Strategic learning and evaluation are important tools for cross-sector collaboration—to monitor and understand progress, to support accountability, and to help continuously adjust approaches, solutions, and strategies along the way. At FSG, we advocate for an adaptive approach to learning and evaluation that meets the needs of collaborative efforts at any given point in time. In the early years of a cross-sector partnership, the process of partnering or partnership health is an important focus. This includes tracking alignment to a shared vision, the extent to which governance is fit-for-purpose and communication flows within and across partners.
Partnering for Change (P4C) is a global partnership between the International Committee of the Red Cross (ICRC), the Danish Red Cross, and the biopharmaceutical company Novo Nordisk to tackle the growing issue of non-communicable diseases (NCDs) in humanitarian crises. The three partners developed an active learning agenda on partnership health for P4C’s first phase (2018-2020). FSG supported the development of this agenda, tools for ongoing monitoring, and conducted annual reviews to help identify areas for development. In this blog, we share some lessons for global cross-sector partnerships tackling issues related to humanitarian crises from our experience of accompanying P4C along its partnership learning journey.
Background to P4C
NCDs have a disproportionate impact on vulnerable populations, who are more likely to be diagnosed late and less likely to have access to ongoing care, particularly for complications. Globally, 85% of premature deaths from NCDs occur in low-resource settings. Humanitarian crises resulting from internal or external conflicts, natural disasters, epidemic or pandemic diseases, and complex emergencies often disrupt existing health systems that are already under-resourced and poorly structured to address chronic care needs where continuity of care is critical. A lapse in care for NCDs, even for a short period of time, can result in high levels of disability and premature death.
Companies, corporate foundations, and other private sector platforms have long been engaged in humanitarian crises, working directly or independently with people affected, and with humanitarian organizations at the local and international levels, both on operational and systemic challenges. Collaboration between humanitarian organizations and corporate actors is recognized as being increasingly essential to address the needs of people affected by humanitarian crises. The private sector can be a valuable partner in addressing the complex issues faced by fragile health systems and people at risk of and living with NCDs, by leveraging their own expertise, resources, innovations, channels, and influence. Yet cross-sector partnership in this space is nascent and can be challenging, not least as it requires close collaboration between organizations with different organizational cultures, expectations, and constraints.
The Global Goals can only be met if we work together. To build a better world, we need to be supportive, empathetic, inventive, passionate, and above all, cooperative. —UN SDG 17
P4C was launched in 2018 to tackle the growing issue of NCDs in humanitarian crises. Components of the partnership include mapping and assessing the current landscape for NCD care in humanitarian crises, working to ensure availability of medicines and equipment and strengthening supply chain management, field projects to develop more context-appropriate approaches to NCD prevention and care, and advocacy to raise awareness about the importance of addressing NCDs in humanitarian crises. The London School of Hygiene & Tropical Medicine (LSHTM) has been brought on board as an academic partner to provide independent scientific evidence and help with needs assessments, intervention design, and documentation of results and learning.
Lesson 1: Building trust takes time and is needed at multiple levels
This may seem obvious but is worth stating, as it is often underestimated. Trust, underpinned by strong interpersonal relationships, is a critical foundation for global partnerships and can take years to develop. This plays out at multiple levels—in the day-to-day management of partnerships, at the institutional level of each partner, ands at the level of global and local ecosystems. The partnership and institutional levels may take precedent in the early years but should not detract from engaging the broader ecosystem of stakeholders critical for impact.
Learnings from P4C’s experience to date:
- Continuous engagement and interaction among a dedicated and resourced Core Team is a good first step. For P4C, establishing a Core Team of dedicated project managers from each of the organizations helped build and reinforce a strong set of personal and inter-organizational relationships, commitment to P4C’s vision, and continuity despite staffing changes. Processes such as written quarterly updates on partnership activities and monitoring on partnership health have provided an additional layer of accountability amongst partners.
- Formal and informal relationships and communication channels initiated through a partnership can help maintain a shared vision, beyond the partnership itself. Regular updates and touchpoints with P4C’s Steering Committee, and exchange with executive management on partnership activities and issues related to NCDs and cross-sector collaboration more broadly, maintained commitment from the top of each partner organization. The partnership is seen by the organizations involved as a commitment to each other to continuously explore ways to advance the issue of NCDs in humanitarian crises. Exchange has given rise to new ideas and since the start of P4C, partners have launched several related efforts on the topic, including, for example, the LSHTM knowledge hub on NCDs in humanitarian settings and Novo Nordisk’s engagement in the Danish Red Cross’ emergency response roster.
