Building HIV Capacity of CBOs through Public-Private Partnerships by HealthHIV

National Center for Health Care Capacity Building

Building HIV Capacity of

Community-Based Organizations Through

Public-Private Partnerships

Remaining Relevant Through Partnerships: A Toolkit

Building Capacity of Community-Based HIV Organizations Through Public-Private Partnerships Introduction "The problems we face today will not be solved by governments alone. It will be in partnerships - partnerships with philanthropy, with global business, partnerships with civil society.“ - Hillary Rodham Clinton at the Global Philanthropy Forum Conference, April 2009 In 2010, the White House released the National HIV/AIDS Strategy (NHAS), the first comprehensive plan from the federal government with the goal of an HIV-free future. The three pillars of NHAS include reducing HIV incidence, increasing access to care, and reducing health disparities. Beyond setting priorities and goals for HIV prevention in the US (See Figure 1), NHAS also calls on government agencies and their public and private partners to align efforts towards a common purpose.

Figure 1. HIV Prevention Goals of the NHAS Over the next five years: • Reduce annual number of HIV infections by 25% • Increase percentage of people living with HIV who know their status to 90% • Reduce HIV transmission rate by 30% • Increase percentage of newly diagnosed people linked to care within 3 months to 85% • Increase proportion of HIVdiagnosed gay and bisexual men, African Americans, and Latinos with undetectable viral load by 20%

While public-private partnerships are exciting tools for HIV non-profits to explore, there are important factors an organization must consider before taking the leap. This publication will

Percent$of$all$People$with$HIV$

In 2012, the Centers for Disease Control (CDC) developed a strategic, High-Impact Prevention (HIP) approach that responds to NHAS, recent biomedical advances, and the static number of new HIV infections each year. HIP also highlights the importance of partnerships at every level of HIV prevention to respond to the five components of HIP (See Figure 2). Given new federal strategies and approaches, including implementation of the Patient Protection and Affordable Care Act (ACA), federal funding limitations and uncertainty, and new data showing engagement of people living with HIV at each stage of HIV care (See Figure 2. Five Figure 3), more community-based organizations (CBOs) Components of HIP have been exploring public-private partnerships as a way to 1. Effectiveness and cost build their capacity, fulfill their missions, improve health 2. Feasibility of full-scale outcomes along the HIV care continuum, and remain viable implementation HIV/AIDS Continuum of Care in this 3. Coverage in target 100%$ populations changing 4. Interaction and targeting healthcare 80%$ 5. Prioritization landscape. 60%$ 40%$ 20%$

82%$ 66%$ 37%$

33%$

0%$ Diagnosed$ Linked$to$Care$ Retained$in$ Prescribed$ART$ Virally$ Care$ Suppressed$ Source:$Hall,$Irene,$E.$L.$Frazier,$P.$Rhodes,$and$D.$R.$Holtgrave.$ConRnuum$of$HIV$Care:$Diﬀerences$in$Care$and$Treatment$by$ Sex$and$Race/ethnicity$in$the$United$States.$PublicaRon.$Atlanta:$Centers$for$Disease$Control$and$PrevenRon,$July$2012.$

Figure 3. HIV/AIDS Care Continuum

25%$

Remaining Relevant Through Partnerships: A Toolkit

offer a framework for organizations to use in exploring and executing a partnership with government agencies, corporations, and private foundations.

