areas in Namibia have limited access to healthcare.

Partners involved

One of the greatest challenges for rural communities to Primary partners:

access healthcare are the long distances to healthcare facilities. According to the study, the average one-way

distance of travel to healthcare facilities was 42 km to

PharmAccess Foundation Namibia: Primary healthcare service delivery

reach a mobile clinic, 64 km for clinics, 99 km for doctors,

107 km for hospitals and 133 km for dentists.

Ministry of Health and Social Services: provision of medication

Heineken Africa Foundation / Namibia Breweries /

Although the Ministry of Health and Social Services of

Olthaver & List: funding for the acquisition of the

Namibia (MOHSS) provides outreach services with a 4x4

mobile clinics

in certain areas, many regions of Namibia are deprived of

USAID: donor for technical assistance in setting up an

primary healthcare services.

Memorandum of Understanding with MOHSS

The study also highlighted that 80% of employers would

Potential secondary partners:

be willing to co-pay for their employees and 41% would

be willing to co-pay for dependents to receive healthcare

Namibia Business Coalition on AIDS: Social marketing of services

if primary health facilities were available within a 20km

Namibia Institute of Pathology: quality assurance

radius of their farm.

Agriculture companies: contractor for the services

Partnership organization

In 2009, Bophelo! was created to conduct mobile multi-

Project approved in 2010

disease screening (blood pressure, body-mass index, rapid

A pilot project was conducted in the last quarter of

blood screening for glucose, cholesterol, haemoglobin,

2010

syphilis, hepatitis B and HIV) at public and private

A steering group committee has been set up

workplaces. Bophelo! was a private-private partnership

Meetings with MOHSS are ongoing

made of Namibia Business Coalition on AIDS (marketing and workplace program support) and PharmAccess (service delivery). The initiative was funded by international donors (USAID, Global Funds, Dutch organizations) as well as by companies contracting Bophelo! for the provision of mobile screening services. At the time, the Namibian Government’s contribution (Ministry of Health and Social Services) was limited to enabling the partnership’s operation through the licensing of the mobile testing facilities.

59


Roles and responsibilities • •

high interest of the donor community

PharmAccess Foundation is responsible for the day to day management of the program

Challenges

The partnership’s steering committee consists of:

- NABCOA

Not all employers are interested in paying for the service

- Namibia Institute of Pathology

For this model to be sustainable, large numbers of

- Namibia Breweries / Olthaver & List (representing

beneficiaries are needed. However, this is not easy in a

Heineken Africa Foundation)

low density country such as Namibia

Legal framework of the partnership

interesting partnership model for:

An organisation/association of rural employers

A formal contract has been signed between Heineken Africa Foundation, Namibia Breweries/Olthaver and

List and PharmAccess

For more information about this partnership,

A letter of support to the partnership has been issued

please contact:

from MOHSS in Namibia •

A Memorandum of Understanding with the MOHSS is

Rina Hough:

foreseen in 2011

+264 61 307711 / r.hough@namibia.pharmaccess.org

Results to date

Or consult the PharmAccess website:

3 round trips of approximately 500km over 12 days

www.pharmaccess.org

28 sites - 30 participating farmers, rural primary school, nutritional support programme

1,925 visits; 1,103 children / 822 adults

Logistics and costing model developed

Success factors •

New and innovative approach leveraging private sector resources to support public health

Public contribution through licensing, free vaccines provision and quality assurance: Ministry of Health and Social Services and the Namibia Institute of Pathology

Sustainability options including the potential establishment of a low cost insurance option, employers’ financial contribution, the involvement of Government bodies for medication provision and the

60


North Star Alliance

Structure Beyond providing logistical expertise, knowledge of and

Building a network of basic healthcare centres for mobile

access to transport operators and in-kind contributions

populations and the communities along Sub-Saharan

such as human resources and office space, TNT brought

transport corridors

in formidable impulse to the partnership by means of Peter Bakker, CEO of the multinational company. Through

Background

a sustained individual commitment, Peter Bakker made

Both the vulnerability of transporters and their role as a

use of his reputation for advocating the initiative towards

vector for the transmission of HIV and other communicable

potential partners.

diseases pose two main challenges to the transport industry and those who depend on it for commercial,

WFP contributed to North Star’s credibility and legitimacy

public and humanitarian purposes:

by using its authority on the international development scene. WFP opened its United Nations network – both

Human resources: Many transporters are losing

international and regional – to North Star by introducing

skilled employees to AIDS faster than they can

North Star to WFP regional offices and later engaging a

train new employees; a direct threat to business

major UN agency – UNAIDS – into the partnership. WFP

sustainability. In the most severely hit regions of

also provided initial funding for starting up North Star’s

Africa, truck drivers would have a working life span of

operations – including salaries and equipment.

no longer than 5 years. •

Social responsibility: In the process of delivering

In the first phase of the project, the strong advocacy

goods or aid, transporters are faced with the

role played by TNT’s CEO contributed to demonstrating

unpleasant reality that they risk introducing HIV and

the potential of North Star thus leveraging public funds

other diseases to recipient communities. Truck drivers

from international and national donors. The Dutch

can become the bridge transmitting HIV from high to

Government donated funds that enabled North Star

low-risk groups.

