Pii: s0002-9610(02)01143-

The American Journal of Surgery 185 (2003) 26 –29 Qualities of enduring cross-sector partnerships in public health Pfizer Medical Humanities Initiative, 235 E. 42nd St., New York, NY 10017, USA Manuscript received September 4, 2002; revised manuscript September 7, 2002 Abstract
The social, economic and political challenges accompanying our rapidly transforming global health environments have created unique social challenges that demand cross-sector solutions. Four cross-sector partnerships are reviewed with a special focus on sector roles, changemanagement, phases of partnership development, and key factors for success. 2003 Excerpta Medica Inc. All rights reserved.
Keywords: Public health; Cross-sector partnership; Healthcare environment; Change management Complex forces at work over the past 2 decades have geography, class, gender, race or religion. Finally, the ac- created myriad social, economic, and political challenges quisition and implementation of new information technolo- that demand cooperative and collaborative solutions. Such gies have ignited a highly compressed, cross-sector and cross-sector partnerships presume clear role delineation, globally competitive exercise in process redesign that has well-defined strategies and objectives, and evolving rela- fundamentally changed the way we communicate and do tionships that challenge historic checks and balances.
business with each other, and in the process ramped up The desire on the part of government, academics, non- expectations for progress absent a fundamental alteration in governmental organizations and industry to forge new part- our human capacity to absorb change without destabilizing nerships reflects the common belief that no one sector can address such complex challenges in isolation. The rapid Without new cooperative approaches then, we find our- advance of technology has supercharged the environment selves at cross purposes and at risk. For paradoxically, accelerating globalization, regionalization and the rate of expanding the flow of information and creating the expec- change in social institutions while virtually disintegrating tation, and in time the reality of free and equal access to geographic boundaries. Success in forming stable and pro- knowledge, has placed the spot light on glaring inequalities ductive cross-sector relationships will largely determine the and human needs that are no longer politically tenable.
extent to which we are able to ensure societal justice andprogress.
Nowhere is this more evident than in the public health arena. In 2000, Gro Bruntland of the World Health Orga-nization described a WHO mission committed to a newuniversalism, “the attainment by all people of the highest Managing change
possible level of health, with emphasis on closing the gapswithin and among countries” This dual focus on “good- The rapid emergence of new technology has conspired to ness—the best attainable average health,” and “fairness— eliminate previously well-defined sector boundaries. On amost fundamental level, these previously heavily segregated the smallest feasible differences among individuals and sectors now possess, in varying degrees, a common lan- groups,” is a challenge whether one is a health leader in guage and set of tools. In addition, information and knowl- South Africa struggling to conquer HIV/AIDS or a health edge are no longer subject to reliable isolation whether by leader in the United States confronting markedly disparatehealth outcomes in African Americans. Our common realitythen is that technologic progress has revealed both ourstrengths and our weaknesses, and that today’s challenges * Corresponding author. Tel.: ϩ1-212-733-5662; fax: ϩ1-212-973- 0002-9610/03/$ – see front matter 2003 Excerpta Medica Inc. All rights reserved.
PII: S 0 0 0 2 - 9 6 1 0 ( 0 2 ) 0 1 1 4 3 - 1 M. Magee / The American Journal of Surgery 185 (2003) 26 –29 The sectors
was founded by Pfizer and the Edna McConnell ClarkFoundation, with 25 years experience in tropical disease Government, business, academics, and nongovernmental research, in partnership with the government of Morocco organizations today confront a complex series of public and with the support of the World Health Organization. It challenges that no one sector can address in isolation. Each was initially launched with grants of $3.2 million by each sector has well defined historic purposes, roles, and strate- partner and a commitment of $60 million in product (Zithro- gies for success. Appreciation of these unique traditional max, an azalide antibiotic discovered by Pfizer, which is assets is a starting point in our common movement toward curative of trachoma with a single dose). Zithromax is part mutual appreciation and partnership.
of a comprehensive public health program designed by the Industry has focused on business performance, the cre- WHO known as SAFE: S for simple lid surgery to correct ation of wealth, the discovery of new markets, the expan- lid inversion; A for the antibiotic; F for face washing, which sion of social engagement, the delivery of customer service, is highly preventative; and E for environmental changes, and expanding and aligning philanthropy with core mission.
notably the creation of infrastructure to assure clean water.
Government has focused on purpose and governance, rede- ITI has thus far treated and cured 4 million patients in 9 fining basic roles and responsibilities, exploring centralized countries with the active support of the presidents and and decentralized approaches, tapping cross-sector exper- tise to expand efficiency, and developing skills as bridgersand collaborators in an effort to share responsibility for creation and execution of sound policy.