What is a Public-Private Partnership? “There are certain things that we just don’t have the ability to do without the help of public-private partnerships.” - Louis O. Spraggins, Regional Care Coordinator for the South Side Help Center in Chicago A public-private partnership is a collaboration involving at least one public organization (non-profit or government agency) and one private party (corporation or foundation). In a Public-Private Partnership, risks, responsibilities, resources and competences are shared to implement a specific plan that addresses a common goal – in this case, ending the national HIV epidemic. Why Public-Private Partnerships? “As a former director of a community based organization in Puerto Rico, I know that public-private partnerships can mean the difference between continuing to provide life enhancing service or closing up shop.” - James Albino, Senior Program Manager, Office of National AIDS Policy, The White House1 Public-private partnerships allow all partners involved the opportunity to maximize their assets and competencies in pursuit of a shared vision. A single organization does not have the capacity to end the HIV epidemic on its own. However, with the help of a private corporation, an organization can maximize its potential impact on the community it serves. Likewise, a private corporation cannot achieve high levels of success without the support of the community. In recent years, private companies have become increasingly focused on Corporate Social Responsibility (CSR), which the Business Dictionary defines as “a company’s sense of responsibility towards the community and the environment.”2 By using a CSR approach, businesses can increase their visibility, form relationships, enhance their reputation, and foster a positive, more-efficient workplace environment. Forming partnerships with NGO’s is a common means through which businesses can achieve CSR. Of course we save money by operating more efficiently which is a direct benefit of our CSR efforts, however the true value we receive from our ongoing initiatives is that of social good will – we believe that setting a good example is the greatest benefit in that we inspire other organizations, companies and individuals to ‘up their game’ when it comes to social and environmental responsibility, which in turn encourages further inspiration in the community leading to a more enlightened perspective on how to run ones business or lead one’s life.” – Garratt Hasenstab, Director of Sustainability at the Verdigris Group

Remaining Relevant Through Partnerships: A Toolkit

Partnerships go far beyond just funding… Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø

Expertise3 (see page 4 for specific examples) Project Sustainability (i.e. through sponsorships)4 Board Development Service Provision/Delivery Marketing and Communications Outreach Technology Improvements Strategic Planning Publication Development Human Capital (i.e.: volunteer service days) Stigma Reduction

What type of partnership will best suit the objectives of the organization? The organization should begin with an internal assessment of its needs. In which ways could service delivery be enhanced, and what sorts of resources would be necessary to make those changes? Answering these more general questions will help the non-profit start to think about potential partners and the ways in which those partners might be able to make the most relevant contributions. Case Studies The following case studies highlight public-private partnerships between HIV-focused, public health non-profits, private corporations, and government organizations, and explain the specific resources, services, and expertise provided by the private agencies. There are diverse ways in which the corporations’ resources, time, and services may be utilized to further the mission of the organization. Deloitte & AIDAtlanta Strategic Planning, Leadership In 2008, AID Atlanta developed a strategic plan, the Training, Patientgoals of which included: merging its behavioral and Centered Medical medical health models under one roof; expanding Home recognition services in the community so that high risk populations were aware of available programs; developing a more sustainable business model to improve their clients’ health outcomes; and providing wrap-around services. With a new strategic vision, the organization understood that they now needed a roadmap to help achieve their objectives.

AID Atlanta’s board reached out to Deloitte, who then worked with the organization to apply for, and win, a service grant that included working with Deloitte executives over eight weeks to fine tune the strategic plan and develop a two-year roadmap. During this time, Deloitte executives conducted research, stakeholder interviews and community

Remaining Relevant Through Partnerships: A Toolkit

scans. Deloitte also provided a project facilitator, who worked with AID Atlanta’s internal project lead to develop a timeline, messaging around the organizational changes, collateral for staff, and employee and leadership training. The firm is currently helping AID Atlanta work toward certification as a Patient-Centered Medical Home (PCMH). Pfizer & DC Department of Health Dissemination In Washington, DC, approximately 3% of residents are of a standard living with HIV, and as many as 50% of these individuals of care are unaware of their status. In order to address this issue, the DC Department of Health and the Office of HIV/AIDS, Hepatitis, STDs, and TB Administration (HAHSTA) partnered with Pfizer in 2009, to design and implement “Offer the Test.” Armed with training and collateral provided by HAHSTA, Pfizer sales representatives were deployed to capitalize on their existing relationships with primary care physicians by discussing the importance of routine HIV testing and answering any questions or concerns the physicians may have had. The “Offer the Test” partnership helped HAHSTA establish a sustainable, replicable model for routine HIV testing, while empowering sales representatives to be active players in the promotion of public health. Walgreens & CDC In 2012, Walgreens and the Centers for Disease Control Building New (CDC) formed a partnership to develop and test a three-year medication therapy management (MTM) pilot Models of Care program, provided by pharmacists in collaboration with & Expanding primary care providers at HIV-focused community Workforce pharmacies. The MTM pilot seeks to improve retention in care, adherence to drug treatment regimens and health outcomes. It will examine the impact of MTM on HIV patients in the community pharmacy setting and then this data will be used to measure the benefits and costs associated with a pharmacy-based program. Similar to the previously mentioned “Offer the Test” program, this program seeks to use existing relationships (in this case, the relationships between pharmacists and HIV patients) to improve health outcomes. How to Form a Public-Private Partnership The framework for establishing a public-private partnership includes the following components: • Define the issue; clarify the motivation; identify the need for resources. • Establish asset needs and existing resources. • Identify prospective partner(s). • Structure partnerships and initiatives. • Implement the partnership. • Assess impact and lessons learned.

