Discussions surrounding public-private partnerships (PPPs) in undernutrition are characterized by optimism by some, mistrust by many, and confusion by all. Optimism, because the private sector is seen as a potential source of expertise, technical resources, and new funding for nutrition. Mistrust because many civil society and government actors have experienced private-sector behavior that undermines public policy. Confusion, because the terms “nutrition” and “PPPs” are rarely precisely defined in debates over the role of PPPs, leading to discussions that are vacuous or overcharged but rarely informative, and because there is little independent evidence of the success of any such venture.
PPPs have potential for mobilizing resources, tapping into the development and delivery capacity of the private sector, and scaling up interventions quickly and efficiently, along with many other benefits. The spectrum of actions to reduce undernutrition and the spectrum of actions in which the private sector is actively involved are both wide, and they overlap significantly. From a nutrition perspective, PPPs are best placed to operate where the benefits (in terms of the reduction of malnutrition) are highest, where publicsector solutions are not readily available, effective, or sustainable, and where there is least risk of adverse outcomes. Where are these spaces, and what are these activities?
In our review (Hoddinott et al. forthcoming), we bring structure to the discussion by clarifying different models of private-sector engagement (such as contractual/noncontractual, input-based/ results-based) and different roles of actors (financiers, implementers, beneficiaries). The literature is awash with case studies that are little more than company publicity. Filtering these out, to focus only on examples with documented impact, we found little in the way of independently generated high-quality evidence of the impact of PPPs on reducing child undernutrition. Caution is therefore required going forward. In the case studies we examined it was also clear that there are successful PPPs, but often these take considerable time to get off the ground. Clear, enforceable contracts and devices for securing and sustaining commitment to avoid hold-up problems are required. Our work has also highlighted the resistance of private-sector firms to working together unless there is a competitive advantage to doing so.
Even where there is solid evidence that an individual PPP appears to be “winwin” in terms of meeting the goals of both partners (for example, reducing undernutrition and making a profit), this is not enough. We need to consider the ethics of engagement—for example, have partners’ interests been conveyed and discussed to reveal actual or potential conflicts? Should PPPs be developed and sustained with companies that have been found to engage in practices that damage nutrition elsewhere? Should PPPs be avoided because participants are so worried about the adverse publicity that they will forgo opportunities to reduce undernutrition? Ethical and effective PPPs require a transparent rule-based administrative process by which projects are developed and procured, with fair incentives for all stakeholders and fair returns to all partners, taking into account their level of involvement and assumption of risk. Private commercial interests need to be assessed alongside public health and nutrition interests, conflicts of interest acknowledged and managed, legislation and ethical codes of conduct adhered to, and the full range of partnership outcomes evaluated. There is a need for both a “stick” of strong, wellenforced government regulation and “carrots” that incentivize pro-nutrition roles