Alliance to strengthen its operations and institutionalize its structure.

In response to these issues, the Dutch Transport Company TNT and World Food Program (WFP) established a public-

In 2007, the group of core partners was expanded

private initiative in 2006, the North Star Foundation. The

to include the International Transport Workers’

objective of the foundation was to promote the health

Federation (ITF) and UNAIDS.

and well-being of long-distance truck drivers and other transport-related workers through a network of basic

In 2009, the partnership further expanded to include

healthcare clinics (coined wellness centres) located along

IT systems developer ORTEC as its newest core partner.

the main transport corridors and hotspots of Sub-Saharan

The same year, the shift in North Star’s governance

Africa.

structure from Foundation to Alliance allowed new strategic partners to add their respective expertise to the

Objective •

partnership. The entry of ORTEC as well as the Dutch not-

The overall objective of the partnership is to improve the health status of mobile workers and communities living along Africa’s major transport corridors.

The specific objective of the partnership is to set up a network of Wellness Centres along major African transport corridors offering preventive and curative health services for mobile workers and corridor communities.

61


for-profit organization PharmAccess Foundation brought

in the expertise that was lacking for North Star Alliance to

Stronger involvement of regional bodies is needed to strengthen North Star’s regional approach

scale up its operations. Interesting partnership model for: Results to date

Transport industry actors

Road and supply chain stakeholders: companies,

As of July 2011, 22 Wellness Centres are operating in DRC, Kenya, Malawi, Namibia, Rwanda, Swaziland,

business coalitions, Transport Union organizations,

Tanzania, Uganda, Zambia and Zimbabwe;

Roads Authorities.

IEC sessions: 6,000-8,000 annually/per centre;

STI treatment: 2,500-3,500 annually/per centre;

For more information about this partnership,

VCT referrals: 1,500-2,000 annually/per centre;

please contact:

Condom distribution: 150,000 annually/per centre

(90% male, 10% female);

Luke Disney, Executive Director:

Embedment in local network of transport companies

luke@northstar-alliance.org

and local donors. Or consult the North Star Alliance website: Success factors •

www.northstar-alliance.org

The consistent strong commitment of TNT’s CEO in promoting North Star played an important role in initiating the initiative

HIV/AIDS represents a real issue closely linked to the core business of TNT, WFP and all actors involved in the transport sector

Switch from foundation to alliance allowing strategic partners to contribute crucial expertise to the partnership

In 2005, the first Wellness Centre was opened at the Mwanza Border – Malawi – and was a useful vehicle for promoting the initiative to potential partners

External expertise was brought in for strengthening North Star’s medical strategy

Challenges •

Reaching the target population (very mobile, difficult to follow)

Harmonisation of protocols is still a challenge in the region

62


Heineken Brarudi

Objective The objective of the PPP is to improve the health situation

Building of a Community Health Centre in the district of

of the Bugendana District’s population by providing access

Bugendana- Burundi

to primary healthcare through a new community health centre.

Background Brarudi is a subsidiary of Heineken International in Burundi,

Structure

providing beers and lemonades produced in its two

Partners involved:

breweries of Bujumbura (capital city) and Gitega. Burundi

The Natives of Bugendana (Les Natifs de Bugendana):

is one of the poorest countries in the world and access to

community association representing the inhabitants of

healthcare remains a challenge for most of its population

the Bugendana rural District

mainly living in the rural areas. The Government is facing

difficulties in responding to the country’s health needs on

Brarudi (local subsidiary of Heineken) and Heineken Africa Foundation

its own i.e. lack of human and financial resources as well

President of Burundi

as problems in managing these resources.

Ministry of Public Health: Chief Medical Officer of

Therefore Heineken feels a moral obligation to contribute

Gitega Province Ministry of Home affairs

to the country’s development in general and more specifically to the Bugendana population that is located in

Partnership organization

the Gitega province where the Brarudi brewery operates

There is a Project Management Committee consisting of

(surnamed Bragita).

representatives of the Natives of Bugendana association, the Ministry of Public Health, the Ministry of Home Affairs

The Bugendana district is deprived of healthcare as well

and Brarudi. This committee is responsible for the project

as education and road infrastructure. In addition, political

management including financial and operational follow-

instability and insecurity during the past few years have

up;

further deteriorated the social and economic development of the Bugendana district.

