The challenge of constituency working in global health partnerships

By Jenny Ekelund

Constituency models are generally acknowledged as the most appropriate and representative governance form for global health partnerships, particularly for those with a large number of stakeholders tackling complex, systemic issues. The model is not perfect, however, and the advent of the SDGs and the new emphasis on universalism has encouraged many partnerships to reflect on their mandate, remit and working practices.

TPI recently completed a study for the newly transformed International Health Partnership for UHC 2030, the movement for progress towards universal health coverage. The research examined constituency models of working in global health partnerships to help inform the working practices of the new partnership Steering Committee. We spoke to 38 individuals representing global partnership secretariats and individual organisations from a range of sectors about their experiences and some fascinating themes emerged:

• Country constituencies in particular can suffer from limited resources and struggle to engage meaningfully. One solution favoured by several partnerships studied was to support communication through the appointment of dedicated ‘focal points’ to serve alongside each constituency member. This allowed the Steering Committee representative to concentrate on strategic matters (making it easier for more senior representatives to take part), with the focal point ensuring effective liaison with the constituency and Secretariat;

• The partnerships studied reported some difficulty engaging individuals with the right level of experience. One partnership had successfully introduced tailored coaching arrangements to allow more junior representatives to contribute fully, but this practice was not widespread;

• It was acknowledged that good governance ultimately hinges on the right individuals with the right skill sets being appointed to the Steering Committee. Many suggested that Secretariat effort should be invested in writing job descriptions for the representatives, in order that only those with a full appreciation of the time commitment and expectations will accept the role;

• Over-inclusiveness can lead to bureaucracy overload – it was recognised that 12-15 individuals is the ideal number for an effective board, but many partnerships studied featured over 30 board seats, usually to accommodate political realities. This can make dialogue and decision-making more challenging;

• The constituency model comes with high transaction costs which can be minimised by giving as much autonomy as possible to individual constituencies to manage their own affairs. This also encourages ownership and leadership;

• Balancing influence among constituencies is a constant challenge; inevitably well-resourced constituencies are better prepared and more able to influence. Others cited clear dominance of more powerful players within the constituencies. There are few easy answers to this, but some suggested that a skilled Chair can work with these dynamics to ensure all parties have a voice;

• Constituencies are sometimes guilty of sending replacements who are poorly briefed or change position from meeting to meeting- one solution is to require constituencies to nominate one representative and one designated alternate only;

• It is crucial not to underestimating the need to invest time and effort to ensure mutual trust and respect between partners, especially up-front (e.g. industry is viewed by some as a source of cash only). A strong solution proposed for this was that potential new constituency players should be involved in designing their own engagement model from the outset, rather than being invited to join a rigid agreement that may not suit their needs or maximise the value they can bring.