Engaging the private sector to deliver COVID-19

tools and achieve Health for All

How to facilitate a public-private

dialogue process

Module 5
LEARNING OBJECTIVES

By the end of the module, participants should be able to

• explain how to implement a public private dialogue based on a six-step process,
• know implementation tips are provided based on field experience, and the skills and
competencies required to facilitate a successful dialogue process.

INTRODUCTION

The brief describes how to implement a PPD process by explaining:

• the six-step process – along with implementation tips - to facilitate an effective public
private dialogue process can be applied to any health priority such as equitable
access to COVID-19 vaccine and other COVID-19 tools; and
• the skills needed to become an effective facilitator and honest broker of a dialogue
process that can results in genuine dialogue and trust between the public and
private sectors working together to achieve a health priority.

WHAT IS PUBLIC PRIVATE DIALOGUE

Definitions of PPD vary greatly with a wide range of terms Box 1. General definition of PPD
used. Examples include “platform”, “process”, "PPDs are structured mechanisms – both
“partnerships”, “committee”, “roundtable” and temporary and permanent- anchored at the
highest practical level, coordinated by a light
“deliberations”. Despite the different terminology and forms, secretariat, and aimed at facilitating a discovery
process by involving a balanced range of public
several common features bind these different concepts and private sector actors in identifying, filtering,
together: accelerating, implementing, and measuring
sector-related policy reforms and actions." [4]
• Participation of multiple public and private sector
stakeholders
• Interaction via forums or “spaces” where participants can physically meet and
communicate
• Convening around common issues or problems that bring the stakeholders together
• Negotiating, collective learning, problem-solving, and decision-making [1] ( [2]

A “genuine” and “true” PPD process will contain one or more of these elements [3].

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PPD comes in many forms: they can be structured or ad hoc, formal, or informal, broad-based,
or issue-specific, permanent, or time-bound. PPD does not necessarily have to be initiated by
the Ministry of Health; it can be driven by forward-thinking arms of government, private sector
entrepreneurs, civil society leaders or third parties such as international donor agencies.

Depending on the focus of PPD, the process involves the government interacting with either a
single group in the private sector or with a wide range of private sector entities through umbrella
groups that represent private sector partners and civil society groups.

LIFE CYCLE PUBLIC PRIVATE DIALOGUE

Typically, a PPD – whether it be in health or other social sector - experiences three phases in its
lifecycle.

Phase 3 Phase 1 Discovery

Institutionalize, •6 months to 2
sustain or exit years
•5 years and
beyond

Phase 2 High Impact Results

•1 to 5 years

Phase 1: Discovery. In this first phase, the PPD process focuses on building trust, educating the
different partners about one another, and discovering what works and does not work to facilitate
collaboration. This phase may yield limited results but can generate “quick wins”. Examples of
areas that can generate a quick win include coming to agreement on (i) how to improve private
sector reporting, (ii) how to reflect private sector contributions in health ministry reports, and (iii)
areas for coordination like sharing of supplies and staff to address a targeted problem.

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Ideally, dialogue partners begin the process by focusing on less contentious issues. More
complex and high-visibility issues are high-risk and can potentially have negative consequences
for the PPD at this stage. If they fail, it could potentially discourage a health ministry from further
dialogue and collaborative processes. Experience suggests waiting until the dialogue partners
have gained experience in collaborating and have established a level of trust before tackling
more contentious issues. The discovery process may last from six months to three years.

Phase 2: High Impact Results. Phase 2 is the most productive phase. Dialogue partners are
motivated by early results and become more experienced in working together. During this
phase, the dialogue partners understand the inclusive process and are comfortable with the
collaboration mechanism. Many of the partners have also gained new collaboration
competencies and skills during the first phase that they now use in the day-to-day management
of the PPD process. The partners begin to realize not only results but also policy and
programmatic successes. As the partners gain confidence, they begin to address more
contentious issues that may lead to conflict and possible crisis. However, with their newfound
PPD competencies and skills, they are more adept at mitigating these. This phase may last from
one to three years, depending on how successful the dialogue partners are in resolving conflict,
sustaining momentum, and achieving results.

