The Joint Centre for Public-Private Partnerships at UCL is pleased to announce a major new collaboration with the World Economic Forum. As one of our first major initiatives since our formation several weeks ago, the Joint Centre is partnering with the Forum to develop and refine a set of best practices for cross-sector collaboration in expanding healthcare access.

Taking input from the Forum’s constituents, and combining it with insights from the PPP Initiative’s Healthcare PPP Guide, the project will build on lessons learned from the Covid-19 pandemic. Ultimately, we will create a set of recommendations designed to enable effective, sustainable healthcare partnerships between the private sector, governments, and multilaterals.

Looking Back at the First Year of the Covid-19 Pandemic 

The past year has been a remarkable one for cross-sector collaboration in healthcare. Since the onset of the Covid-19 pandemic, private companies have worked alongside governments to create reliable tests for the virus, manufacture protective equipment at scale, adopt transmission mitigation protocols, and of course, develop and distribute several safe and effective vaccines in record time. But this kind of collaboration did not emerge out of thin air. It was the direct result of a unique set of incentives: with a deadly virus threatening to kill millions and disrupt large sectors of the economy, the private sector was—overnight—incentivized to support public health goals. The question is: will this kind of collaboration continue as we move into a post-pandemic world? Without an emergency like Covid-19 to incentivize action, how can we ensure that effective cross-sector engagement becomes a mainstay of global health policy, rather than an aberration?

The Project

Even in the absence of a global catastrophe, cross-sector collaboration is still possible. But it will require a more deliberate approach. Effective public-private partnerships require incentives to be thoughtfully designed, and conflicts of interests must be effectively understood and managed. To achieve this, governments and corporations alike will need professionals who understand the conditions that enable successful partnerships, and are well-trained in frameworks and skills like negotiation, political management, engagement of the public as a partner, and stakeholder analysis.

Our collaboration with the Forum—a global, virtual endeavor—seeks to address these gaps, preparing and enabling executives in both the public and private sectors to create and maintain effective public-private partnerships. The project will involve four key elements:

  • An inaugural workshop, seeking validation and commitment from our partners and constituents
  • A series of roundtable discussions and interviews, designed to generate insights, learn from successes and failures, and better understand the relevance of country context to Covid-19
  • A “Best Practices” paper—linked to the Healthcare PPP Guide—designed to facilitate future public-private partnerships in healthcare
  • A presentation event for disseminating the paper’s findings

The  Joint Centre is thrilled to have the World Economic Forum—one of the world’s preeminent conveners for public-private cooperation—as our partner in this endeavor. This project builds on years of collaboration between the Forum and the PPP Initiative (the Joint Centre’s co-founder), including work on the World Health Organization’s Independent High-Level Commission on Non-Communicable Diseases.

Now, with the new Joint Centre acting as a convening partner, this project will move beyond any particular disease category, instead focusing on the urgent issue of healthcare access, combining the Healthcare PPP Guide with lessons learned from the past year. 

This exciting partnership with the Forum is only the beginning. The Joint Centre continues to grow—expanding its network of partners, and developing additional projects and research initiatives like this one—in service of one of its most fundamental goals: accelerating cross-sector collaboration in healthcare.

Today’s ministries of health face a host of complex, costly challenges. Around the world non-communicable diseases, aging populations, and COVID-19 threaten to strain existing healthcare structures, overwhelm national healthcare budgets, and outpace existing infrastructural capacity. These crises have pushed healthcare systems to a breaking point, and—with the possible exception of COVID-19—only stand to become more dire with time. 

Governments have struggled to keep up. The challenges are too costly, too complex, and they are growing too quickly. But, with cash-strapped ministries of health struggling to manage these crises, one thing has become clear: neither governments nor the private sector have the resources—financial, operational, and human—to address them alone. Increasingly, public-private partnerships (PPPs) have been used to combine the relative strengths of both the public and private sectors, enabling overextended governments to do more with less. Not only can PPPs save money, they can also serve as highly effective management structures, spurring innovation and fostering efficiency. But while their advantages are many, PPPs can also be challenging. Solutions must be negotiated, and conflicts of interest must be managed. Successful PPPs require cross-sector collaboration and interdisciplinary skillsets, and professionals who are equipped with these skillsets are—currently—few and far between. Simply put, the future of healthcare lies in PPPs, but if public- and private-sector executives are to be prepared for that future, they will need to be armed with certain skills and frameworks that they need to succeed.

Enter the Joint Centre for Global Infrastructure Policy, an ambitious new Joint Centre to be established by the PPP Initiative and the Bartlett Faculty of the Built Environment at University College London. Motivated by a desire to combine the Bartlett’s world-renowned emphasis on interdisciplinary study with the PPP Initiative’s economics-driven approach to healthcare issues, the Joint Centre will develop a new healthcare curriculum for graduate and executive education courses emphasizing the frameworks, skills, motivations and incentives that underpin successful healthcare PPPs. This curriculum—rooted in the foundational PPP courses pioneered by Professor Alan M. Trager at Harvard Kennedy School and Johns Hopkins SAIS—will use the research and teaching methods associated with healthcare PPPs, combining The Bartlett’s studies of infrastructure investment, finance, and governance with healthcare issues. Further, the Centre will act as a convening mechanism, bringing together high-level executives from across borders and across sectors, including public and private sector executives, graduate students, and constituent donor organizations. Together, they will address the world’s most pressing healthcare challenges: non-communicable diseases, aging populations, and Covid-19. In the process, the Joint Centre will seek to change the way we think about healthcare to include not only medical, scientific, and public health concerns, but also infrastructural and economic ones as well.