- Listening and adapting to local needs is crucial to advancing and shifting ownership locally. Building trust and securing the buy-in of partners’ field staff and the broader ecosystem locally as interventions at country level were introduced has been challenging and taken time. Trust cannot simply be transferred. There is no quick way around this; ideas conceived globally need to account for the time it takes to build relations at a local level, listen to needs and adapt. Having the LSHTM as an intermediary on research has helped bring field staff and other stakeholders, including local academia, health care institutions, government, and civil society, on board. However, this remains an important area of ongoing learning for the partnership—understanding existing operational programs and the specificities of the local health system; how P4C can add value; and listening and adapting to the needs of local teams, local authorities, health staff, and populations affected.
Lesson 2: Balance setting boundaries with flexibility when it comes to private sector engagement
Private sector engagement in humanitarian affairs is particularly sensitive when it relates to medicines and the health of vulnerable populations. Patience, open and honest dialogue, flexibility, and in some cases also clear boundaries to avoid (fears of) undue influence, are key ingredients for enabling private sector contributions in these contexts.
Learnings from P4C’s experience to date:
- For the private sector partner: Be patient and willing to take a back seat in certain instances, particularly around data collection which can be sensitive. Longer-term engagement can increase trust and unlock opportunities to meaningfully engage. For P4C, it was decided to keep commercial activities entirely out of the partnership from the outset, and all engagement—including at the local level—has been undertaken by Novo Nordisk HQ-based, non-commercial, sustainability staff.
- For humanitarian organizations: Work with private sector partners to align on boundaries for engagement, be honest, and communicate clearly to set expectations. This applies to international organizations and nonprofits in general but is particularly true for humanitarian actors, whose independence and neutrality are core to their mission, values, and license to operate. As in the case of P4C, this may require ongoing alignment on expectations between programmatic/operational functions vs. resource mobilization/partnership functions.
- For both: Bringing in independent measurement and learning partners, like the LSHTM was engaged in the case of P4C, can strengthen the partnership’s legitimacy by ensuring that its activities are evidence-based and importantly provide an additional, healthy interface with partners to broker the honest conversations that inevitably need to be held as a partnership develops. When considering the involvement of academic partners, it is important to consider what is feasible in contexts where needs are urgent and funding limited, and it may be difficult to justify committing human resources to research.
Lesson 3: Advocacy is a natural joint activity for a global partnership, but expectations, liabilities, and risks need to be managed
Advocacy is often seen as the natural place for cross-sector partnerships to prioritize. Nevertheless, differences in advocacy approaches, cultures, and expectations, as well as associated liabilities and risks, need to be actively considered and managed by the partnership.
Learnings from P4C’s experience to date:
- Partnership can be an opportunity to strengthen advocacy and voice on specific topics, drawing on partners’ complementary credibility, networks, and expertise. Joint events, such as the one held by P4C partners at the World Health Assembly in 2019, where partners and other stakeholders (including the Minister of Public Health in Afghanistan, the WHO, World Bank and UNHCR) exchanged on the needs for, and experience with, integrating NCD care into the health response, and views on multi-stakeholder partnerships represent opportunities to bring together stakeholders that otherwise might not have met, around the same agenda.
- The route to getting there is seldom straightforward, and partners need to balance different traditions of communications and advocacy, as well as differing expectations, liabilities, and perceived risks. P4C partners had different perspectives on the nature, and therefore timing, of advocacy—advocacy that generates awareness on the agenda itself versus advocacy that aims to share the outcome of local activities already implemented and results generated. There was a need to understand and jointly evolve the partnership’s advocacy approach to find common ground that all partners felt comfortable with and delivered value for the partnership’s common objectives. Through the process, partners have learned from each other and widened their own understanding of what can lead to positive outcomes for advocacy.
The ICRC, the Danish Red Cross, and Novo Nordisk have now committed to Phase II of P4C—a new three-year period guided by the same common vision and overall objectives of the partnership, pushing targets and results further through deeper exploration of thematic focus areas (such as patient self-care) further integration of services, and building on the trusted relationships established and the learnings generated during Phase I.
At FSG, we have long advocated for and supported collaborative approaches to complex social problems. Partnership is not a panacea for social change; it can be hard work and is not without its pitfalls, particularly when collaboration spans across sectors and geographies and focuses on inherently unstable environments. Moving forward, we encourage P4C and similar partnerships to continue applying an adaptive approach to learning. A natural next step for P4C will be to understand, document, learn, and strengthen the ways in which collaborating delivers value to partners’ common objectives beyond what partnering organizations could deliver individually.