Phase 3: Future Direction. As the PPD process now takes on a life of its own, it is appropriate
for the partners to question its future direction: Should the dialogue process be maintained in its
current structure (institutionalized)? Should it take on new challenges? Should it be transferred
to a more appropriate organization such as a government, non-partisan institution, and/or
advocacy group (transfer)? Or, perhaps, PPD process has run its course and should be
disbanded (exit).

HOW TO STRUCTURE AND FACILITATE A PPD PROCESS

Building on experience from other social sectors, there are six concrete steps to launch and
manage a successful public private dialogue process. The figure below maps the six steps by
the PPD lifecycle. The following is an overview of the steps and tasks to implement them.

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 • Step 1: Build foundation
Phase 1 - Discovery
• Step 2: Set rules

• Step 3: Formalize process

• Step 4: Set direction
Phase 2- High
Impact Results • Step 5: Orchestrate partners

Phase 3 -
• Step 6: Decide future
Institutionalize,
sustain or exit

Step one: build the foundation for the public private dialogue process
Laying the groundwork for an inclusive dialogue process is dependent on a core leadership
group comprised of public, private, and civil society representatives. This core group directs the
tasks needed to lay the foundation for the PPD’s success or failure. Tasks include: (1)
identifying key public, private and civil society stakeholders to become partners in the dialogue
process (see module on how to identify relevant partners using landscaping tool), (2) selecting
an appropriate mechanism and/or platform (in some cases, the PPD will have to create a new
one), (3) ensuring not only the “right” groups are involved but also that there is “balanced
representation”, and (4) determining if an “honest broker” is needed to facilitate the process
and guide the leadership group. Tasks #1, #3 and #4 are based on good practices from other
successful PPD processes (see PPD video #1 for more information on good practices).

Implementation tips for step one includes:

• Involve private actors from the start. Private sector Step One Implementation
stakeholders can help the ministry of health decide who Tips
should or should not participate in a dialogue process. They ✓ Involve private actors from the
start
can also help the ministry decide when to involve them and ✓ Select only relevant private
actors
at what stage. Stakeholders can also help decide where to
✓ Form a core group of
“house” the PPD process. champions
✓ Invest in collecting data
• Prioritize participants in a PPD process. There are many
private sector stakeholders and many are not necessarily critical to the health priority and/or

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 health system gap that is the focus of the PPD initiative. Select only those relevant private
sector and civil society actors to narrow the number and focus of public private dialogue.
• A core group of champions will emerge organically. This group should be a mix of public,
private, and civil society leaders. Encourage them early on to become the core leadership
group. Shared leadership conveys “legitimacy” to the inclusive process.
• Invest in collecting data. Data is scarce, particularly on the private for-profit sector. It is
worthwhile to invest in collecting data to produce evidence that can debunk myths about the
private sector and “depoliticize” the discussions during the discovery phase.

Step two: set the rules for the public private dialogue process
Once the relevant dialogue partners have been identified, the first order of business is to align
their interests, create group norms, and agree on the dialogue process’ purpose. These actions
will build trust, mutual understanding, and shared values. Together, the dialogue partners strive
to (1) reach agreement on how they will work together (the “rules of engagement”), (2) create
processes that embody the values of a collaborative initiative (e.g., balanced membership, joint
decision-making and transparency in all communications), and (3) establish mechanisms to
resolve conflict.

Implementation tips for step two includes:

• Invest the time upfront to build the “rules” on how the
Step Two Implementation
dialogue partners will work together. This investment Tips
pays off in the long run. This is a simple – often non- ✓ Invest time to build the rules of
engagement
controversial – process. This step is an important
✓ Avoid the “blame game”
exercise to allow partners to get to know each other, to ✓ Codify the rules
✓ Enable champions to lead
express their fears and their concerns as well as
aspirations.
• Be careful to not let the first meetings become a “blame game” session. Instead, steer
the dialogue partners towards common values and shared interests/concerns.
• Codify the “rules” into a code of conduct or MOU that all partners sign – preferably in a
public forum with public recognition. This sends clear signal to the dialogue partners and
their constituents that they are embarking on a new way of doing business.
• It is critical for the core leadership group to “jointly lead” the process as early as
possible. Seeing both public and private sector leaders in the front of the room, leading
the deliberations of rules ---- sends a powerful signal to the participants and confers
legitimacy to the agreements reached on the rules. The tricky part, however, is not to fall

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 back into “old” relationship dynamics in which one sector or individual dominates the
PPD process.