Academics have traditionally focused on a mission of Sharing the Care was initiated in 1993 as a partnership service, education, and research. Today they confront di- between Pfizer, the National Governors Association, and the minishing resources and increasing demands for service and National Association of Community Health Centers to help social action. In response, they have emphasized reengi- insure that patients served by over 375-community migrant neering of patient care processes to accomplish operational and homeless health centers had access to modern pharma- efficiencies, and constructive approaches to partnering em- ceuticals. Governors in 48 states provided leadership in phasizing trust and transparency, with a constant eye on enabling the launching and continuation of programming.
The Health Centers provided a health care delivery infra- Nongovernmental organizations (NGOs) have focused structure to reach at risk target patients. Pfizer provided free on shaping attitudes and behaviors of government, industry pharmaceuticals and assumed responsibility for keeping and academics. This relatively new mission has been lay- Health Center pharmaceutical shelves stocked. In its 10th ered upon one of traditional service and activism directed at year, the program has provided nearly $300 million (whole- specific concrete objectives with a high degree of immedi- sale) in pharmaceuticals to more than 1.8 million patients acy. They have focused on virtual communications, orga- who have received 5.7 million prescriptions nizational building, and campaign execution skillfully le-veraging new low cost information technologies and high media credibility. The first NGO was the International RedCross established in the 19th century. Today there are over Launched in 2000, the South African HIV/AIDS part- 26,000, in charge of administering nearly 20% of the US nership provides Diflucan, Pfizer’s antifungal medicine to overseas development, and including such well-known the South African Health Ministry free of charge for treat- brands as Amnesty International, Greenpeace, and Doctors ment of HIV/AIDS-related cryptococcal meningitis and esophageal candidiasis. With some 40 million infected pa-tients in South Africa, nearly 10% require life-saving treat- ment for opportunistic infections. The partnership providesclinical training in diagnosis and treatment of opportunistic Four cross-sector partnerships supported by the Pfizer infections as well as support for expansion of prevention Foundation over the past 10 years were analyzed. Three of programming and education in conjunction with the South the partnerships were international and one was domestic.
African health ministry and hospital network. Thus far thepartnership has dispensed 1.3 million doses of Diflucan to patients in six African countries and trained 6500 healthworkers The International Trachoma Initiative (ITI), founded in 1998, is a nonprofit partnership dedicated to the eradication Academic alliance for AIDS care and prevention in Africa of trachoma. Trachoma, the leading cause of blindnessworldwide, is caused by Chlamydia trachomatis infection Academic Alliance for AIDS Care and Prevention in of the eyelids with subsequent contraction and inversion of Africa was formed in 2001 by 13 prominent physicians and the lid resulting in scarring of the cornea and blindness. ITI scientists from Africa and North America in partnership M. Magee / The American Journal of Surgery 185 (2003) 26 –29 with Pfizer, Makerere University Medical School in Kam- that the human effort translates into a highly coordinate and pala, Uganda, and with the support of the President and Minister of Health in Uganda. The goal of the alliance is toimprove the quality of medical care for 27 million HIV Phases of development
infected people in sub-Saharan Africa by teaching preven-tion, treating HIV/AIDS patients, and conducting on-going research. Using Uganda as a primary experience, andfunded with an $11 million grant from Pfizer, the effort has Most successful cross-sector partnerships begin with a broken ground for a training institute, clinic, and laboratory personal relationship between two individuals of different on the campus of Makerere University Medical School and sectors who are well positioned to advance a proposal begun training of African clinicians and on-site clinical within their own organizations. Most often, the original treatment programs. Programs include a pediatric maternal concept takes seed off line and grows to a point of excite- program for HIV, hands on clinical training of health care ment between the principals and is subsequently shared with workers, outreach programming to empower trainees to their organizations. Meetings are organized, the concept return and deliver care in their own countries, rapid expan- advanced, input gathered, and the proposal refined. Along sion of AIDS diagnostics, coordinated expansion of access the way, in ones and twos, staff with most at stake are to pharmaceuticals for treatment, and a program to dissem- layered on and their enthusiasm captured. Meeting incre- inate learning from the Uganda experience to other coun- mentally, the growing vision fleshes out, is validated as both tries with high HIV/AIDS prevalence around the world good and doable, and initial data not only reinforce theconcept but also are the group’s first taste of success. Out ofthe idea fusion process emerges a common vision that is Key factors for success
right sized to the task at hand and the environment in place.
