III. Choosing Partnerships: Factors to Consider

Whether and how USG-foundation interactions unfold depends on the answers to questions about the nature of the problem being addressed, communication between stakeholders and their commitment of resources, and the ways decisions are made. This chapter highlights some questions that federal officials engaged in health and social services may wish to examine as they consider philanthropic initiatives and whether to partner with foundations in their efforts.

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Key Findings from This Chapter

Three central questions address the wisdom and feasibility of establishing partnerships between federal and foundation philanthropic stakeholders:

1. What is the scope of the problem and what piece can stakeholder partners address?
   Our analyses suggest that more narrowly defined problems may hold greater potential for partnerships between USG and foundations. Clear or narrowly defined problems, such as reducing illness and death from malaria, allow potential stakeholders to assess whether strategies to address it are compatible with their organizational capabilities. When a problem is less clearly understood or broader in scope, such as poverty or democratization, greater ambiguity or complexity may hamper partnerships.
2. What are the costs of the partnership and what value is added by partnering?
   Partnership costs stem from the need to identify partners, navigate organizational or cultural constraints and differences; maintain communication; execute, implement, and monitor agreements; and provide governance. Benefits can also be substantial, such as organizational learning, minimizing duplication, and leveraging additional funding. Organizations that use partnerships have sometimes developed approaches to identify and assess costs and benefits in order to choose whether, at what point, and how to partner.
3. Who needs to be at the table and how can they be encouraged to participate?
   Convening stakeholders can be both a useful planning exercise and a potential partnership strategy. Including those with the authority to make decisions about participation and resources appears critical to an initiative’s success. Although foundations are not the only possible conveners, they may have advantages in this role over government or for-profit entities.
   Certain leadership structures used by USG, such as the U.S. Malaria Coordinator, may also facilitate partnerships by offering a single, well-defined, and clearly understood point of contact for foundations or other private entities, as well as aligning federal agencies and efforts.

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Questions surrounding the desirability and feasibility of partnerships may not be answered definitively in the early stages of a philanthropic initiative. Nevertheless such questions merit thought from the beginning and reconsideration throughout the lifecycle of an initiative.

A.    Scope of the Problem

Philanthropic action may spring from specific and focused concerns, or from an understanding of a broad and global nexus of challenges. Some problems can be straightforward or narrowly defined, such as the suffering caused by malaria. Others inevitably entail greater complexity, such as the suffering caused by poverty. Either way, the nature of the problem has implications for the feasibility of different philanthropic approaches, including partnering efforts.

Clear definition of a problem allows potential stakeholders to assess whether suitable strategies to address it are compatible with their organizational missions and within their programmatic capabilities. A clear view of the problem also allows already committed stakeholders to assess whether other organizations might be interested in addressing the same problem. In such instances, productive interaction among USG and foundations may be feasible, and partnership might be an option, even if the particular roles of each partner will need to be elaborated.

When a problem is less clearly understood or broader in scope, there likely will be greater ambiguity or more complex choices regarding appropriate interventions. Moreover, as problems become more complex and multifaceted, it may be less obvious whether potential partners would be willing to buy into an integrated intervention strategy or will commit to supporting its intensive pursuit. In such instances, interactions between USG and foundations may take a less intensively collaborative form, focusing on coordination or communication about a problem. However, early interaction on that basis sometimes can allow stakeholders to work toward narrowing the definition of the problem or, alternatively, to carve out their own pieces of the problem to address.

USG-foundation work to address malaria offers an example of how a narrowly defined problem can become a focus for collaboration. While malaria affects many lives, its causes and effects are relatively straightforward and well-understood, as are the potential solutions. The Bill & Melinda Gates Foundation, an early leader in addressing the malaria problem, hired well-credentialed senior advisors and program officers to craft a strategic plan for its malaria program and manage its implementation. The Foundation created formal partnerships through grant awards and informal partnerships through education and advocacy efforts.

Some have suggested that USG’s centralization of malaria efforts in the President’s Malaria Initiative (PMI) was influenced by the Gates Foundation’s work (Seattle Times, January 24, 2007). PMI was established to assist national malaria control programs in up to 15 target countries, focusing on four well-defined interventions: (1) spraying with insecticides; (2) insecticide-treated mosquito nets; (3) lifesaving drugs; and (4) treatment for pregnant women. All of these interventions use readily available approaches to reduce the number of malaria infections, supplementing the vaccine development and distribution work led by Gates. PMI, in turn, communicates and collaborates with federal agencies, international agencies, and private sector philanthropists, including foundations.

