More than 500 million people in Africa lack access to critical medicines—“and yet you can find a Coca-Cola in almost every village on the continent,” says Teresa Chahine, a senior lecturer on social entrepreneurship at Yale SOM. This gulf between the accessibility of medicine compared to soda gave rise to Project Last Mile, which for roughly 10 years has connected African ministries of health with Coca-Cola’s supply chains and logistics expertise with the intention of more efficiently distributing medical supplies and driving demand for lifesaving public health services.
The collaboration has the scale to make a substantial impact. But it also raises a question central to public-private partnerships the world round: how do two organizations with very different missions build trust? “Project Last Mile is a tricky case because we’re talking about Coca-Cola, a multinational corporation that through its fundamental business operations creates negative public health impacts,” Chahine says. “How do you even build trust in cases like this so that you can benefit from the unique internal knowledge that private companies possess?”
Chahine tackles this question in a recent study with four colleagues from the Yale School of Public Health: Sarah Christie, Leslie A. Curry (who also has an appointment at Yale SOM), Emily Cherlin, and Erika L. Linnander, who directs the Global Health Leadership Initiative. The researchers interviewed public and private employees involved in Project Last Mile in South Africa, Mozambique, and Eswatini (the former Swaziland). They used software to sift through the reams of transcripts in search of insights into methods for instilling and maintaining trust.
“Partnerships are ubiquitous but how they perform and endure is less well understood,” says Christie, the study’s lead author.
The researchers found four variables central to trust, which together can make the difference between a successful partnership and one that falls apart.
First among them the fact that people matter; these partnerships need advocates who not only support the work and possess technical expertise, but who express a nuanced understanding of diplomacy and who can fluidly navigate different stakeholder demands.
Second, the researchers found that tangible results are essential to laying a foundation of trust. “The value of these partnerships can’t be hypothetical, and results have to happen early on,” Chahine says. “This contains an important message for anyone working in partnerships like these: you should structure them in a way to create short-term wins throughout the arrangement.”
A third key consideration when crafting public-private partnerships is the context in which the work takes place. Chahine noted that different countries possess different ideas about private-sector intentions, or about the relative venality of government agencies. This context must inform efforts to build trust between partners.
“Trust will collapse if it appears that either side is simply doing this for a check or a pretty photo campaign. Champions on each side play an important role in this process of aligning goals.”
Finally, bonds of trust remained contingent on a careful alignment of incentives and expectations. “This is probably the trickiest part,” Chahine says. In the case of Project Last Mile, Coca-Cola needs to see genuine value in strengthening government institutions and expanding individuals’ access to medications. And the same is true on the government side: agencies and representatives must have genuine interest in the partnership. “Trust will collapse if it appears that either side is simply doing this for a check or a pretty photo campaign,” Chahine says. “Champions on each side play an important role in this process of aligning goals.”
Finally, across all four of these dimensions, Chahine described clear and consistent communication as a “crosscutting factor” in the establishment of trust.
It’s important to recognize that these bonds of trust depend on the people working on the front lines, Chahine notes. While the idea for Project Last Mile was born from high-level conversations at the World Economic Forum, “it is really the foot soldiers who make this work,” she says. The project would not exist without those first, catalyzing conversations among the powerful, but the project’s success ultimately depends on myriad bottlers and delivery workers, across Africa along with midlevel employees spread across various ministries of health.
Public-private partnerships can play a key role in tackling major public health problems, says Curry, which means it’s critical to help them succeed: “It is perhaps more important than ever to leverage the potential of PPPs to address health inequities globally. Understanding how to build essential trust through these sets of behaviors can help cultivate and sustain PPPs to achieve real impact.”
The implications reach beyond public health, adds Linnander. “To achieve the ambitious targets set out in the Sustainable Development Goals, we need to work more effectively across organizations and industries,” she says. “The factors uncovered in this study—drawn from a real-life partnership across multiple country settings—will help visionaries and innovators start faster and have more impact.”
The findings provide a checklist for any organization interested in solving problems that don’t fit neatly within a single sector. “I was trained in public health, and we often point to the private sector as part of the problem,” Chahine says. “We less often find ways to get them to be part of the solution, even though there is a lot of potential. If we’re going to tackle some of the biggest challenges we face today, we need to get all sectors involved.”