Response from Rafael Bengoa, Director, Dept. for Management of non-communicable diseases, WHO: Partnerships between the public and private sectors are more essential than ever to alleviate the world’s global health burden. But too many of them fail. That is because most of these collaborations are vertical; that is, they come into a country, set up a programme, and leave. There is no sustainability in an approach that does not leave behind a foundation for local intervention and local capacity building. It is not that the partners don’t come to the table with good intentions, but they too often fail to see that a quick fix is not going to address the complexity of a growing health crisis like diabetes. Many partnerships are designed around a false dichotomy: whether an intervention should be about prevention or treatment. The question is not treatment versus prevention, but treatment plus prevention. Only comprehensive approaches which cover the entire spectrum of interventions have a chance of controlling a health problem in a community. We have learned from HIV/AIDS that it is necessary to provide treatment in a community if you wish to build the necessary trust for them to undertake prevention. The World Health Organization (WHO) clearly depends on public–private partnerships to achieve its goals. The task we face is too huge for any one organisation to tackle single-handedly. But at the same time, we have to retain an arm’s length distance from the private partners around the table. We don’t have any direct relationships with private companies, but work with organisations and foundations such as the International Diabetes Federation and the World Diabetes Foundation, in which private companies and their interests may be represented. The rules of the game are written so that there is no conflict of interest. It is as important for industry as it is for the WHO that we retain our independence in any partnership in which we are engaged. Done well, public–private partnerships need not threaten the integrity of either partner; in the best of circumstances, they enhance it. In a world in which healthcare systems are failing people with chronic diseases, we need a new paradigm in which patients with chronic conditions like diabetes become their own healthcare providers, with healthcare professionals playing a supporting role. This patient-centred healthcare model will depend more than ever on partnerships. It is important that we get it right. Rafael Bengoa is director of the Department of Management of Non-communicable Diseases at the WHO. His main focus of expertise is in the comprehensive management of chronic conditions. | 
