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Public-private partnerships in health: exploring origins and implications


This paper draws on the history of ideas in order to investigate early 20th century shifts in economic thought that have led to widespread 21st Century asumptions about the effectiveness of private-sector actors in improving health outcomes.

Firstly, I explore the legacy of the ‘socialist calculation debate,’ with particular reference to the epistemological arguments made by Friedrich Hayek. I then situate the emergence of public-private partnerships (PPPs) in global health in a longer historical debate over the relative efficacy of private actors in allocating resources efficiently.

Drawing on the empirical example of advance market commitments (AMCs) in health, I suggest that the evidence-base attesting to the economic and social benefits of subsidizing private-sector actors to help realize global health goals is far weaker than proponents of increased PPPs typically acknowledge.

Somewhat counterintuitively, the problem of a lack of evidence is fuelled by exact phenomenon that currently eludes critical scrutiny: the heightened role of private actors in health. Lastly, I argue that this apparent weakness – the difficulty in obtaining empirical evidence of private-sector efficacy and cost-effectiveness – functions as a rhetorical asset for private actors rather than, as might be expected, a liability.


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Ingrid James