Public-Private Partnerships: A Handwashing and Hygiene Promotion Example

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/educa
  tional 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 childrens grooming
  and health
• Dirt, feces, and germs are widely understood to
  cause disease
• Obstacles
• Soap and water are limited resources.
• Im 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, Womens Childrens 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
Ghana Womens Handwashing Behaviour Study -2002

• Occasion Claims of Hand Claims of Hand
  Actual
• Washing
  Washing with Soap Observ
• (n448) (n436) (n188)
• After defecation/toilet 82 76 37
• Before feeding a child 21 6 -
• Before preparing food 40 11 -
• Before eating 86 14 -
• After eating 85 53 -
• After farm work 15 8 -
• After Sweeping 13 5 -
• After cleaning up childs feces. 0 0 31
• Source Clean Hands, Healthy Life- Ghana washes
  her hands A Public-Private Partnership to save
  lives. Business plan

24
Case Study Ghana (4)

• Drivers
• HW after eating
• HW after contact with public toilets.
• Using soap to feel clean/ beautiful. 
• Mothers prioritize their childrens health
• Obstacles
• Childrens stools are not thought dangerous
• Soap is often kept hidden to prevent misuse
• Scented soaps- luxury items
• interfere with the taste of food

25
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

26
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.

27
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???

28
PPPs -Problematic? Kerala (2)

• Ethical Implications
• Risk of privatization of traditional government
  responsibilities
• Destroying indigenous practices
• Polluting environment with new industrial products

29
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

30
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

31
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

32
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

33
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)

34
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 URLwww.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/Country20act/gha
  napu.pdf.