Partnerships Across Sectors – Interview with Dessislava Dimitrova, Technical Review Panel, The Global Fund, and Former Deputy Minister of Health of Bulgaria

Dessislava Dimitrova was interviewed by Katri Bertram.

In this interview, we talk about international development partnerships at the global and country levels, and how different sectors – government, private sector, and civil society – collaborate. We also discuss the critical importance of including citizens and end beneficiaries in the governance of and impact goals set by partnerships. Key takeaways are summarised at the end of the interview.

Dessislava Dimitrova, Technical Review Panel, The Global Fund to Fight AIDS, Tuberculosis and Malaria and Former Deputy Minister of Health & Head, National Health Insurance Fund, Bulgaria and Chair, Standing Committee of the Regional Committee of the World Health Organization, Europe

Could you tell us about your background, and how you have engaged with external partners in your work?

My career started in the private sector at McKinsey & Co advising health insurance companies in the US. I quickly realised my passion is to extend health services globally, rather than maximise shareholder value, so I continued my career at the World Bank Group. At that time, almost two decades ago, the idea of stakeholder capitalism was yet to develop and partnerships were mostly transactional, around subcontracting services from a donor to an implementing partner. There are a lot of weaknesses in this model as we now well understand – mainly that the risk lies with one of the partners and there is limited exchange of learnings from the implementer to the donor about on-the-ground challenges and opportunities.

Later, as I continued with Dalberg Global Development Advisors and the Results for Development Institute, the nature of partnerships began to change in two ways – partnerships began to be developed around multiple stakeholders focused not simply on financing and completing a task but also around learning. Some of the work of the Results for Development Institute, for example, focuses on developing networks of partners that enable learning, empower local change agents as well as connecting and building the skills of individuals and institutions on the ground.

In my mid-career, I had an opportunity to serve the Government of Bulgaria as advisor to the Minister of Finance initially and then as Deputy Minister of Health and Head of the National Health Insurance Fund’s Board. There, I realised first-hand the challenges in coordinating and aligning partners’ contributions to a country’s long-term development.

Firstly, governments’ National Health Plans are ministers’ top priority, yet partners’ work is often organised around their own commercial or other objectives that do not always fit within countries’ National Health Plans.

Secondly, within a ministry of health, there is always some sort of emergency, be it infectious disease outbreak, or lack of supply of medicines, or health workforce strike, etc. Addressing these immediate needs takes priority over long term planning, especially when it requires figuring and applying innovative approaches to partnering beyond procurement and subcontracting. 

In my last role at the World Economic Forum, the work of the team was focused specifically on supporting countries to partner with the private sector and other relevant partners from the health and healthcare ecosystem. Having an independent broker of such partnerships is an invaluable service to countries’ needs when their day-to-day work needs to focus on the urgent daily country needs.

You have worked with different types of partners in your career. Has partnering with the private sector been different from e.g., civil society organisations? If yes, how?

The only difference that I have observed is that in general, governments do not trust the private sector as much as they trust civil society organisations. As such, the expectations from the private sector seem to be higher, especially in terms of financial contribution to projects. Yet, private sector partners have incredible capacities in developing and launching innovative products, projects and system changes. 

I would love to see more examples where governments leverage private sector partners’ “know-how” rather than wait for direct financing for programs and activities. We still have a long way to go in partnering with the private sector to move from a “transactional” interaction focused on exchange of funding or procurement to true partnership that involves building a joint vision and then implementing it in a risk-sharing approach.

“I would love to see more examples where governments leverage private sector partners’ ‘know-how’ rather than wait for direct financing for programs and activities.”

Dessislava Dimitrova

What has your experience been with different types of partnership platforms? Can you provide examples of what platforms have in your experience worked well, and why?

The biggest global partnership platforms in health are focused on specific diseases and interventions and they have achieved incredible results. For example, Gavi has helped immunise more than 822 million children, preventing more than 14 million deaths. Similarly, the Global Fund partnership has saved 38 million lives of people with TB, HIV/AIDS and Malaria since 2002. The impact of the Coalition for Epidemic Readiness and Innovation (CEPI) is scaling up as we speak. Both Gavi and CEPI were just nominated for the Nobel Price. As we align towards achieving the goal of Universal Health Coverage in our lifetimes, the continued success of these partnership would depend also on their contribution to building sustainable health systems with adequate domestic financing and appropriate value-based services to ensure sustained impact.  

Partnership platforms focused on social entrepreneurship are also critical in the transformation ecosystem. Such is the Global Development Incubator (GDI) which works to build and scale the next generation social impact solutions. It catalyses potential partnerships and connects opportunities for funders, individuals, and organisations to work together while engaging and empowering organisations and initiatives to stand on their own as influencers in their fields.

