Audit Culture by Cris Shore and Susan Wright

Author:Cris Shore and Susan Wright
Language: eng
Format: epub
Publisher: Pluto Press

Going Global: PPPs in the Developing World

Led by the World Bank and supported by European banks and the International Monetary Fund (IMF), the 1990s saw the development of a remarkable network of international organisations, corporations, national government and philanthropies advocating for PPPs on a global scale. These used forums like the G20, G8 and WEF to promote their uptake. As Hall (2015: 13) notes, ‘this promotion takes two forms: a marketing and propaganda campaign on a global scale; and the use of public money to subsidise the private borrowing of PPPs’. Governments and the EU also created special units to provide subsidised loans and guarantees to support PPPs. For example, David Cameron’s Conservative government established a permanent centre to promote PFI projects around the world, staffed mainly by private sector executives, inside the Treasury itself. The UK government claimed that ‘through partnership with the private sector, PPPs enable the delivery of efficient, cost-effective and measurable public services within modern facilities whilst minimising the financial risk’ (UK Government 2013). A steady stream of publications from legal firms and external consultants, including McKinsey and PwC, provided further legitimacy and impetus. As a result of this enthusiastic proselytising, the PFI model has been adopted by several countries in the Global South.

The push for PPPs in public health was led by the World Bank, which approved 78 health facilities between 2004 and 2016 (Lister 2018: 272). This dominance was achieved by displacing the World Health Organization’s (WHO) ‘horizontal’, holistic and coordinated sector-wide approach to the health of a population focused on distributive justice and the socioeconomic determinants of health inequalities. By contrast, the World Bank promoted a vertical, ‘results-based financial management’ approach (Lethbridge 2015: 4) and advanced public–private partnerships. By the late 1990s, the WHO had aligned itself with the World Bank’s agenda and, from 1998, 10 new global health partnerships were established annually, with 100 in operation by the mid-2000s. These involved businesses concerned with health infrastructure and delivery systems, drug companies and philanthropic organisations. For example, by 2007 spending by the Bill and Melinda Gates Foundation roughly matched that of the WHO (Ruckert and Labonté 2014: 1601).

Many of these PPPs adopted a vertical approach to intervention that was effective within its narrow focus but was not sustainable or coordinated with other donors or local health providers. For example, 75 per cent of PPP funding targeted specific infectious diseases that yield auditable results, even though these are not major causes of ill health in most of the world. The major killers, like childhood diarrhoea, are the outcome of poverty and other less auditable social factors (Ruckert and Labonté 2014: 1604). PPPs had some positive effects, including the development of 50 vaccines and 25 drugs for diseases affecting impoverished populations (2014: 1602). However, many involved partnerships, for example between Coca-Cola and the Bill and Melissa Gates Foundation, Coca-Cola and Save the Children, Cadbury and UNICEF (the UN Children’s Fund), and Hershey and the American Cancer Society (Ruckert and Labonté 2014: 1606). This has given

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