The Centre will attract top-level talent not just from within the UK, but from around the world. Drawing from the worlds of investment, planning, finance, and management, the Centre’s potential reach extends far beyond that of a conventional school of public health. With the potential addition of a public service fellowship program, top-tier graduate students could be encouraged to apply PPP knowledge to careers in the public sector, ensuring that—over the long run—PPP expertise would pervade the public sector as well as the private sector. 

The Joint Centre for Global Infrastructure Policy enjoys support from a diverse group of public, private, and multilateral stakeholders. Potential donors include governments; NGOs specializing in international public health; multinational biopharmaceutical companies; global infrastructure developers and asset managers; and government-backed, institutional investors. This diverse set of supporters would allow the Joint Centre to address the medical, policy, development, investment, and management considerations associated with delivering effective and sustainable healthcare PPPs.

Key Questions

The Centre will seek to address several key questions, including: 

1. In what ways are our current health systems insufficient, and, if they must be changed, what form should they take going forward? What needs to be done and how will it be accomplished?

2. How can health systems be made more resilient? How can they be strengthened to address inequality?

3. How can low- and middle-income countries “skip steps” in the development of health systems and their treatment of individuals?

4. What is health as an investment? How can governments work across sectors and ministries to leverage their investments most effectively?

5. How can multilateral organizations add government capacity in cross-sector healthcare partnerships?

Today in the Harvard Business Review, PPPI President and Founder Alan M. Trager writes about the essential strategic elements of successful PPPs, and how PPPs can be used to combat non-communicable diseases.

COVID-19 has presented institutions of higher learning with a difficult challenge: how to educate students from a distance. With all the videoconferencing tools at our disposal these days, this might seem—at first—like an easy task. But as I have learned through years of experience in graduate and executive education, the intimacy and interactivity of the classroom are among an educator’s most valuable assets. So back in May, with COVID-19 social distancing mandates in place throughout much of the world, the PPP Initiative (PPPI) found itself facing a difficult challenge: without a classroom, how would we educate graduate students and public- and private-sector executives on something so subtle, so complex, and so interdisciplinary as public-private partnerships?

From July 13th to July 24, PPPI and the National University of Singapore’s School of Public Health (NUSSPH) set out to answer this very question, offering—for the first time in our history—a 100% digital workshop. “Introduction to Healthcare PPPs,” a pilot program that engaged a diverse and talented group of healthcare professionals and executives, demonstrated a compelling proof of concept for distance learning, and offered a glimpse of what the future might hold for distance-based healthcare PPP executive education.

Co-taught with Professor Kee Seng Chia, NUSSPH’s founding dean, the workshop took place over six sessions, each about three to four hours, spanning two weeks. Conducted entirely over Zoom, thanks in no small part to NUS’s excellent technology platform and support staff, the program combined lectures, Q&A sessions, and two participatory group projects in which students gained experience with the skills and frameworks that underpin successful PPPs. Learning directly from PPPI’s newest core curriculum, the 135-page PPP Government Guide, participants engaged with eleven carefully-selected case studies, which allowed them to gain hands-on experience with real-world PPP examples. 

Participants were recruited from a wide variety of institutions, including public-sector entities like Singapore’s Ministry of Health, National Kidney Foundation, and the Health Promotion Board; private-sector companies like Fitbit, GlaxoSmithKline, and Apple; and academic institutions like NUS. Productive interaction between sectors is a key element of any successful PPP, and as such, project groups were sorted specifically to encourage cross-sector engagement. As one participant wrote, “I enjoyed the diverse perspectives from different partners: public, private, and academic.”

Of course, executing a successful program via Zoom was no easy task. Without a classroom dynamic, our ability to “read the room” and make adjustments “on the fly” was significantly compromised. To compensate, PPPI engaged in extensive preparation. For each one-hour lecture, PPPI prepared a detailed slide deck—usually 40-50 slides—with content that was closely tied to the Guide and relevant case studies. These decks were distributed 24 hours in advance to give participants the opportunity to familiarize themselves with the content before attending each session. Lectures emphasized repetition and “re-capping” of previous lectures to ensure that participants had a strong foundation in the fundamentals before moving on to more advanced concepts.

A significant time difference also presented unique challenges. Each class began at 8am in Singapore, which is 8pm in New York. Between lectures, group projects, and presentations, the sessions would often continue late into the night, EST. The time difference necessitated a “hand-off” between Professor Trager, who delivered the lecture/Q&A, and Professor Chia, who—along with a group of highly-competent teaching assistants—directed the participatory group projects. Both professors’ extensive experience in healthcare executive education enabled them to execute this transition seamlessly; though each offered a unique perspective on the workshop’s content, the program maintained a smooth flow and a clear forward thrust. 

