5

Key Messages and the Way Forward¹

To close the workshop, Jo Boufford and John Lange facilitated a discussion on the key messages and questions for the future that resonated with the participants. Boufford started the discussion by providing a brief summary of key points identified by members of the workshop planning committee. Following Boufford’s overview, Lange invited workshop participants to share their own key take-away messages.

First, Boufford summarized the purpose of the workshop: to highlight the key funding transitions occurring in global health, how both donors and countries are managing these transitions, and what potential roles the private sector can play. Starting with the transitions, Boufford remarked how surprised many participants were to learn about the number of transitions occurring. Visibility on the programmatic transitions and their effects is somewhat limited for those who are not engaged in them directly, she said. The potential risks associated with not planning or coordinating these transitions were raised several times. In listening to the donors speak about their challenges with transitioning countries, a common concern Boufford heard was ensuring continued services and protection for key and vulnerable populations. One workshop speaker made the comment

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¹ In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, the workshop did not attempt to provide a full analysis of the political context related to global health transitions, a landscape of all possible models to support countries in transition, or establish any conclusions or recommendations about needs and future directions. The key messages and way forward focus on the issues identified by the speakers and workshop participants.

that external funding programs often prioritize these populations precisely because they were previously marginalized and lack access to services. Numerous speakers emphasized the importance of supporting civil society to reach these populations after funders leave. Boufford also observed how the question of the changing role of donors, particularly bilateral donors, was raised several times. Should donors focus on funding global public goods or supporting capacity building in the public sector?

Country ownership and country-led solutions was another issue raised by multiple speakers. Different perspectives on what it means were offered, but a common thread was the importance of political will to sustain health progress that has been made and support new solutions going forward. Several speakers emphasized the importance of community engagement for fostering political will. Others provided examples of strong high-level government leadership for addressing health issues.

It also became clear from the workshop, Boufford said, that there are important opportunities for the private sector, but there are also challenges. A key question was: How can the role of private-sector organizations and private-sector financing help to manage these transitions? Boufford noted the discussions on private-sector engagement focused on both financing and country capacity building. A strong theme Boufford heard during the workshop was the value the private sector can bring through sharing know-how and business expertise. Another issue raised was how to get health on the agenda of companies outside of the traditional health sector.

Boufford noted that the tensions with private-sector engagement were explored during the workshop. While global agreements, including the Sustainable Development Goals, explicitly call for private-sector engagement, Boufford acknowledged that tension still exists. During the workshop, the issue on engaging with different types of companies was raised. Some companies do well and others do harm, and there are companies that may do harm but want to make positive contributions. It can be very difficult to positively engage them if they are shut out from the initial conversation, Boufford said.

Boufford noted the issue of NCDs and the acknowledgment during the workshop that only 1 percent of development funding is allocated to NCDs. Addressing NCDs means starting from nothing. She flagged the suggestion made during the workshop to focus on the living and not just the dead to activate resources for NCDs. As a final point, Boufford noted the call during the workshop to focus on primary care systems and prevention to address complex and overlapping health needs.

Following Boufford’s overview, workshop participants offered several additional key messages and questions for the way forward. Below is a list of the additional points raised by individual workshop participants:

• Value of platforms in countries to develop and coordinate PPPs.
• Need to explore further where these platforms can exist and how they can provide a space to identify opportunities and facilitate negotiation.
• Need to examine if such platforms can exist at the regional or global level as well as the country level.
• Opportunity for the United Nations to play a PPP facilitating role at the country level, particularly through the UN resident coordinator.
• Importance of focusing on scaling. There are many examples of PPPs in the small, innovative, proof of concept phase. The focus should be on what is succeeding in scaling.
• Potential to distill common elements of an enabling or favorable policy and regulatory environment to facilitate sustainable solutions in countries.
• Need for a clearer understanding of the sequence of transitions occurring in specific countries and how transitioning programs are coordinating with each other and other stakeholders.
• Importance of the role of government in regulating and monitoring the influx of new partners crowding into countries to ensure accountability, coherence, and impact.
• Opportunity to engage new partners outside of the health sector coupled with the need to help them understand the health sector, which can be hard for outsiders to wrap their heads around.

To close the workshop, Lange noted from his own perspective how it was striking to hear all of these transitions brought together in one meeting. There are many changes coming in global health. The timetable and predictability for some are defined, and others are much less clear. The different ways in which PPPs can be creative and contribute during and after these transitions provide many opportunities as well as questions that still need to be explored.

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