Mike Magee MD
University of North Carolina
Chapel Hill, NC
November 10, 2006
Complex forces at work over the past two decades have created a myriad of social, economic and political challenges that demand cooperative and collaborative solutions. Such cross-sector partnerships presume clear role delineation, well defined strategies and objectives and evolving relationships that challenge historic checks and balances.
The desire on the part of government, academics, non-governmental organizations and industry to forge new partnerships reflects the common belief that no one sector can address such complex challenges in isolation. The rapid advance of technology has supercharged the environment accelerating globalization, regionalization and the rate of change in social institutions while virtually disintegrating geographic boundaries. Success in forming stable and productive cross-sector relationships will largely determine the extent to which we are able to ensure societal justice and progress.
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. No where 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.
Government, business, academics, and non-governmental 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.
Non governmental organizations (NGO’s) 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 19thCentury. Today there are over 26,000, in charge of administering nearly 20% of the U.S. overseas development, and including such well-known brands as Amnesty International, Greenpeace, and Doctors Without Borders.
Beyond a common understanding of the strengths and capabilities of each sector, and the desire for collaboration reflected in a willingness to mutuallly plan, to align goals and objectives and to share risk, there remains the issue of environmental readiness. What are tye 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 defines the challenges and serves 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.
Successful partnerships evolve over time through a series of stages. While each project is unique unto itself, the following phases are common.
1. Creation Phase
Most successful cross-sector partnerships begin with a personal relationship between two individuals of different sectors who are well positioned to advance a proposal within their own organizations. Most often, the original concept takes seed off line and grows to a point of excitement between the principals and is subsequently shared with their organizations. Meetings are organized, the concept advanced, input gathered, and the proposal refined. Along the way, in ones and twos, staff with most at stake are layered on and their enthusiasm captured. Meeting incrementally, the growing vision fleshes out, is validated as both good and doable, and initial data not only reinforces the concept but also is the group’s first taste of success. Out of the idea fussion process emerges a common vision that is right sized to the task at hand and the environment in place.
2. Launch Phase
Moving from concept generation to public launch creates vulnerability and liability since the effort may succeed or fail and by definition as a cross-sector partnership will have ample witnesses to outcome. It is a critical pre-determinant of success therefore that leaders in each sector be adequately informed and supportive. This support should be reflected not only in the willingness to devote capital and resources to the effort, but also in all parties clear agreement on the science, scope of the challenge, objectives, and project timetable. Together, these elements, assured from the leadership of each sector, constitute political stability. Top leadership support must be clear and decisive, mid level support may not be enough. With that as a basis, structural readiness with consideration of economics, education and training, and communication must be assessed. Equally essential are well established relationships with grass-roots health providers committed to the target population and to long term continuity of care to sustain health gains. Those gains must be measurable against baseline data that has been collected, collated, displayed and disseminated. Finally, at the time of the launch there should be an overarching comprehensive public health strategy encompassing environmental improvements, education and training, basic prevention, and appropriate diagnostics and treatments. In this regard, an expert advisory group with in-country (community) credibility and experience is essential.
3. Sustainability Phase
Long term sustainability is dependent on a clear definition of roles and responsibilities, and clarity of governance. A lack of clarity undermines operational execution, measurement, communications, and long term planning. Governance may be shared in partnership, through representation of an oversight board, delegated to a single member of one of the sectors responsible to an advisory board, or may be assigned to a new entity charged not only with executing the plan but also ensuring continued constructive collaboration of the parties. The choice of governance structure is a function of the preferences of the parties involved, and the extent and proposed duration of their common public purpose. Whatever the structure, who’s in charge should be clear to all to assure accountability. Of equal importance is strong leadership with special emphasis on both operational and communication capabilities as well as existing credibility in the community. The community network of service should be well defined, resourced, and sustainable. This network should be tied to the cross-sector partners and governance by a reliable communication plan inclusive of both internal and external customers. Such a network will provide ongoing support for planning, facilitating, negotiating, and problem solving. Finally, the ability to observe and analyze data and absorb key lessons insures on-going refinement of the project. As important, it allows the cross sector partnership to determine the term of the engagement as well as possible end points. The prejudice should always be toward action, openness, and accountability.
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 demands 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 non-governmental organizations are increasingly overlapping in the areas of social purpose. The ability to significantly organize their varied and often complimentary skills and resources will significantly benefit society. Such collaboration will be increasingly necessary to address the health care needs of an increasingly interconnected global society.Thank you.