In 2010, a partnership was formed to develop, implement,

In the first 6 months, monthly meetings of the Project Management Committee Regular supervisory visits of local and international

operate and maintain a community health centre in the

Heineken representatives during the development and

district. This health centre would benefit an estimated

implementation phase

population of 25,000 inhabitants. This collaboration brings

Heineken’s financial and technical resources as well as its

Annual review of project progress by the Project Management Committee

medical expertise together with the Government’s human

resources and land concession as well as the Bugendana

The Project Management Committee is responsible for elaborating regular activity reports

community’s financial and in-kind contributions. Roles and Responsibilities •

Brarudi is in charge of the situation and risk analysis, advocacy and fund raising, development and submission of the project proposal to the Heineken Africa Foundation and of the monitoring and evaluation of the project

The Government of Burundi is in charge of further fund raising, technical assistance, funding steering and supervision the community health centre’s operations

The Bugendana community is in charge of advocacy and fund raising at the local level and of building and managing the health centre

63


Heineken is the main funder of the project through

Challenges

its Heineken Africa Foundation. It is in charge of

Burundi’s lack of political stability

monitoring and evaluating the project in collaboration

Limited capacities of the Government and the

with Brarudi

association of the Natives of Bugendana to ensure the operation of the health centre on the long - term e.g.

Legal framework of the partnership:

staff salaries, drugs and health centre’s operational

An agreement was signed between Brarudi, the Heineken

costss

Africa Foundation and the association of the Natives of Bugendana where the respective responsibilities,

Interesting partnership model for

contributions and deadlines were set.

CSR departments of multinationals willing to contribute to health projects in countries where they

Results to date • •

operate

Effective PPP between the Government, Brarudi and

National ministries of health and home affairs

the community of Bugendana

Associations active in community development

The community health centre is now up and running and was officially inaugurated and handed over to the

For more information about this partnership,

Ministry of Public Health in February 2011

please contact:

The medical staff received specific training on Malaria and HIV testing, care and treatment conducted by

Dr Emmanuel Kamo:

Brarudi’s chief medical officer

+242 06 900 12 88 - emmanuel_kamo@heineken.nl

Success factors •

Involvement of Heineken both at local level -project initiation and coordination by its subsidiary- and international level with the involvement of Heineken Africa Foundation in the project funding, supervision and steering;

Strong ownership and important participation of the Bugendana community in the projects initial request from the Bugendana inhabitants to Heineken and the Burundian Government, fund raising, community work – e.g. raw material collection, labor contribution – and health centre management on the long run

Good selection of key partners and service providers – construction company, medical training by Brarudi’s chief medical officer: assessment of their skills and expertise

64


Health Insurance Fund

HIF vision and mission The HIF’s vision is that ‘families in Africa are healthy and

Providing access to affordable quality healthcare to lower

wealthy’. The HIF’s mission is ‘protecting the wealth of

income groups in sub-Saharan Africa

low-income families from health-related risks’, so that families can lead lives of self-reliance, meet their own

Background

basic needs and build a better future for their children. To

Health is a crucial economic asset, particularly for the

achieve this mission the overall goal of the HIF program is

working poor. Their livelihoods depend on it. Poor people

to help build a healthcare delivery system that functions

suffer from poorer health and die younger. They have

efficiently and effectively over a long period. This will

higher than average child and maternal mortality, higher

make an important contribution towards achieving the

levels of disease, and more limited access to healthcare

United Nations Millennium Development Goals (MDGs)

and social protection. When poor people become ill or

of reducing poverty and hunger (Goal 1), combating HIV/

injured, their entire household can become trapped in a

AIDS, Malaria and other diseases (Goal 6), and reducing

downward spiral of lost income and healthcare costs.

child and maternal mortality (Goals 4 and 5).

In Africa over 50 percent of healthcare costs are financed

To realise its overall goal, the HIF program has set itself the

out-of-pocket. The consequences of this are that every

following specific goals:

year, approximately 44 million households, or more than 150 million individuals throughout the world experience

For low-income families: provide access to an

catastrophic expenditure. About 25 million households or

affordable and quality private health insurance

more than 100 million individuals are pushed into poverty

scheme to reduce health and health-related financial

by the need to pay for healthcare services. The majority of

risks

these people live in Sub-Saharan Africa, a continent that

For healthcare providers and insurers: provide

carries approximately 50 percent of the world’s burden

sufficient and stable income streams, affordable

of disease yet spends less than two percent of the global

financing options and quality technical assistance to

health expenditure. African public healthcare systems have

reduce their financial and operational risk

not been able to deliver the required quality and capacity.

The Health Insurance Fund (HIF) is an initiative of

For donors: provide innovative and more effective financing mechanisms For governments: work together in an effective

PharmAccess and Kees Storm (former CEO of the life

and sustainable partnership to build an enabling

insurance and pensions company AEGON) to implement

environment (including the legal framework).

an alternative approach to traditional and current healthcare delivery and financing mechanisms with

Structure

funding from and in close cooperation with the Dutch

Implementors

Ministry of Foreign Affairs, The World Bank, USAID and, in

the case of Kwara State, Nigeria, the local government.