Alternatively, MCC offers a good example of an agency that addresses problems with broad scope. Although it targets a short list of nations and focuses on economic growth interventions, MCC has defined the nature of the problem it is addressing and its goals in the expansive terms set out by the U.S. Department of State. In its Foreign Assistance Framework, the State Department sets as the primary goal of all USG foreign aid, “To help build and sustain democratic, well-governed states that respond to the needs of their people, reduce widespread poverty, and conduct themselves responsibly in the international system” (U.S. Department of State 2007).

MCC’s adoption of the broad USG mission may constrain the range and intensity of its partnerships with foundations. MCC’s organizational structure includes a unit dedicated to multilateral and donor relations, which seeks to engage NGOs, foundations, and other private sector entities. In practice, however, MCC has engaged in relatively few partnerships with foundations. This may, at least in part, stem from the expansive nature of the problem MCC seeks to address. MCC’s most noteworthy interactions with foundations have, to date, taken the form of fairly general memoranda of understanding (MOU) rather than concrete and intense partnerships. Another factor that limits partnerships is that MCC’s intervention strategy requires recipients of aid to devise their own interventions. Thus much of the onus for partnership rests on in-country actors (the MCAs), who may have little access to U.S. foundations.

The result may be that collaboration between MCC initiatives and foundations is more likely to arise by serendipity than by plan. The example of MCA-Armenia’s collaboration with the Lincy Foundation—to augment road-building efforts called for in that country’s MCC compact—came about perhaps more through circumstance than through active efforts to promote collaboration. Lincy was already working on highway reconstruction in the country when MCA-Armenia selected this activity as one of its development priorities.^[1]

B.    Weighing the Costs and Benefits of Partnership

A clear caution emerged from case study discussions: intensive partnerships present challenges, and their value should be weighed carefully before partners commit. The United Nations Foundation echoed this caution in its undated report on public-private partnerships. The report emphasized the difficulties associated with such collaboration and concluded that any such effort “should deliver better results than what any partner could achieve alone” (U.N. Foundation n.d.). Case studies indicated that identifying partners could be difficult and time consuming. Moreover, after partners are identified, different and sometimes conflicting organizational cultures and constraints must be worked through. Also, the more intensely collaborative or formal the partnership, the more resources are likely to be required to support the interaction itself—including regular communications and structures for shared operations, administration, and governance. The relative paucity of full partnerships in the cases studied here may reflect this difficult reality. Examples from the case studies shed light on the issue, highlighting instances where collaboration has or has not added value, and suggesting some ways to determine if value is added.

Formation of partnerships should be preceded not only by attention to the question of costs, but also by the specific identification of how value will be added. In formulating the Global Alliance for Vaccines and Immunization (GAVI), the founding partners (World Health Organization, World Bank, UNICEF, and the Gates Foundation) identified two primary areas where value might be added. First, they believed that a pooled financing mechanism—which eventually took shape as the International Finance Facility for Immunization (more commonly known by its acronym, IFFIm)—would enable GAVI to leverage more funding to support access to immunization than would be possible otherwise. Second, they recognized that the administrative burden on recipient countries could be reduced if GAVI centralized bureaucratic procedures. Rather than dealing with multiple funders’ reporting requirements, recipients of this funding would deal with GAVI alone. This approach helped to address a major concern of U.S. foreign aid recipients voiced by the HELP Commission (2007).

Organizations may also benefit from systematic procedures for assessing the value added by partnering activities. In-country MCAs working with the MCC might be interested in partnering with other funders, but they would be required to demonstrate explicitly the value of any collaborative effort in the cost-benefit analysis that is part of MCC compact development. Formal cost-benefit analysis may not be appropriate in all cases of potential collaboration, but such tools can formalize and systematize the assessment of value added through collaboration—as can the more flexible and subjective measures, such as the “expected return” (ER) metric developed by the William and Flora Hewlett Foundation, which considers other funders’ contributions.

Part of weighing and identifying the value of collaboration is focusing on how to minimize its cost or burden. Avoiding reporting requirements from each of multiple donors in GAVI is a good example of lessening the burden associated with partnerships. MCC’s reliance on MOUs as its primary collaborative vehicle with other donor organizations, rather than more intensive collaborations, may reflect its emphasis on containing administrative costs. In some cases, important costs may be intangible. The Ashoka Fellows program offers an example in which partnerships with USG or other governments may be avoided, at least in part because the costs have been deemed to outweigh benefits. Ashoka does not accept any funding from USG or other governments and seems hesitant to interact with any government. This is understandable, given that Ashoka Fellows often seek to change the way their own countries’ governments act or are structured. Similarly, in some cases, social entrepreneurs’ independence or integrity might be perceived as compromised should they be affiliated in some way with the U.S. government.

