Many health problems affecting the poor have been neglected because of lack of commercial incentives, or have proven intractable when tackled by the public sector or NGOs independently. Public-private partnerships attempt to overcome these obstacles.

In recent years, a number of public-private partnerships (PPPs) have been established to enhance access to existing technologies, or to stimulate investment in researching and developing new products. The partnerships involve international agencies (such as the World Health Organization), pharmaceutical companies and national governments.

Partnerships for access to medicines
One group of public-private partnerships plays a critical role in increasing access to medicines by providing products free or at discounted prices to governments and non-governmental health providers. Over 15 pharmaceutical companies are now involved in PPPs, including the Accelerating Access Initiative for HIV/AIDS and several partnerships for the control or elimination of major tropical diseases. Programmes often entail a multi-partner effort at country level to ensure the distribution and proper use of the medications.

Issues
Public-private partnerships for access to medicines raise a number of questions: how do they affect, or integrate with the broader development of health policy and services in the countries in which they operate? Governance, ownership and other issues are also important in light of wider efforts to harmonise development assistance and align it with national policy for poverty reduction and health.

Our work
The Institute led a series of country case studies for the Initiative on Public-Private Partnerships for Health (IPPPH) to explore the issues raised by public-private partnerships for access to pharmaceuticals. Case studies took place in Uganda, Botswana, Sri Lanka and Zambia in 2003/04, with financial support mainly from the UK Department for International Development (DFID).

The clearest finding was that drug donations for tropical diseases – usually linked with elimination efforts – have provided very considerable benefit. However, drug access initiatives addressing HIV and AIDS were complicated by fragmentation, questions of financial sustainability and certain conditionalities. Compared to the overall need for access to proper HIV and AIDS treatment, the scope of these efforts has been modest. The studies found that the programmes were welcomed by some governments and health care providers but that there were problems and limitations.

For a summary of the findings, read the briefing prepared for representatives of organisations including the World Health Organization, UNAIDS, and the Global Fund to Fight AIDS, TB and Malaria: Donation or discount-based drug ‘access’ programs for tropical diseases and HIV/AIDS (PowerPoint presentation).