The HIF Program is funded and managed by the Health Insurance Fund (HIF). HIF contracts PharmAccess International to develop and implement

To address the current healthcare challenges in Africa,

the HIF Program. Additionally, PharmAccess

HIF has developed an innovative healthcare financing

provides technical support as well as medical and

and delivery model, which it is implementing in Nigeria,

administrative quality control. The design of the HIF

Tanzania and Kenya. The HIF program considers the

Program includes an extensive operational research

healthcare system as a value chain in which all elements

(OR) component. The Amsterdam Institute for

of the healthcare system – patients, hospitals and clinics,

International Development (AIID) and the Center

laboratories, medication, administrative systems, financing,

for Poverty-Related Communicable Diseases (CPCD)

laws and regulations – must be in place to enable the

have been contracted by HIF to conduct independent

delivery of quality healthcare. Healthcare systems consist of

impact evaluations of the insurance schemes.

delivery and financing.

The actual execution of the insurance schemes is the responsibility of a local insurance company,

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Health Maintenance Organization (HMO) or

Kenya: The Tanykina Dairy Plant Ltd. is selected as the first

Third Party Administrator (TPA). These are local

target group in Kenya. This is a private limited company,

implementing organisations selected and contracted

jointly owned by its members. The Tanykina organisation is

by PharmAccess to deliver the insurance product

a relatively young one (established in 2005) and growing

to the target groups through a network of private

rapidly. Its current group size totals 20,000 people.

and public sector healthcare providers. This includes marketing, enrolment, upgrading management,

Success factors

financial management and data management. The

1. Sustainable healthcare financing model

local insurance company then contracts healthcare

Multi-funding strategy increases the total resources

providers. These are primary and referral level

available for health: contribution to cover the health

healthcare providers selected for the provision of

insurance premium is currently paid by individuals,

health services to the members of the target groups.

local Governments and donors. This model also offers an opportunity for employers and employees to

Donors

finance a health insurance scheme

The main donors of the HIF program are:

Reduced risk of unpredictable and catastrophic health

The Dutch Ministry of Foreign Affairs

expenditure for employees of and improved access to

The Kwara State Government, which agreed to co-

quality healthcare services

finance the expansion of the HIF Programme in Kwara

Predictable and affordable income streams for local

Central

healthcare providers which in turn stimulate private

The Global Partnership on Output-Based Aid (GPOBA)

sector investments in health and result in an increased

The United States Agency for International

quality of healthcare services

Development (USAID) •

STOP AIDS NOW! through the Amsterdam Dinner

2. Improved aid effectiveness and reduced risks of

(organised by DGO- a network of Dutch companies

crowding out private and public resources

and organizations involved in the fight against HIV/ 3. Using private healthcare providers for reaching

AIDS worldwide).

public health goals Results to date Nigeria: There are currently three insurance schemes

4. Improved healthcare provision (mixed delivery

operational in Nigeria funded by the Dutch Government

strategy)

through the HIF: the Lagos Scheme, a scheme for market

women and their dependents, a group of approximately

Performance-based financing is introduced at public facilities to improve the efficiency of public sector

80,000 and two schemes for farmers and their dependents in Kwara State (Kwara North and Kwara Central). A group of approximately 150,000 people. In Lagos a fourth scheme is funded by the GPOBA. This scheme is for employers and employees (and their families) of small businesses in the Computer and Allied Products Dealers Association of Nigeria (CAPDAN) and consists of approximately 22,000 people. Tanzania: There are two schemes operational in Tanzania. The first focuses on 40,000 members of the Promotion of Rural Initiatives and Development Enterprises Limited (PRIDE) and their households in Dar-es-Salaam and the second focuses on 40,000 coffee farmers, members of the Kilimanjaro Native Cooperative Union (KNCU) and their households in Moshi region.

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healthcare provision •

Using private healthcare providers to alleviate the burden of public healthcare providers

Challenges •

Efficient selection of enrolees based on their health profile remains a challenge

Implementation has shown that fine-tuning and tailoring of the health insurance package is required

Insufficient control of the processes at the healthcare provider level

Insufficient resources for local partners to implement the programs

Interesting partnership model for: Private insurance companies, microcredit organisations, workers organisations/federations cooperatives. For more information about this partnership, please contact: Hans Peter Wiebing - Acting Director: +31 (0) 20 5668100 - hp.wiebing@hifund.org Or consult the Health Insurance Fund website: www.hifund.org

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www.partenairescontrelesida.org

www.pharmaccess.org

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Guideline: Developing Public-Private Partnerships to Fight HIV/AIDS, Tuberculosis and Malaria