Step three: formalize the public private dialogue process

Many argue that a formal structure is needed to create a “level playing field” between public,
private, and civil society partners participating in a collaborative initiative. Indeed, establishing a
formal structure that provide “back bone” support to the public private dialogue is considered a
good practice (see PPD video #1 for more information on good practices). There is, however,
no consensus on a “one-size fits-all” approach for dialogue platforms that ensure success (see
O’Hanlon forthcoming, 2022 for alternative options on dialogue structures). The literature and
practitioners both agree that for a PPD process to succeed, dedicated capacity is required to
support the day-to-day work of a collaborative process and to help move the agenda and PPD
partners forward [4] [5] [3]

To develop traction, dialogue partners together need to: (1) create a formal structure that
serves as the “backbone” of the process (e.g. secretariat), (2) establish systems and processes
for key functions (e.g. setting meeting agendas, ensuring transparent communications, taking
minutes and archiving them, and collecting data to monitor progress) and (3) mobilize
resources to hire staff, fund the secretariat and carry out the PPD activities (e.g. data collection
and analysis, training and capacity building in dialogue skills, collaborative events like meeting
and communications, etc.)

Implementation tips for step three includes:

• Money can be an obstacle in collaborative initiatives like
Step Three Implementation
public private dialogue. It takes money to convene meetings, Tips
collect data, set up reporting and communication, and hire ✓ Look for resources immediately
✓ Secure resources – funds and in-
staff to manage the day-to-day operation. kind - from all PPD partners
• Start to look for resources (funds and in-kind) early in the
process to establish collaborative structure. It does not take a lot, but it does take
resources.
• Last point about funds, it is important to secure resources from all PPD partners – even if it
a nominal amount. Partner contributions is a strong measure of their individual commitment
to the PPD process.

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Step four: set direction for the public private dialogue process
The power of collaboration comes not from the number of dialogue partners but from the
coordination of their activities. Mutually reinforcing activities ensure that public, private, and civil
society partners’ efforts, and activities are aligned towards achieving a common purpose like
rolling out the COVID-19 vaccine.

To set direction, dialogue partners (1) develop an action plan that serves as the driver for
mutually reinforcing activities, (2) define “success” and agree on metrics by which to measure it,
(3) develop a simple system to collect and report on PPD processes and progress on mutually
reinforcing activities, and (4) create a culture of learning that enables dialogue partners to learn
from both their successes and failures.

Step Four Implementation

Implementation tips for step four includes:
Tips
• Pause and take time to build consensus on the definition of
✓ Build consensus on what
success. The shared vision unites, propels, and sustains the “success” looks like for PPD
process
public private dialogue process. ✓ Agree on data to measure
• Data is important to create a culture of learning and is used success
✓ Secure PPD partner commitment
to monitor progress, learn, and adapt. But getting all to share data
dialogue partners – particularly private sector and civil
society partners – to share data is a challenge for different reasons. Find ways to address
head on the data challenge when setting up group norms and rules.

Step five: orchestrate partners

Orchestrating public, private, and civil society partners in a dialogue process entails working
tirelessly both in the public eye and behind the scenes to establish collective ownership, to
balance the tension between coordination and accountability, and to negotiate compromises
and defuse potentially contentious issues.

Enabling dialogue partners to realize each other’s potential entails (1) managing all partners’
commitments, (2) holding all partners accountable to their commitments and to mutually
reinforcing activities, (3) building each partner’s capacity and helping them mobilize resources
to play their role to the best of their ability, and (4) continuously engaging partners to build trust.

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Implementation tips for step five includes:
• Invest in building dialogue partner competencies and skills. Step Five Implementation Tips
This investment pays off when conflict arises. These skills will ✓ Invest in building partner
also “travel” with the dialogue partners to the next competencies and skills
✓ Honest broker can model new
collaborative initiative. skills
✓ Maintain strict meeting and
• An honest broker can help partners apply new competencies reporting schedule
through coaching and by modelling partnership behaviors.
An honest broker can play an instrumental role in building partner’s capacity in PPD
competencies and skills while keeping the partners focused to move the process forward.
• Not all dialogue partners can participate equally – primarily because of different skills levels
and resources. Plan for it but also avoid “free riders”.
• Maintain a strict and regular meeting schedule to review progress (using data) and to hold
all dialogue partners accountable to their commitment.

