The 7 unhealthy habits of global health partnerships - and what we can learn from them

In 2006, Kent Buse published a thought-provoking paper outlining 7 “unhealthy habits” of global health public-private partnerships (GHPs). Nearly 20 years later, many of these observations are still painfully relevant. As someone who works closely with multi-stakeholder partnerships in global health, I’ve seen these patterns repeat themselves. Here are the 7 gaps Buse identified and my take on them, including action points for GHP leaders.

1. Global health partnerships are too narrow in focus, ignoring health systems

Many GHPs are created to tackle specific issues (HIV, tuberculosis, hepatitis), and rightly so. But this often means they overlook the broader health system context in which they operate. Very few initiatives manage to be effective both at the disease-specific level and at the systemic level.

Why? Because improving a country’s overall health system is a long, complex, and costly effort. If your core mandate is to eliminate HIV in Eastern Europe, it’s hard to justify - or fund - major investments in broader health systems strengthening. But without it, sustainable impact might be difficult.

➡️ My action point: While the primary focus of the GHP may be on specific diseases, include at least one health systems indicator (e.g., diagnostics access, workforce readiness) in the GHP framework to ensure broader, sustainable impact without missing the program’s core focus.

2. The private sector is more represented than low and middle-income countries and NGOs

It’s true that many GHP boards are dominated by private sector voices. But I think this is only part of the story.

A lot of meaningful collaboration happens off-paper, through co-developing and co-authoring research, co-hosting events, or sharing tools and data. Many governments and NGOs don’t want formal roles in partnerships, but they’ll still engage actively in less structured ways. Focusing only on official representation might not give the real picture of who is involved in (and represented by) the partnership.

➡️ My action point: Keep reserved seats for governments and non-governmental organisations, but don’t stop there. Measure their participation and representation by looking at active partnerships, not just formal board roles.

3. Poor management undermines everything

Unclear roles, lack of performance monitoring, vague partner selection criteria, poorly managed conflicts of interest… these are all too common.

I’ve seen many well-intentioned initiatives fail not because of poor strategy or lack of funding, but because of weak operations. It’s up to GHP managers to get the basics right. Without that, even the best ideas can’t take off, and reputational damage can be lasting.

➡️ My action point: Invest in skilled partnership/project managers, not just technical leads. Develop clear management tools: partner maps, decision toolkits and records, role descriptions, charters, MOUs, governance documents, meeting minutes and regular performance reviews to ensure smooth collaboration.

4. The public sector is losing ground

The growing presence of the private sector in healthcare is a trend we can’t ignore. While the corporate world brings valuable resources, innovation, and efficiency, it’s the role of the government to ensure equity, accessibility, and sustainability for all.

So, in my opinion, the real question isn’t “Should the private sector step back?”
It’s “Should the public sector step up?”

➡️ My action point: Don’t ask the private sector to step back, help the public sector step up. Invest in people and systems so governments can lead: knowledge sharing, training, and support to shape their own policies.

5. Global health initiatives are chronically underfunded

The funding gap in global health has recently become more visible than ever. Without adequate resources, GHPs simply cannot deliver.

But let’s not forget: it’s not just about how much money we have, it’s also about how we use it. Streamlining focus, avoiding costly generalist consulting, going virtual when possible, and hiring smartly can go a long way. One senior expert who gets things done is worth more than a whole team with no direction.

➡️ My action point: Be concrete. Don’t plan around ideals, plan around what’s feasible. Use a modular, tiered budget (minimum-optimal), link activities to realistic funding levels, and track spending with a simple, shared dashboard.

6. Lack of harmonisation = duplication + waste

Duplication is a popular enemy in global health. Thankfully, coordination and harmonisation have improved somewhat since 2006, but we’re still not where we need to be.

Partnerships should actively look for existing coordination platforms and contribute to them. That said, in many cases, the leadership needed to truly harmonise efforts must come from regional or supranational institutions.

➡️ My action point: Before launching a new activity, conduct a stakeholder mapping: who’s already doing this, and where are the gaps? Plug into existing platforms, even if it means sharing visibility.

7. Restricting staff from external partnerships

Okay, I might have an extreme vision here, but I do not believe in competition for the sake of it.

Many of the best ideas and collaborations come from informal exchanges, joint panels, or conversations at conferences. Restricting that is a missed opportunity.

If your organisation is clear about its mission and responsibilities, there should be no reason to block staff from forming external partnerships. Each opportunity should be evaluated on its own merits. Automatically prohibiting collaboration is often a sign of fear, and fear rarely leads to good decision-making.

➡️ My action point: Shift from a “permission-based” to a “principles-based” approach. Instead of banning external collaborations with competitors, set clear guardrails (e.g., transparency, time limits, no conflicts) and guide staff to engage wisely.

Conclusion

Kent Buse’s 2006 paper is still a great read today, and honestly, a lot of what he pointed out remains a reality in global health partnerships. The challenges might have evolved, but they’re far from gone. If we want real, sustainable impact, it’s up to us to take these lessons seriously and take action. Whether it’s improving public sector capacity, managing partnerships better, or being smarter about funding, we’ve got to move past the same old mistakes. It’s all about finding the balance, getting the right people at the table, and making things work without overcomplicating it.