Exploring the Role of Public-private Partnerships in Health Systems Strengthening: Experience from Southern Africa

The Brief draws from a Scinnovent Centre commissioned study as part of the African Science Granting Councils Initiative (SGCI) Theme 3. The study sought to explore and understand the role PPPs could play as viable technological catch-up vehicles and investment financing mechanisms to build a competitive African health sector that is interlinked with a vibrant local pharmaceutical industry complex, capable of supplying drugs, vaccines and other health products that assure health inclusion and social security. The Brief draws from co-produced primary and secondary qualitative and quantitative evidence from five southern African countries, namely Botswana, Namibia, South Africa, Zambia and Zimbabwe to highlight and examine examples, opportunities, successes, failures of and lessons from PPPs in health-industry innovation and health system financing. We identified and analysed various configurations of PPPs, including non-conventional PPPs with two or more partners drawn from non-governmental organisations (NGOs), donor agencies, industry, and other for-profit and non-profit enterprises, academia and social enterprises. The non-conventional and usually time-limited PPPs link up with governments to strategically address specific maladies and intra-system challenges, as specific mechanisms for achieving better, more responsive and resilient health systems. This study speaks broadly to the roles of PPPs in addressing global health inequity through market adjustment, the importance of embeddedness of local pharmaceutical suppliers with poor populations in low-middle income countries to drive overall health (social) inclusion. It also unpacks an array of context-specific social, economic, political, geographic, and epidemiological factors which cannot be successfully examined if the lens is not anchored on the sub-regional, regional and global political economies. The study expanded literature for the southern African region which hitherto disproportionately focused on public-private engagement in South Africa, with very little known about the other countries, outside of Zimbabwe and Mozambique, in which narratives on the health-industry complex from the perspectives of pharmaceutical manufacturing have only been recently captured.