Step six: decide the future of the ppd process

At this juncture dialogue partners can decide together if the PPD process has achieved its
purpose and should be disbanded, or if it should be repurposed for another health system
challenge, or ultimately, institutionalized to become an established forum for public and private
interactions in health.

Implementation tips for step six includes:

• It is not a sign of failure if a collaborative initiative Step Six Implementation Tips
runs its course. It is good practice to stop, reflect ✓ Ending is not a sign of failure
and possibly move on to another opportunity. ✓ Ending may open new
opportunities
• Disbanding a PPD process may open new
opportunities for collaboration.

SKILLS NEEDED TO FACLITATE AN EFFECTIVE PPD

PROCESS

In collaborative initiatives like PPD, relationships matter. PPD calls for “relationship brokering”,
requiring dialogue partners – including health ministry staff – to take a more “facilitative”
approach, to act as an enabler. Building and maintaining these complex relationships requires a
policymaker, along with his/her dialogue partners, to develop technical competencies and so-
called “soft” skills in dialogue.

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Core technical competencies to facilitate effective PPD include:

Politically astute. An effective policymaker and his/her dialogue partners need to develop a
“sixth sense” – political acumen – based on political knowledge and experience combined with
“practical wisdom”.

Effective communicator/Active Listener: Skillful communication can increase support for PPD’s
objectives, build trust among the dialogue partners, and foster cooperation. A policymaker
needs to become an excellent communicator with dialogue partners from radically different
organizational cultures to enable meaningful exchanges.

Honest Broker/Facilitator. Effective leadership requires the core leadership group learn how to
become good facilitators. This is a demanding role that requires they take off his or her
“institutional hat” and become an honest broker representing the wider public interest and the
partnership’s common goal.

Skilled Negotiator and Persuasive Advocate. In the PPD process, the policymakers might want
to improve skills in negotiating and persuading others, to find common ground among different
actors with different norms, organizational mandates, and cultures as well as competing
interests.

Capable Manager of Conflict. A certain amount of friction is inevitable when you bring together
different organizations with distinct backgrounds to work collaboratively on a common task. It is
essential for a policymaker to learn how to manage conflict appropriately and constructively.

To perform these new competencies requires a new set of skills. These skills include facilitation,
communication, quality conversations, adapting learning and conflict resolution. Learning these
new skills and practicing them is one of the incentives to attract and retain busy professionals in
a public private dialogue process.

As PPD initiatives and partnerships with private sector and civil society partners become the
norm, governments and their dialogue partners will ultimately have to build the necessary skills
and develop public private dialogue competencies and skills.

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Development partners and international organizations can play an instrumental role in
encouraging partners to acquire these new competencies and skills but also in providing
resources and technical assistance to train both public and private dialogue partners in these
competencies and skills. Investing in these skills pays off down the road when dialogue partners
start to jointly implement activities – that is when tension begins to emerge.

CONCLUSION

This brief offered guidance on how to structure and facilitate an effective PPD process. Although
PPD is considered an “art”, one can observe that PPD process is also based on “science”.
There is growing evidence on what makes a collaborative initiative like PPD successful along
with best practices and tools to ensure the process is productive and effective. With training and
practice, many of the new competencies and skills will become routine – even intuitive – and
can help strengthen relations and capacity to govern a health system. With this understanding,
we hope more low- and middle- income ministries of health will be empowered to work with their
private sector and civil society counterparts to act now to initiate a PPD process that will tackle
an important public health issue like equitable access to COVID-19 vaccines and other tools.

REFERENCES

[1] R. a. W. L. Tennyson, "The Guiding Hand: Brokering Partnerships for Sustainable

Government.," The Prince of Wales Business Leaders Forum and the United Nations
Staff College, 2000.
[2] U. N. C. o. T. a. Development., "Survey of Good Practice in Public-Private Sector
Dialogue. UNCTAD/ITE/TEB/4.," United Nations, 2001.
[3] I. U. f. C. o. N. a. N. Resources, "Collboaration and multistakeholder dialogue.
Literature review.," 2012.
[4] B. a. W. A. Herzberg, "The Public-Private Dialogue Handbook: A Toolkit for Business
Environment Reformers.," The World Bank Group, 2006.
[5] J. a. K. M. Kania, "Collective Impact.," Standard Social Innovation Review, 2011.

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