Remaining Relevant Through Partnerships: A Toolkit

The formation of a public-private partnership does not happen overnight. The design phase is characterized by careful planning. Before even contacting potential partners, an organization must determine its own needs and decide what types of services might help address those needs and who might be able to provide them. During the execution phase, the organization must make their case to the private partner and then the members of the newly formed partnership must work together to develop goals, establish timeframes, and delegate roles. The final stage is an ongoing one: both partners must continually assess the progress of the partnership and modify plans where they see fit. I. Design Phase5 Choosing the Perfect Partner Before engaging in a partnership, it is important to assess the assets that a potential partner will bring to the table – what skills, resources and expertise can they contribute to the partnership and ensure a successful outcome? Some examples of areas of expertise that businesses can provide include: strategic planning, marketing and/or legal expertise, public relations skills, communications, board development, technology innovation, fundraising, project planning and management and funding diversification Tips for Finding Partners 1. Start with what is known: An organization should first consider any existing relationships they might have with businesses and foundations. Is there an existing funder that can go further, be a true partner and complement the work of the organization? When considering prospective government partners, start with agencies with which relationships are already established and begin the conversation there. 2. Look further: Perhaps there is a foundation or corporation who can’t provide funding but who could provide other resources, such as in-kind goods or services, a loaned executive, etc. This can be a good way to establish a relationship without asking for a financial contribution or grant. 3. Make connections: An organization can present its board with a list of prospective partners to see if anyone has contacts and can make an introduction and/or offer insight and assistance. Foundations can serve as excellent partners. They can, for example, play an important role in gathering and disseminating information, convening thought leaders and assembling forums to educate stakeholders on issues facing the HIV sector. Warning: Ø Evaluate potential partners well; organizations should beware not to align themselves with partners that may damage their reputation simply by association.

Remaining Relevant Through Partnerships: A Toolkit

Ø Ensure that the partnership will not compromise the non-profit’s core mission and values. II. Execution Phase 1. Making the Case • Consider potential partner’s goals (increasing scope and scale, mobilizing resources, improving quality, building credibility with stakeholders, building external capacity). • Identify assets and capabilities that the organization can provide a prospective partner. These may include: access to customers, human capital, subject matter expertise, distribution and media development. • Develop an organization portfolio. Partnerships are good for companies’ public relations; consumers are more likely to have a positive feeling about a brand if they see that the company is communityminded. As companies are focusing more on CSR, consumers are choosing to spend their money with those they view as good corporate citizens. This need in and of itself can open the door to a public-private partnership. Warning: Ø Be patient: There may be a lag period in which the private organization is figuring out their terms and conducting research on the organization, before they contact them to finalize the partnership. 2. Establishing Guidelines In order to build a successful relationship, it is important that there is a mutual understanding of the mission, goals, objectives, responsibilities, deliverables and commitment of each partner. A lack of shared goals, unclear roles and responsibilities, miscommunications and one or both partners not having the capacity to deliver can result in an unsuccessful partnership. Public-private partnerships can fall on a spectrum of formality, and terms can be agreed upon verbally, with MOUs, or even formal contracts. Some sort of written agreement is strongly recommended, because it will help ensure that both partners are on the same page, and keep the project on track. However, some way or another, the business agreement should address the following: Ensure that the partnership aligns with the organization’s strategic goals. Establish a clear delegation of responsibilities. Be clear about expectations and deliverables. State the objectives. Maintain an open and frank line of communication: assign organizational contacts. Ø Establish a timeline. Ø Establish reporting guidelines and check points. Ø Ø Ø Ø Ø

