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 Foundations 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 entitiesfor 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 participationprimarily by drug companies developing vaccinescritics 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 USGs 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 Coordinators role in aligning the various federal agency anti-malaria efforts helps to ensure that these agency perspectives will be represented at such meetings.