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Public-Private Partnerships: A Handwashing and Hygiene Promotion Example

Public-Private Partnerships: A Handwashing and Hygiene Promotion Example. April 26, 2007 Sara Abdoulayi, David Hostler, Stacey Succop, and Sarah Wilkins ENVR 890 003. Presentation Outline. What is a public-private partnership? “Health in Your Hands” Handwashing Initiative

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Public-Private Partnerships: A Handwashing and Hygiene Promotion Example

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  1. Public-Private Partnerships: A Handwashing and Hygiene Promotion Example April 26, 2007 Sara Abdoulayi, David Hostler, Stacey Succop, and Sarah Wilkins ENVR 890 003

  2. Presentation Outline • What is a public-private partnership? • “Health in Your Hands” Handwashing Initiative • Case studies from “Health in Your Hands” • PPPs Problematic? • Pros and cons of PPPs • Recommendations and conclusions

  3. What is a Public-Private Partnership? • “…the combination of a public need with private capability and resources to create a market opportunity through which the public need is met and a profit is made.” • According to the United Nations Development Program (UNDP), the broadest definition of a PPP includes agreement frameworks, traditional contracting, and joint ventures with shared ownership.

  4. How does a public private partnership work? • Public and private organizations work together to: -determine a commonly-agreed upon goal for social benefit -produce consumer research -design and implement a promotional/educational campaign -evaluate the campaign

  5. Global handwashing partnership • The World Bank and the Water and Sanitation Program $$ • Bank-Netherlands $$ • USAID $$ • London School of Hygiene and Tropical Medicine • Academy for Educational Development (AED) • UNICEF • CDC • Colgate-Palmolive • Proctor & Gamble • Unilever • National soap companies • National governments • NGOs

  6. “Health in Your Hands” • Global initiative for promoting handwashing and hygiene through public-private partnerships around the world • Functioning for more than 5 years • Current projects in Ghana, Peru, Nepal • Project in Senegal is planned, but delayed

  7. “Health in Your Hands” Objectives • To reduce the incidence of diarrheal disease, in particular among children under five, by making handwashing with soap at critical times universally recognized, promoted, and practiced. • To implement large scale handwashing interventions and use lessons learned to promote the approach at the global level. • Transparency among and equality of partners

  8. Why partner to promote handwashing? • Soap industry gains market expansion • Public agencies benefit from the marketing expertise of the soap industry and thus have stronger capacity to relay health messages to target audiences via marketing campaign strategies • Social responsibility

  9. General Steps Followed by “Health in Your Hands” • Catalyst initiates discussion (this can be an organization in the host country, an organization pursuing new projects, or a private company) • Formation of a steering committee • Funds mobilization • Conduct handwashing behavioral study (formative research) • Design communications strategy • Testing of communications strategy • Execution, monitoring, and evaluation

  10. Case Study - Nepal • Population: 28.9 million • 1/3 below poverty line • 75% subsistence farmers • Remote and landlocked • Civil strife • Susceptible to natural disaster

  11. Case Study – Nepal (2) • 2003 • Child mortality 91/1000 due to diarrheal disease (DHS 2001) • 1 in 5 children suffer from diarrhea • More prone to diarrhea in households with well-water source for drinking water

  12. Case Study – Nepal (3) • Public partners: UNICEF, World Bank, USAID/EHP • Private partners: Nepal Lever Ltd., market leader (subsidiary of Unilever Inc.) and Aarti Soap and Chemicals, local company

  13. Case Study – Nepal (4) • Goal: To contribute to the reduction of diarrheal incidence through handwashing with soap at critical times and using correct techniques • Objectives: • To generate awareness on importance of handwashing with soap • Reach 5 million people, including 500,000 school children

  14. Case Study – Nepal (5) • Phase I: Consumer Baseline Survey • Phase II: Marketing Strategy • Mass media advertising including posters, brochures, radio spots, and tv commercials • Community-based outreach: female health volunteers, sanitation motivators, door-to-doorvisits, demonstrations in schools • Phase III: Program Lauch (2004) • National Sanitation Action Week in May 2005

  15. Case Study - Peru • Population: 28.7 million • 54% below poverty line • IMR 35/1,000 • Urban slum population • Remote rural population • Arid coastal region • Andes mountains • Tropical rainforest

  16. Case Study – Peru (2) • Need: • Diarrheal disease was the 3rd leading cause of childhood disease • Rationale: • Past efforts to improve water infrastructure have not reduced diarrheal disease • Peruvian government expressed interest in a PPP at World Bank Water Forum

  17. Case Study – Peru (3) • Timeline • Government expressed interest: May 2002 • Project inception: March 2003 • Formative research results: September 2004 • Bidding for PPP design: July 2005 • Formal launch of campaign: July 18, 2005 • Evaluation: TBD

  18. Case Study – Peru (4) • Drivers • Mothers are judged by their children’s grooming and health • Dirt, feces, and germs are widely understood to cause disease • Obstacles • “Soap and water are limited resources.” • “I’m careful when I defecate.” • “Doing laundry counts.”

