The interplay between global public private partnerships (GPPPs) and national contexts: A case study of the Global Fund’s Country Coordinating Mechanism (CCM) in Ethiopia

Henock B. Taddese is a PhD Student and Teaching Assistant at ScHARR. He is a graduate of the Europubhealth masters course (EPH), which is a programme jointly run by ScHARR, Copenhagen University in Denmark and EHESP School of Public Health in France. Henock has worked for several years coordinating and advising community health and HIV/AIDS prevention and control programmes in Uganda, and his home country, Ethiopia.

The title of Henock's research project is The interplay between global public private partnerships (GPPPs) and national contexts: A case study of the Global Fund’s Country Coordinating Mechanism (CCM) in Ethiopia. You can also view a presentation about his work by clicking on this link.

Background: Global Public Private Partnerships (GPPPs) are flourishing in the global health governance landscape as a modality for mobilising and managing resources to accelerate attainment of global health targets. The mechanisms are generally viewed favourably as they are widely thought to have desirable effects of enhancing multi-sectoral engagement and deliberative decision-making. However, there is lack of understanding of how they work in real-life, especially in developing country contexts.

Study Aim and Theoretical Framework: This study sets out to explore the interaction between GPPPs and the national ‘context’ in developing countries. The study adopts a theoretical lens, which conceptualises the interaction between social actors and ‘context’ as constituting a dialectical relationship (dynamic interaction) between actors, institutions and deep-lying contextual factors.

Methods: I undertook a case study of the country coordinating mechanism (CCM) of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in Ethiopia. This is a qualitative study employing in-depth interviews with forty-four policy makers, non-participant observation of CCM meetings and documents’ analysis. Data collected through the different methods were analysed interpretively whereby critical themes or ‘story lines’ about actors’ interactions in the CCM are interpreted in relation to relevant institutional and contextual factors.

Findings: The critical themes or ‘story lines’ that dominate actors’ interactions in the CCM include: Consensus and compromises to safeguard the national interest; priority of clinical care over community based interventions; actors’ perceptions of each other (A public sector that gets its way, a timid civil society, a cautious donor community, and a private sector missing in action); and the ‘effective system’ argument. The pertinent institutional factors in relation to these themes include adopted rules and norms, such as: Decision through consensus, partnership, country ownership, performance based funding, zero tolerance to fraud, and composition of the CCM. The relevant contextual factors constitute: The nature of the Ethiopian State; history of AIDS in Ethiopia; poverty alleviation/development as a political pledge; legal frameworks for regulating civil society; CSOs’ representation and coordination crisis; and the processes in which national strategic plans are formulated in the country.

Implications of study: By exploring how the identified critical ideas and narratives relate to institutional and contextual factors, the study adds to the meagre understanding of the ‘embeddedness’ of such globally designed mechanisms in national contexts.