Students were consistently engaged and insightful, and frequently pushed the discussion far beyond what we would have thought possible over video-conference. In fact, over the run of the course, we devoted approximately one third of our total lecture time to answering over forty distinct participant questions, which were—without exception—challenging, thoughtful and creative. This was no doubt due partly to the high caliber of our participants, but also to the consistently high attendance rates, which were regularly perfect or near-perfect. By the time participants were asked to present their final projects, in which they applied what they had learned to a real-world healthcare challenge in Singapore, they were able to demonstrate a clear facility with the frameworks and skills that underpin successful PPPs. 

In their anonymous course evaluations, participants consistently praised the course’s “balanced approach” between hands-on work and lectures, and cited the “discussions” and “group projects” as among the most beneficial parts of the class. “The lectures were insightful and organized, clear and concise,” wrote one participant, while another felt that “the group work segment was the most enjoyable, as it allowed us to bounce ideas off one another and think about different perspectives.”

Thanks to the generous support of Amgen, PPPI will continue to expand our programming at NUS and beyond over the next year. By refining our curriculum materials and improving our distance-learning methodologies, PPPI is eager to lead the way in distance-based executive education for healthcare PPPs—both within Southeast Asia, and around the world.

Since my last update on the PPP Initiative (PPPI), the world’s healthcare landscape has changed dramatically. Covid-19 has upended our daily lives, strained the world’s healthcare systems, and exacerbated existing healthcare crises like non-communicable diseases (NCDs) and aging populations. But as the healthcare landscape has changed, so too has the conversation surrounding healthcare public-private partnerships (PPPs). With more governments turning to PPPs as a way to achieve “more with less,” PPPI’s core objective—turning awareness into action—has never been more relevant. To that end, PPPI has achieved two significant goals: the production of a new, expansive core curriculum and the development of pioneering PPP workshops.

Core Curriculum

After nearly a year of development, PPPI’s newest core curriculum document, the PPP Government Guide: Designing Healthcare Solutions with PPPs, is now available on the website of the Multilateral Relations Office, Office of Global Affairs (OGA), HHS. OGA’s decision to publish the Guide will help support numerous governments and multilateral organizations around the world in their efforts to build capacity for healthcare PPPs.

Based on 17 years of PPP research and education, the Guide is designed to help executives in the public sector understand the incentives, motivations, frameworks, skills and management of conflicts of interest that underpin successful PPPs. It will serve numerous governments and leading universities. As a 135-page PPP primer which covers the preparation, engagement, and value creation associated with healthcare PPPs, the Guide has been carefully designed to develop and deepen executives’ learning process, using evidence-based case studies to situate abstract concepts in real-world examples.

 Pioneering Virtual Workshops

While the PPP Government Guide can be read independently, it is much more effective when accompanied by a hands-on workshop, executive education program, or graduate program. As such, the PPP Initiative is currently planning a series of high-level virtual workshops, engaging a wide variety of stakeholders: ministry of health professionals, graduate students, and executives in both the public and private sectors. The first of these virtual workshops will take place in July, hosted by the National University of Singapore’s School of Public Health and co-taught by Founding Dean Chia Kee Seng. Additional workshops are being discussed. Each workshop will give us an opportunity to means-test the Guide, incorporating participant feedback to ensure continuous improvement of our pedagogy and frameworks.

A Global NCD Platform

Since early 2018, PPPI has worked closely with WHO’s Independent High-Level Commission on NCDs to promote an understanding of the economic consequences of non-communicable diseases. It is our view that, by taking an economic approach to this massive healthcare crisis, governments and multilaterals will be better equipped to develop innovative solutions, including engagement with the private sector.

In 2018, when I was asked to serve as a Technical Expert to the Commission, global capacity for healthcare PPPs was significantly underdeveloped, and the Commission’s work was focused primarily on the health impacts of NCDs, rather than the economic impacts. My work advocating for an economics-minded approach—with a significant emphasis on negotiation—was well-received, and in March of 2019, I was asked to moderate a roundtable discussion co-chaired by the World Economic Forum and the governments of the United States and Kenya. Participants included 45 officials from UN member states and fifteen private-sector representatives. And in April of that same year, I presented a WHO-commissioned paper, Potential Business Models that Involve Private Sector Support for National Responses in Preventing and Controlling NCDs, to high-level members of the Commission in Geneva. Throughout the remainder of 2019, PPPI continued to support key Commission members.

The Commission’s Final Report, released in December of 2019 includes Recommendation Six, which calls on WHO to “increase its engagement with the private sector to promote their effective and meaningful contribution to global NCDs targets and goals.”

As global support for healthcare PPPs builds worldwide, PPPI continues to prepare both governments and the private sector to develop partnerships that are effective, stable, and sustainable. 

After nearly a year in development, PPPI’s latest core curriculum document, the PPP Government Guide: Designing Healthcare Solutions with PPPs is available on the website of the Office of Global Affairs (OGA), US Department of Health and Human Services (HHS).

To read the Guide please visit the OGA website.