Remaining Relevant Through Partnerships: A Toolkit

Please refer to Appendix B for a sample business agreement template.6 III. Evaluation Phase “A key aspect of measuring partnership results is agreeing up front to a rigorous, standardized approach to continuous reporting throughout the process. Thorough evaluation enables partnerships to measure both impact and value for each specific program, while also providing important benchmarks that can be used as lessons learned for helping to build prevention, care, and treatment efforts.” – Ambassador Eric Goosby, MD, US Global AIDS Coordinator (& Exec. VP of Policy & Planning for Chevron)7 A successful partnership requires ongoing communication and process monitoring. In accordance with the timeline, a decision must be made as to whether the partnership should be continued, terminated, scaled-up or scaled-down. Communicate with one another as well as with the public about progress, making sure to highlight minor accomplishments along the way. Checklist to Evaluate Partnerships8 • • • • • • •

Are the benefits delivered through the partnership sustainable? Have the intended outcomes been achieved? Have there been any unexpected outcomes? What evidence is there that the partnership has been valuable? What have been the costs benefits of the partnership, both financial and nonfinancial? Have there been any institutional changes? What lessons have been learned? Make sure to reflect upon and share these lessons within the partnership.

Conclusion Public-private partnerships enable partners from different sectors to work together to improve education and expand services in the fight against HIV/AIDS. As a result of increased collaboration and the diversification of funding, CBOs that work to prevent and treat HIV have an opportunity to engage in public-private partnerships that will allow them to enhance their safety net programs and delivery mechanisms, and ultimately increase their impact on the communities that they serve.

Remaining Relevant Through Partnerships: A Toolkit

APPENDIX A: ADDITIONAL RESOURCES Ø National Coalition for Public-Private Partnerships: http://www.ncppp.org Ø Institute for Public-Private Partnerships: http://www.ip3.org/ip3_site/

Remaining Relevant Through Partnerships: A Toolkit

APPENDIX B. PUBLIC – PRIVATE PARTNERSHIP AGREEMENT

This Public – Private Partnership Agreement (the “Agreement”), made effective as of ________, 2010, by and between the [Name of non-profit], (“_________”), [Address], [City], [State] [Zip], and ________________________ (“Company”), with principal offices at ______________.

Background A.

If relevant, background information about the private company’s grant program.

B. (Non-profit X) desires to work with ____________ as the prime contractor (“Prime”) of a proposed (name of project) project, and (Company X) is willing to participate in the (name of project) as the subcontractor (“Sub”) for the proposed project further described in this Agreement. NOW, THEREFORE, in consideration of the foregoing and the mutual promises and the covenants and agreements set forth below, Prime and Sub agree as follows: 1.

Program Requirements

A. Prime and Sub shall abide by all applicable rules, regulations, and requirements of the [name of project]. Failure of either party to do so shall result in the termination of this Agreement, at which time […] B.

Address any government legislation that may affect the terms of the partnership.

[Name of] Project Non-profit intends to apply for a grant (or ask for assistance) from the [Company] to support the following [project]: [insert project description]. 2.

Roles and Responsibilities of [Partner A]

A. [Partner A] shall coordinate with [Partner B] as required to facilitate administration of [Project]. This coordination may include, but not be limited to, any of the following tasks and duties as required: (a) (b) (c) (d) 3.

Acting as ______ Implementing _____ Monitoring _____ Providing_____ Roles and Responsibilities of [Partner B]

Remaining Relevant Through Partnerships: A Toolkit

A. [Partner B] shall coordinate with [Partner A] as necessary and useful to ensure compliance with requirements of [Project]. Such coordination may include, but is not limited to, any of the following tasks: (a) (b) (c) (d) 4.

