Ngoasong Michael Zisuh
A Global Health Partnership Model: Using Social Network Theory to Strengthen Health System Functioning
This paper provides a theoretical framework to study Global Health Partnerships (GHPs) as facilitators of access to medication. Such public-private partnerships usually refer to explicit contracts (North, 1990; Williamson, 1996b) involving at least three parties: a private corporation, an inter-governmental organization, and a developing country government, to establish a new organization, generate new products or services and contribute dedicated resources to achieve a shared health-creating goal (Buse and Walt, 2000b; Richter, 2004a). However, GHPs also involve relationships, characterised by informal ties that are embedded in a network of actors (Granovetter, 1983; 1985). This is because; state and non-state actors voluntarily agree to undertake specific functions in health governance (Dodgson, et al., 2002) and ‘share risks, responsibilities, resources, competencies and benefits’ (Nelson 2002: 47). Therefore, both contractual and informal dimensions are useful to understand GHPs, and to explain the organizational forms preferred by GHPs in facilitating access to medication.
The paper develops a network model of ‘partnership’ to improve health system functioning. ‘Partnership’ is used in this context in relation to the global and multisectoral nature of healthcare. The model uses social network theory to set out the functional and operational requirements for a GHP in relation to barriers to access to medication in an African country. GHPs are a response to the growing pandemic of diseases (such as HIV/AIDS, malaria and TB) that impose a double burden on the functioning of national health systems. States in poor and disease-endemic countries no longer possess sole responsibility for healthcare. In addition, the inability of partner-organizations in a GHP to meet the requirements for legitimacy calls for organizational and institutional changes respectively. Therefore, to understand the development process and effectiveness of GHPs, there is needed to define them as organizational forms that are amenable to social network and institutional theories. Networks link organizational affiliations within and between global and national partners. The opportunities to network and build coalitions in a way that increases the chances of facilitating access to medication in Cameroon are identified and discussed.
Key Words: Social network theory, institutions, health systems, healthcare, public-private partnership, Cameroon
Buse, K. and Walt, G. (2000b). “Global public--private partnerships: part II - what are the health issues for global governance?” Bulletin of the World Health Organization 78:699-709
Dodgson, R., Lee, K., & Drager, N. (2002) ‘Global Health Governance: A Conceptual Review.’ Discussion Paper No. 1. Department of Health and Development, World Health Organization.
Granovetter M. (1983) The strength of weak ties: A network theory revisited. Sociological Theory 1:201-233.
Granovetter, M. (1985). ‘Economic Action and Social Structure: The Problem of Embeddedness’, American Journal of Sociology, 91: 481 – 510.
Nelson, J. (2002). Building Partnerships: Cooperation between the United Nations System and the Private Sector. New York: United Nations Department of Public Information.
North, D. C. (1990) Institutions, Institutional Change and Economic Performance, Cambridge, Cambridge University Press.
Richter, J. (2004a). ‘Public-Private Partnerships for Health: A Trend with no Alternatives?’ Development 47(2): 43-48.
Williamson, O. E. (1996b) The Mechanisms of Governance, New York, Oxford University Press.