Power to the Partners?: The politics of public-private health partnerships
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Thematic Section
Power to the Partners?: The politics of public-private health partnerships
KENT BUSE AND ANDREW HARMER
ABSTRACT Ken Buse and Andrew Harmer review the political dimensions of global public–private health partnerships through the ‘three faces of power’ lens. They attempt to answer the questions: who has power; how is power exercised; and on what basis? Evidence, although scant, suggests that a northern elite wields power through its domination of governing bodies and also through a discourse which inhibits critical analysis of partnership while imbuing partnership with legitimacy and authority. KEYWORDS global health; elitism; pluralism; governance; membership
All politics is about power. The practice of politics is often portrayed as little more than the exercise of power, and the academic subject as, in essence, the study of power.Without doubt, students of politics are students of power: they seek to know who has it, how it is used and on what basis it is exercised (Heywood, 1999:122).
Introduction Public^private partnerships (PPP) have become a prominent feature of our global health landscape in the past decade. As Figure 1 illustrates the number of global health PPPs has steadily increased since1982; reaching a high-point in 2000 with17 new partnerships.1 Since 2000, the flurry of partnership launches has subsided, providing breathing space to reflect upon the political implications of this important mechanism of global governance. In looking at the politics of PPPs in health we see how PPPs have introduced new actors into, and generated additional resources for, the international health arena. In doing so, PPPs have altered the relative distribution of power among organizations, between public and private sectors, and between the global North and South. PPPs have changed the policies and practices of public sector organizations, such as those of the World Health Organization (WHO), which has given rise to considerable debate and controversy (Buse and Waxman, 2001). Concerns have been raised as to whether or not such partnerships are desirable; the circumstances under which partnerships should be employed; the manner in which criteria for the selection of appropriate activities, companies and industries should be established; the best ways to structure and monitor interactions between sectors so as to avoid real and perceived conflict of interest; how Development (2004) 47(2), 49–56. doi:10.1057/palgrave.development.1100029
Development 47(2): Thematic Section 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 0 0 0 0 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3
Figure 1: Number of new ‘global’ public^private health partnerships:1974^2003
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to coordinate the proliferation of initiatives at the global and national level; and how to integrate them into national health systems (Buse and Walt, 2000a, b; Richter, 2003). Partnership has also created new opportunities for the private sector to exercise power and influence over domains wh
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