Acting as ______ Implementing _____ Monitoring _____ Providing_____ Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the District of Columbia, without regard to the conflict of laws provisions thereof. The parties agree that all litigation or other legal proceedings under this Agreement shall be brought in the State or Federal courts located in the [jurisdiction]. The parties hereby submit to the exclusive personal and subject matter jurisdiction and venue of such courts and agree to waive the defense of an inconvenient forum. 5.

Termination

The terms and conditions of this Agreement shall remain in force and effect until … 6.

Miscellaneous

A. Assignment. Neither this Agreement, nor any rights, duties or obligations described in this Agreement, shall be assigned or subcontracted without the prior written consent of both [Partner A] and [Partner B] which shall not be unreasonably withheld. In the event that [Partner A] and [Partner B] approve an assignment, each and all of the terms and conditions of this Agreement shall extend to the benefit of the successors and assigns of [Company]. B. Governing Law. This Agreement shall be governed by the laws of the United States and the State of [name of state] as to all matters, including but not limited to matters of validity, construction, effect and performance. C. Forum and Venue. All actions regarding this Agreement shall be forumed and venued in a court of competent subject matter jurisdiction in [County, State]. D. Entire Agreement. This Agreement and any documents referred to herein constitute the complete understanding of the parties and merge and supersede any and all other discussions, agreements and understandings, either oral or written, between the parties with respect to the subject matter hereof. E. Severability. Whenever possible, each provision of this Agreement shall be interpreted in such a manner as to be effective and valid under applicable law, but if any provision of this Agreement is held to be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of such provisions of this Agreement.

Remaining Relevant Through Partnerships: A Toolkit

F. Nondiscrimination. In carrying out this Agreement, [Partner A] and [Partner B] shall not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, ancestry, age, or disability as that term is defined in the American with Disabilities Act. [Partner A] and [Partner B] shall ensure that applicants are hired and that employees are treated during employment without regard to their race, religion, color, sex, national origin, ancestry, age, or disability. Such action shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training including apprenticeship. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed by their authorized representatives effective as of the date first above written.

Non-profit:

Private Company:

BY: _____________________________

PRINT NAME: ____________________

TITLE: ___________________________

DATE: ___________________________

Remaining Relevant Through Partnerships: A Toolkit

Albino, J. (2010, May 13). The Role of Public Private Partnerships in the National HIV/AIDS Strategy. blogaidsgov HIV Policy Programs Research New Media. Retrieved June 1, 2014, from http://blog.aids.gov/2010/05/the-role-of-public-private-partnerships-in-the-national-hivaids strategy.html#sthash.dVQmVKcH.dpuf)’ 2 http://www.businessdictionary.com/definition/corporate-social-responsibility.html 3 Collaboration and Connection: How Foundations Partier Effectively to Address Their Community's Information Needs. (2012, January). Retrieved June 1, 2014, from http://www.knightfoundation.org/media/uploads/publication_pdfs/KF_kcic_partnerships_report_2012.pdf 4 Ibid, Source 2. 5 Guide to Successful Corporate-NGO Partnerships. (2008). Retrieved June 1, 2014, from http://www.gemi.org/resources/gemi-edf%20guide.pdf 6 The template was adapted from the Sample Public-Private Partnership Agreement on the Official Website for the Department of Transportation: https://www.dot.state.oh.us/Divisions/Planning/Grants/Related%20Documents%20%20Pages/PPP%20A greement%20SAMPLE_ODOT%20DERG.doc 7 Goosby, M. (2013, August 7). Public-Private Partnerships Are Vital to Creating an AIDS-Free Generation. The Huffington Post. Retrieved June 3, 2014, from http://www.huffingtonpost.com/ambassador-eric-goosby-md/publicprivate-partnership_3_b_3719564.html 8 From BPD’s “Putting Partnering to Work,” pg. 26, 2001

National Center for Health Care Capacity Building Syncing Innovative Appraoches with Successful Outcomes

E-mail: training@healthhiv.org Telephone: 202.232.6749 Fax : 202.232.6750

Website: www.healthhiv.org @HealthHIV www.Facebook.com/HealthHIV http://www.YouTube.com/HealthHIV http://tinyurl.com/HealthHIVLinked