Finally, partnership platforms organised around innovative financing are some of the most game-changing examples today. The Healthy Brains Global Initiative (HBGI) seeks to address brain health problems by financing it through building a case for return on investment not only from traditional donors but also from impact investors. This way, it directly makes itself accountable for the specific economic return their interventions would bring. Similar is the approach of the Stop TB Partnership’s Accelerator for Impact (A4i), the SDG500 fund and the Malaria No More Innovative Financing Coalition.   

One common thread among all these partnerships is that they have robust governance structures with engaged country and patient / end-user representatives, diverse funding sources, dedicated secretariats and program management units, passionate and fair leadership teams that inspire committed and entrepreneurial staff.

What have the main challenges been in bringing together diverse partners?

Partnerships, by definition, are comprised by diverse institutional or individual stakeholders. Yet, it is this diversity of stakeholders that is the main challenge – each partner has his own expectations, organisational priorities, and objectives. This could be overcome through the introduction of value-based services where partners unite around common outcomes. This way, the risks and benefits are shared among all partners.  

“Partnerships, by definition, are comprised by diverse institutional or individual stakeholders. Yet, it is this diversity of stakeholders that is the main challenge.”

Dessislava Dimitrova

Over the past years, there has been a lot of focus on partnerships at the country level. Has this influenced your own work? If yes, how?

Within countries, the partnership platforms are often smaller, organised around specific service innovations to address specific needs. For example, the program MomCare in Kenya is a partnership platform, based on the MTIBA platform (developed by PharmAccess) which connects patients, providers, government funders and private patient funders. There are policy-based partnerships such as the SDG Partnership Platform in Kenya that brings institutional public and private stakeholders to design and implement country-level systemic changes.

My work was focused on global issues advocacy that is most effective when combined with country-level proof points and evidence. The collaboration with country-level partnerships was invaluable as it allowed my team to support and accelerate country work, without having to pick a specific local partner.

Could you define how you personally would define a successful partnership in international development?

Where the citizens or the populations who are the main beneficiaries of the partnership can articulate the impact of the partnership on their own health and wellbeing improvement.

A successful partnership is “where the citizens or the populations who are the main beneficiaries of the partnership can articulate the impact of the partnership.”

Dessislava Dimitrova

Has impact played a role in determining which partners you have worked with? What other factors have driven engagement?  

The main values that underpin a successful partnership are those that underpin any relationship – justice, trust, transparency, service, commitment, and responsibility. When these values are present, the impact would be a natural result. I have selected partners mostly on these values as concrete evidence of impact is not always available, especially for country-led initiatives.

Not all partnerships manage to get past planning to implementation. Are there any benefits in bringing together partners even if practical collaboration does not happen in the end?

Yes. Building the values listed above takes time and even if one effort fails in delivering its expected outcome, the process of collaboration could help build trust, so that the second or third attempt would succeed. Also, learning is an organic, on-going process and we must often try one approach, reflect on its results, and continue building by incorporating the insights from the prior efforts. As Aristotle once said, “what we have to learn to do, we learn by doing.”   

If you look forward 5 to 10 years, would you hope that organisations work differently together? If yes, how?

Reports on the “future of work” indicate that the composition of organisation’s workforce will comprise of traditional full-time employees, networks of contractors and freelance contributors. This means that each organisation which enters a partnership would be a conglomeration of internal partnerships already. This would mean strategy and communications within organisations internally and externally would need to be impeccable to successfully move such ecosystems or partners forward.

Key points summarised:

  • Partnerships should build a joint vision and then implement it with a risk-sharing approach. Partnerships are often still highly transactional in nature.
  • There are different types of partnerships, including partnerships focused on specific interventions, social entrepreneurship partnerships, policy-based partnerships, and innovative financing partnerships.
  • A successful partnership is where the citizens or the populations who are the main beneficiaries of the partnership can articulate the impact of the partnership.
  • The main values that underpin a successful partnership are those that underpin any relationship – justice, trust, transparency, service, commitment, and responsibility.
  • Independent brokers for partnerships are an invaluable service to countries’ needs when their day-to-day work needs to focus on the urgent daily country needs.

Published by Katri Bertram

Katri works in international development, and is a mom of four children. She is driven in her work to ensure that all people can receive quality healthcare, gender equality becomes a reality, and organisations working in these areas leverage the power of partnerships for impact. 
Katri has worked at the World Bank, where she headed External Relations for the Global Financing Facility for Women, Children and Adolescents (GFF), and Save the Children, a non-governmental organisation that works in 120 countries, where she headed global advocacy, policy and campaigning.
 Katri lives in Berlin/Germany, and is Finnish by nationality. She is a graduate from the London School of Economics (Master in International Relations), the Hertie School (Master in Public Policy), and the University of York (Bachelor in Economics and Politics). 
Also follow Katri on LinkedIn and Twitter.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

<span>%d</span> bloggers like this: