Qualities of enduring cross-sector partnerships in public health

Managing change 

The rapid emergence of new technology has conspired to eliminate previously well-defined sector boundaries. On a most fundamental level, these previously heavily segregated sectors now possess, in varying degrees, a common language and set of tools. In addition, information and knowledge are no longer subject to reliable isolation whether by geography, class, gender, race or religion. Finally, the acquisition and implementation of new information technologies have ignited a highly compressed, cross-sector and globally competitive exercise in process redesign that has fundamentally changed the way we communicate and do business with each other, and in the process ramped up expectations for progress absent a fundamental alteration in our human capacity to absorb change without destabilizing our societies.

Without new cooperative approaches then, we find ourselves at cross purposes and at risk. For paradoxically, expanding the flow of information and creating the expectation, and in time the reality of free and equal access to knowledge, has placed the spot light on glaring inequalities and human needs that are no longer politically tenable.

Nowhere is this more evident than in the public health arena. In 2000, Gro Bruntland of the World Health Organization described a WHO mission committed to a new universalism, “the attainment by all people of the highest possible level of health, with emphasis on closing the gaps within and among countries” [1]. This dual focus on “goodness—the best attainable average health,” and “fairness—the smallest feasible differences among individuals and groups,” is a challenge whether one is a health leader in South Africa struggling to conquer HIV/AIDS or a health leader in the United States confronting markedly disparate health outcomes in African Americans. Our common reality then is that technologic progress has revealed both our strengths and our weaknesses, and that today’s challenges require cross-sector solutions.

The sectors 

Government, business, academics, and nongovernmental organizations today confront a complex series of public challenges that no one sector can address in isolation. Each sector has well defined historic purposes, roles, and strategies for success. Appreciation of these unique traditional assets is a starting point in our common movement toward mutual appreciation and partnership.

Industry has focused on business performance, the creation of wealth, the discovery of new markets, the expansion of social engagement, the delivery of customer service, and expanding and aligning philanthropy with core mission. Government has focused on purpose and governance, redefining basic roles and responsibilities, exploring centralized and decentralized approaches, tapping cross-sector expertise to expand efficiency, and developing skills as bridgers and collaborators in an effort to share responsibility for creation and execution of sound policy.

Academics have traditionally focused on a mission of service, education, and research. Today they confront diminishing resources and increasing demands for service and social action. In response, they have emphasized reengineering of patient care processes to accomplish operational efficiencies, and constructive approaches to partnering emphasizing trust and transparency, with a constant eye on institutional integrity.

Nongovernmental organizations (NGOs) have focused on shaping attitudes and behaviors of government, industry and academics. This relatively new mission has been layered upon one of traditional service and activism directed at specific concrete objectives with a high degree of immediacy. They have focused on virtual communications, organizational building, and campaign execution skillfully leveraging new low cost information technologies and high media credibility. The first NGO was the International Red Cross established in the 19th century. Today there are over 26,000, in charge of administering nearly 20% of the US overseas development, and including such well-known brands as Amnesty International, Greenpeace, and Doctors Without Borders [2].

Key factors for success 

Beyond a common understanding of the strengths and capabilities of each sector, and the desire for collaboration reflected in a willingness to mutually plan, to align goals and objectives, and to share risk, there remains the issue of environmental readiness. What are the factors that must be in place to ensure success?

First, if it is true that all politics are local, so too are all successful cross-sector partnerships in so far as they acknowledge in their planning, design and management the realities of time, place, people, and institutions in the target geography.

Second, in any cross-sector initiative in health, there should be some level of representation from each of the four sectors. The partners must have a well-defined common need or public purpose that unites them. What is that common passion?

Third, the proposed project or solution must be right sized to the problem or challenge at hand. Too small and the effort will lack resources to ensure measurability and sustainability. Too large and the effort will create structure without solution.

Fourth, human conditions must be right. This includes identifiable optimistic leaders with the time and willingness to commit and a reservoir of good will among the players to support both innovation and implementation of the common vision, the structural integration, the joint governance, and ongoing civic engagement.

Fifth, there needs to be accurate information and baseline data that clearly define the challenges and serve as a grounding for future reasonable outcomes. It is not enough to marshal human resources. There must be an established organizational capacity, processes, and oversight to ensure that the human effort translates into a highly coordinate and effective service result.

Phases of development 

Summary 

The social, economic and political challenges accompanying our rapidly changing and fundamentally transforming global environments have created unique social challenges that demand cross-sector solutions. These new models of collaboration are uniquely evolving and being shaped by the transformational forces at work in our modern society, which demand both competency and equity.

In pursuit of these new partnerships in the health sector, there should be a bias toward action, early organization and prevention, health consumerism and relationship based care, elimination of health disparities, and an integrated vision of health as the leading edge of development with an emphasis on sustainability.

Successful cross-sector partnerships in health are fundamentally inclusive and actively involved in bridging government, business, academic, and NGO communities. They favor joint value creation over passive philanthropy. Careful early assessment for mission and strategy, inclusion of key players and issues, clear measurable goals, and political readiness are critical elements for future success. Use of an independent expert advisory committee in design and monitoring of comprehensive public health strategies is valuable.

Obstacles to success include absence of top level leadership, basic disagreements on the fundamental scientific underpinnings, absence of strong prevention programming, hidden political agendas, exclusion of key sectors, and failure to identify a key issue and address it proactively.

Government, business, academics, and nongovernmental organizations are increasingly overlapping in the areas of social purpose. The ability to organize their varied and often complimentary skills and resources will significantly benefit society.