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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

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
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
what is a public private partnership
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.
how does a public private partnership work
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

global handwashing partnership
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
health in your hands
“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
health in your hands objectives
“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
why partner to promote handwashing
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
general steps followed by health in your hands
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
case study nepal
Case Study - Nepal
  • Population: 28.9 million
  • 1/3 below poverty line
  • 75% subsistence farmers
  • Remote and landlocked
  • Civil strife
  • Susceptible to natural disaster
case study nepal 2
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
case study nepal 3
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
case study nepal 4
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

case study nepal 5
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
case study peru
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
case study peru 2
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
case study peru 3
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
case study peru 4
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.”
case study peru 5
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)
case study ghana
Case Study - Ghana
  • Population: 22.9 million
  • Skewed towards young
  • IMR 53/1,000
  • 60% subsistence farmers
  • Large refugee population from Liberia, Togo, etc.
case study ghana 2
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

case study ghana 3
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

case study ghana 4
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

case study ghana 5
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
case study ghana 6
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.
ppps problematic kerala 1
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???

ppps problematic kerala 2
PPPs -Problematic?: Kerala (2)

Ethical Implications:

  • Risk of privatization of traditional government responsibilities
  • Destroying indigenous practices
  • Polluting environment with new industrial products
overall pros of ppps
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
overall cons of ppps
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
recommendations
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
conclusions
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
example ppps
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)
references
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.