  19. Case Study – Peru (5) • Public partners • Peruvian Ministry of Health (lead agency) • USAID (funds for formative research) • JSDF (funds for developing communications) • Private partners • Colgate-Palmolive (printed materials/soap) • Boga Comunicaciones SA (cable TV) • Radio Programmas Peru (local radio)

  20. Case Study - Ghana • Population: 22.9 million • Skewed towards young • IMR 53/1,000 • 60% subsistence farmers • Large refugee population from Liberia, Togo, etc.

  21. Case Study – Ghana (2) • Need: 25 %of deaths are due to diarrheal disease in children under age 5; 9 million cases of dd per year, and rising. • Partnership initiated by Ghanaian government agency- Community Water and Sanitation Agency (CWSA) in 2001 • Rationale: • Reduce infant morbidity and mortality with the end goal of reducing poverty. • Compliments the rural H20 sector strategy: H20, Sanitation, Hygiene

  22. Case Study – Ghana (3) • Lead Agency: CWSA- coordinator • Public sector/World Bank: Ministries of Works & Housing, Women’s & Children’s Affairs, NCWSP II- World Bank- $$$ Ministry of Health - local health servicesMinistry of Education: School Health Education Program • Private sector: Unilever, PZ-Cussons, GETRADE, AGI- Provide technical assistance; in-kind. • External Support Agencies:  UNICEF: Support to schools component.DANIDA: Support to schools component CIDA & WHO

  23. Case Study – Ghana (4) Drivers • HW after eating • HW after contact with public toilets. • Using soap to feel clean/ beautiful.  • Mothers prioritize their children’s health Obstacles: • Children’s stools are not thought dangerous • Soap is often kept hidden to prevent misuse • Scented soaps- luxury items; interfere with the taste of food

  24. Case Study – Ghana (5) Initiatives: • Mass Media – aimed at mothers and school aged children • Direct Consumer Contact- visits to 2 districts in each of the 6 regions- (health care facilities, schools) …. • District Level Program (through schools, health centers and communities) • Public Relations and Advocacy

  25. Case Study – Ghana (6) • Phase 1 carried out from September 2003 to August 2004 • August 2004 - Evaluation of media initiative looked successful • Commercials re-aired in 2005 to reiterate message.

  26. PPPs -Problematic?: Kerala (1) Characteristics of Kerala as compared to rest of India: • highest hygiene standards • lowest diarrheal deaths • highest awareness on prevention of diarrheal diseases • lowest childhood mortality • highest female literacy. • highest access to safe water SO WHY KERALA???

  27. PPPs -Problematic?: Kerala (2) Ethical Implications: • Risk of privatization of traditional government responsibilities • Destroying indigenous practices • Polluting environment with new industrial products

  28. Overall Pros of PPPs • Financial and in-kind resources are contributed • Local & international efforts are combined • Locals guide the development with expert aid • Efforts are focused on a circumscribed problem • Programs are compatible with the population • Education is a durable good

  29. Overall Cons of PPPs • Selection of partners can be tricky • Conflicts of interest to ensure profit • Financial leverage affects decision-making • Shifting of responsibilities from governments • Sustainability is questionable • Ethical considerations • Bureaucracy

  30. Recommendations • Can PPPs be applied to capacity building and infrastructure strengthening? • Ideals/values and grounds for rejecting partnership should be established before entering a PPP • Third-party monitoring • Rigorous monitoring & evaluation

  31. Conclusions • “Health in Your Hands” has exhibited some success and evaluations continue • Some keys to success include: • Partnership equality/transparency • Community involvement • Rigorous formative research • Comprehensive evaluation • PPPs are a relatively new concept • PPPs have pros and cons and will require more research to establish best practices

  32. Example PPPs • Health in Your Hands • Global Alliance for Vaccines and Immunization • International AIDS Vaccine Initiative • Medicines for Malaria Venture • Global Alliance for TB Drug Development • Initiative on Public-Private Partnerships for Health (database) • Public-Private Partnerships for the Urban Environment (database)

  33. References • World Bank, 1994. World Development Report • Thomas A. Curtis V. Public-private partnerships for health; a review of best practices in the health sector. July 2003 • The global public-private partnership to promote handwashing with soap [Online] [cited 2007 April 21]; Available from: URL:www.globalhandwashing.org • Buse, K.; Waxman, A. “Public-Private Health Partnerships: A Strategy for WHO.” Bulletin of the World Health Organization. August 2001, 79 (8), 748-754. • Roberts, M.J.; Breitenstein, A.G.; Roberts, C.S. “Chapter 4: The Ethics of Public-Private Partnerships.” Public-Private Partnerships for Public Health. April 2002, Harvard University Press, Boston, MA. • Wheeler, C.; Berkley, S. “Initial Lessons from Public-Private Partnerships in Drug and Vaccine Development.” Bulletin of the World Health Organization. August 2001, 79 (8), 728-734. • Widdus, R. “Public-Private Partnerships for Health: Their Main Targets, Their Diversity, and their Future Directions.” Bulletin of the World Health Organization. August 2001, 79 (8), 713-720. • PRISMA. “Behavioral Study of Handwashing with Soap in Peri-urban and Rural Areas of Peru.” Joint Publication 11E. September 2004. 1-159. • Shiva, V. "Saving lives or destroying lives? World Bank sells synthetic soap & cleanliness to Kerala: the land of health and hygiene” • “PPPHW program: the story of Ghana.” Available at http://www.globalhandwashing.org/Country%20act/ghanapu.pdf.

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