The Robert Wood Johnson Foundation (RWJF) is experienced in partnering with the federal government and other foundations. It has developed a process for the careful consideration of partnership opportunities. RWJF’s interactions with others often originate during the initial strategic process when RWJF considers different approaches to achieving its program goals. Consistent with the due diligence characteristic of large foundations, this process includes a survey of existing programs and players in the area. According to a respondent from the foundation, since USG is “involved in virtually everything we are interested in,” on most RWJF projects, program staff identify USG activities in the area. Staff members then evaluate what type of interaction offers the most potential for achieving the particular program goals. At the most basic level, there must be common ground on the approach, priorities, and goals. The utility of interaction will vary by program area and even by project; an RWJF effort to improve an existing USG program would involve a different type of interaction than trying to create broad strategies to reduce childhood obesity, for example. The type of interaction RWJF ultimately pursues depends on a staff evaluation, at a tactical level, of the costs and benefits of interaction.

From its experience the foundation believes that the benefits to interaction can be substantial. They include useful learning, minimized duplication, and even leveraging additional funding. While deeper interaction can amplify these benefits, RWJF often decides that less formal or no interaction is the most efficient path. Previous RWJF interactions have revealed that initial enthusiasm over the obvious benefits of interaction can obscure the high costs of deeper relationships. Building full partnerships requires careful development and understanding of rules and roles, either through memoranda or contracts, which the foundation has found to be challenging.

C.    Participation By Key Decision Makers

Input from stakeholder organizations can strengthen philanthropic initiatives that address health and social service needs, regardless of whether or not the effort will involve partnerships with them. Hearing from stakeholders in recipient countries, NGOs, research organizations, and other donor organizations should increase the likelihood that the initiative avoids redundancies, encourages local ownership, and has a better chance for sustainability. The same is true in the domestic sphere. Of particular importance to interactive efforts is the participation of those with the authority to make decisions and direct resources.

Although foundations are not the only possible conveners of such interactions, they have advantages in this role. The largest foundations, such as Gates (in its international and domestic work) and RWJF (in the domestic realm), bring stature and resources that create incentives for others to participate. Moreover, private foundations may be viewed as neutral actors, in comparison to federal agencies, which may engender partisan distrust, or for-profit companies, whose motives may be doubted by potential collaborators.

Both the Gates Foundation and RWJF offer examples of this convening role. The former appears to have been particularly effective at bringing key stakeholders into their international initiatives. The fact that Gates’ program officers are technical experts in their fields appears to help them identify and enlist others doing important or innovative work on a problem. The Gates approach typically has involved convening meetings of those already working on some aspect of a problem as part of the Foundation’s initial formulation of its involvement in the field. Through large conferences and more intimate “listening sessions,” Gates has enlisted researchers, policymakers and other public officials, NGOs, practitioners, and other philanthropists to help understand problems and develop strategies for addressing them. The culmination of these processes has sometimes been the establishment of new collaborative entities—for example, the Program for Appropriate Technology in Health (PATH), and GAVI. Similarly, RWJF has cast a wide net in convening meetings of stakeholders from various areas of the public and private sectors to strategize around problems, as the Nurse Funders Collaborative illustrates.

Convening stakeholders, however, does not necessarily ensure their participation, whatever the level of interaction intensity. The evolution of the GAVI governance structure illustrates some of the tensions that can affect stakeholders’ participation. Over time, the interplay between GAVI members has yielded a structure in which founding members have permanent supervisory board seats, while developed and developing nations fill rotating seats; in fact, some problems have arisen with respect to representation in these rotating seats. Among developing nations, resource scarcity has made it difficult for all of the needed individuals to participate at an appropriate level. Meanwhile, those developed nations not holding a seat at a particular time may then have less incentive to continue participating. Also, although many agree that incentives are necessary to encourage private sector participation—primarily by drug companies developing vaccines—critics worry that profit may overwhelm other motives, with the potential to taint the alliance.

In addition to convening a multilateral forum and promoting participation, the other side of the participation equation involves ensuring simple access to productive interaction. One example of attention to that concern is the legislation establishing PMI, which designates the U.S. Malaria Coordinator as USG’s lead representative at all international malaria prevention and treatment meetings, including those sponsored by Roll Back Malaria, the World Bank, the World Health Organization, and UNICEF. Rather than seeking to bring stakeholders to the table, the Malaria Coordinator responds to requests from foundations and other organizations to participate in interactive efforts, offering a single, well-defined, and clearly understood point of contact for foundations or other private entities seeking to interact with USG around malaria. At the same time, the Coordinator’s role in aligning the various federal agency anti-malaria efforts helps to ensure that these agency perspectives will be represented at such meetings.