Search

Background: Public Private Partnerships (PPP) are increasingly utilized as a public health strategy for strengthening health systems and have become a core component for the delivery of TB control services in India, as promoted through national policy. However, partnerships are complex systems that rely on relationships between a myriad of different actors with divergent agendas and backgrounds. Relationship is a crucial element of governance, and relationship building an important aspect of partnerships. To understand PPPs a multi-disciplinary perspective that draws on insights from social theory is needed. This paper demonstrates how social theory can aid the understanding of the complex relationships of actors involved in implementation of Public-Private Mix (PPM)-TB policy in India. Methods: Ethnographic research was conducted within a district in a Southern state of India over a 14 month period, combining participant observations, informal interactions and in-depth interviews with a wide range of respondents across public, private and non-government organisation (NGO) sectors. Results: Drawing on the theoretical insights from Bourdieu's "theory of practice" this study explores the relationships between the different actors. The study found that programme managers, frontline TB workers, NGOs, and private practitioners all had a crucial role to play in TB partnerships. They were widely regarded as valued contributors with distinct social skills and capabilities within their organizations and professions. However, their potential contributions towards programme implementation tended to be unrecognized both at the top and bottom of the policy implementation chain. These actors constantly struggled for recognition and used different mechanisms to position themselves alongside other actors within the programme that further complicated the relationships between different actors. Conclusion: This paper demonstrates that applying social theory can enable a better understanding of the complex relationship across public, private and NGO sectors. A closer understanding of these processes is a prerequisite for bridging the gap between field-level practices and central policy intentions, facilitating a move towards more effective partnership strategies for strengthening local health systems. The study contributes to our understanding of implementation of PPP for TB control and builds knowledge to help policy makers and programme managers strengthen and effectively implement strategies to enable stronger governance of these partnerships. [ABSTRACT FROM AUTHOR]

In today's globalizing world the nature of relationships between the North and South is changing to account for the closing gap in capacity to carry out research of international standard. The development of a lexicon sophisticated enough to address adequately these changing relationships, however, lags behind and is not supported by the current recourse to the jargon of “partnership”. In this paper we explore the difficulties of negotiating a productive path through the dynamics of power and control that characterize international research collaborations. We call attention to this issue through recounting the story of the development of two quite different, but related, international research relationships in which we have been involved. We suggest that there is an important difference between those aspects of the relationship that respond to institutional needs and agendas and those aspects that relate more directly to the human relationships upon which the work in the field actually depends. We set out this difference in a tentative framework, where the relationship between researchers is labelled “partnership” and the institutional relationship “collaboration”. It is hoped that, by its inclusion in a journal on social policy, this paper may also stimulate discussion on the extent to which these issues are particular to international relationships or are, indeed, generalizable to national-level partnerships and collaborations within the UK and Europe. [ABSTRACT FROM AUTHOR]