The private foundations of global health partnerships

This paper broadly explores the influence of private foundations in the governance of global health. Such foundations, including Rockefeller and Ford, have historically played an important role in infectious disease control, providing seed finance to develop vaccines (e.g. yellow fever) and direct interventions to eradicate intestinal parasites (e.g. hookworm). More recently these actors have utilized their material resources to facilitate and broker strategic coalitions between pharmaceutical companies, civil society groups, international organizations (IOs) and states in “innovative” policy arrangements variously known in the literature as public-private, multi-sectoral and multi-stakeholder partnerships. Partnerships, such as the GAVI Alliance, the Institute for OneWorld Health and the Global Fund to Fight AIDS, Malaria and Tuberculosis, to name but a few high-profile cases, have been identified as appropriate policy responses to complex, and seemingly intractable, global health problems. However while theorists and practitioners have devoted considerable attention to the implications of these instruments for health governance, applying policy analysis to assess the modality’s institutional effectiveness (cf. Buse and Harmer, 2007) as well as raising normative concerns around the consolidation of private sector power within IOs (cf. Utting and Zammit, 2006), there remains a relative paucity of empirical research on the role played by foundations in both financing partnerships and by inference influencing global health policy. While a number of key researchers recognize the importance of these actors to the emergence of the partnership model (Bull and McNeill, 2007; Buse and Lee, 2005; Widdus and White, 2004) there remains a fairly broad consensus among development actors, including most official agencies, that foundations remain a relatively benign source of development finance, as opposed to agents whose influence extends beyond the basic material and into the more subtle and complex ideational sphere of health policy and governance (and increasingly procedural areas which runs counter to more recent, although not historical, grant-making foundation activity which is deemed to be premised on a sanctified and partially regulated principle of non-interventionism). The papers presented on this panel go a long way to redressing this oversight, by showing how, contra to earlier research on global health partnerships (GHPs) which tended to acknowledge yet not sufficiently explore these actors, foundations should be seen as key actors in health, as well as GHP configuration. This paper has three objectives. The first is to locate foundations within the dominant theoretical traditions in foundation studies, which have broadly been defined as the pluralist (liberal) and the critical (Gramscian) schools. Despite their initial application to other development sectors these offer some, albeit limited, conceptual pointers when examining GHPs, and more broadly, issues of power in global health governance (GHG). The second is to explore why this has taken place – that is, to show how new modes of philanthropy and new governance modalities are tightly wedded within a combination of domestic regulatory and political processes and broader governance discourses. The third is to show how foundations have been important in partnership formation. Using a select few examples from GHPs with substantive foundation participation this section forwards a conceptual framework that posits how foundations have shaped – and continue – shape the trajectory of global health policy.