Beyond a common understanding of the strengths and capabilities of each sector, and the desire for collaborationreflected in a willingness to mutually plan, to align goals Moving from concept generation to public launch creates and objectives, and to share risk, there remains the issue of vulnerability and liability since the effort may succeed or environmental readiness. What are the factors that must be fail and by definition as a cross-sector partnership will have ample witnesses to outcome. It is a critical predeterminant First, if it is true that all politics are local, so too are all of success therefore that leaders in each sector be ade- successful cross-sector partnerships in so far as they ac- quately informed and supportive. This support should be knowledge in their planning, design and management the reflected not only in the willingness to devote capital andresources to the effort, but also in all parties clear agreement realities of time, place, people, and institutions in the target on the science, scope of the challenge, objectives, and project timetable. Together, these elements, assured from Second, in any cross-sector initiative in health, there the leadership of each sector, constitute political stability.
should be some level of representation from each of the four Top leadership support must be clear and decisive, mid level sectors. The partners must have a well-defined common support may not be enough. With that as a basis, structural need or public purpose that unites them. What is that com- readiness with consideration of economics, education and training, and communication must be assessed. Equally es- Third, the proposed project or solution must be right sential are well established relationships with grass-roots sized to the problem or challenge at hand. Too small and the health providers committed to the target population and to effort will lack resources to ensure measurability and sus- long-term continuity of care to sustain health gains. Those tainability. Too large and the effort will create structure gains must be measurable against baseline data that has been collected, collated, displayed, and disseminated. Fi- Fourth, human conditions must be right. This includes nally, at the time of the launch there should be an overar- identifiable optimistic leaders with the time and willingness ching comprehensive public health strategy encompassing to commit and a reservoir of good will among the players to environmental improvements, education and training, basic support both innovation and implementation of the common prevention, and appropriate diagnostics and treatments. In vision, the structural integration, the joint governance, and this regard, an expert advisory group with in-country (com- munity) credibility and experience is essential.
Fifth, there needs to be accurate information and baseline data that clearly define the challenges and serve as a ground- ing for future reasonable outcomes. It is not enough tomarshal human resources. There must be an established Long-term sustainability is dependent on a clear defini- organizational capacity, processes, and oversight to ensure tion of roles and responsibilities, and clarity of governance.
M. Magee / The American Journal of Surgery 185 (2003) 26 –29 A lack of clarity undermines operational execution, mea- prevention, health consumerism and relationship based care, surement, communications, and long-term planning. Gov- elimination of health disparities, and an integrated vision of ernance may be shared in partnership, through representa- health as the leading edge of development with an emphasis tion of an oversight board, delegated to a single member of one of the sectors responsible to an advisory board, or it Successful cross-sector partnerships in health are funda- may be assigned to a new entity charged not only with mentally inclusive and actively involved in bridging gov- executing the plan but also ensuring continued constructive ernment, business, academic, and NGO communities. They collaboration of the parties. The choice of governance struc- favor joint value creation over passive philanthropy. Careful ture is a function of the preferences of the parties involved, early assessment for mission and strategy, inclusion of key and the extent and proposed duration of their common players and issues, clear measurable goals, and political public purpose. Whatever the structure, who is in charge readiness are critical elements for future success. Use of an should be clear to all to assure accountability. Of equal independent expert advisory committee in design and mon- importance is strong leadership with special emphasis on itoring of comprehensive public health strategies is valu- both operational and communication capabilities as well as existing credibility in the community. The community net- Obstacles to success include absence of top level lead- work of service should be well defined, resourced, and ership, basic disagreements on the fundamental scientific sustainable. This network should be tied to the cross-sector underpinnings, absence of strong prevention programming, partners and governance by a reliable communication plan hidden political agendas, exclusion of key sectors, and fail- inclusive of both internal and external customers. Such a ure to identify a key issue and address it proactively.
network will provide ongoing support for planning, facili- Government, business, academics, and nongovernmental tating, negotiating, and problem solving. Finally, the ability organizations are increasingly overlapping in the areas of to observe and analyze data and absorb key lessons insures social purpose. The ability to organize their varied and often on-going refinement of the project. As important, it allows complimentary skills and resources will significantly benefit the cross-sector partnership to determine the term of the engagement as well as possible end points. The prejudiceshould always be toward action, openness, and accountabil-ity.
References
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Source: http://ww.thecmafoundation.org/projects/pdfs/rxwellness/Cross%20Sector%20Collaborations.pdf