EP91 The Dynamics of Private Public Partnerships with Samara Mbugua

Note: The I AM GPH podcast is produced by NYU GPH’s Office of Communications and Promotion. It is designed to be heard. If you are able, we encourage you to listen to the audio, which includes emphasis that may not be captured in text on the page. Transcripts are generated using a combination of software and human transcribers, and may contain errors. Please check the corresponding audio before quoting in print. Subscribe now on Apple Podcasts, Spotify or wherever you get your podcasts.

I AM GPH EP91 The Dynamics of Private Public Partnerships with Samara Mbugua
EP91 The Dynamics of Private Public Partnerships with Samara Mbugua

Maureen: Hello, you're listening to the I am GPH podcast. My name is Maureen Zeufack and in this episode, I get a chance to speak with Samara Mbugua. Samara is an alumna of the MPH program who graduated with a concentration in community and international health. And she now serves as president of the inaugural GPH alumni board. Samara currently works as a Global Health Analyst at Becton, Dickinson and Company or BD, a global medical technology company. Samara is a proud child of Kenyan and Zimbabwean immigrants, and this background heavily inspires the work she does, working with public-private partnerships or PPPs by supporting the planning, implementation, and monitoring of various programs ranging from tuberculosis to HIV and AIDS, among other topics- partnerships, and initiatives which seek to improve the lives of people worldwide. If you'd like to hear more about what PPPs are and their impact, hear Samara's travels and experiences as part of her role, and an important discussion regarding having a seat at the table, please stick around to hear more.

Maureen: You're listening to the I am GPH podcast. I'm joined today in this episode by Samara Mbugua. Welcome onto the podcast.

Samara: Hi, thank you so much for having me here. I'm excited to speak with you today.

Maureen: My first question is, can you tell me more about BD, the company you work at, and your current role there? What does being a global health analyst entail?

Samara: Absolutely. So I work for Becton, Dickinson and Company, BD for short, and we are a global medical technology company headquartered in New Jersey. Our purpose is to advance the world of health and we're able to achieve this in a variety of ways. So one way is that we engage in medical research. We develop diagnostics for infectious diseases and cancer. We have a pretty robust medication management tool system, and we do health promotion around infection prevention and infusion and sharps safety. We also have a large surgical business and interventional devices business as well, and we do have diabetes management businesses as well. So it's a pretty wide platform, but we are as a whole a very much patient-centric company. So whatever we do, the patient is at the center of that wheel. And then your second question about what being a global health analyst entails, so in my role... I've been in this role for going on two years, but I've been with the company for about five, and in this current role, I contribute to the planning and implementation of our public-private partnerships. And these are primarily in low- and middle-income countries or LMICs for short. Now my work on a daily basis really runs the gamut. So pre-COVID, one day I would be deploying BD global health fellows overseas for three-week assignments to either Kenya, Ethiopia, Rwanda, or China, or India. So it really varied, but we would utilize some of our local talent in other countries. Another activity that I engage in is just around analytics, capturing metrics from these fellows' trips as well as metrics around some of the other public-private partnerships we have or PPPs for short. I also engage in the communications planning for world disease days like World AIDS Day that recently passed and World TB day that is coming up in March. I draft content for advocacy campaigns, and I love writing, so it's really great to be able to write about global health topics. So those are just some of the things that I engage in on a daily basis. But really it's driving the activities around our PPPs.

Maureen: So on that topic of PPPs, could you tell our audience what public-private partnerships or PPPs are, and why are they important?


Samara: Absolutely. So PPPs are a form of long-term contracts between a public and a private entity through which the public and private entity jointly invest in the provision of public services. And through this arrangement, the private sector takes on a significant financial, technical, and operational risk, and they are held accountable for defined outcomes. Now that is a mouthful. So in simple terms, the WHO describes PPPs as an effective way to capitalize on the relative strengths of the public and private sectors to address problems. Now, my team focuses on problems related to pressing public health needs, really center on infectious diseases, maternal and newborn health, antimicrobial resistance or AMR for short, and health worker and patient safety, just to name a few. Why are PPPs important? That's an excellent question. So when we think of having public and private sector come together, it's a unique marriage, and I believe that these partnerships are able to drive innovation in very unique ways that we wouldn't have otherwise thought about, and these are diverse collaborations. So through that, you're going to get diversity of ideas, plans, and processes. So I think there's great value in promoting PPPs.

Maureen: Thank you for clarifying that. So what might be the value-add for large corporations? What's in it for them?

Samara: So large corporations like BD benefit in a variety of ways, but there's really one that stands out to me. So I'm going to go back to BD's purpose, which is to advance the world of health. And I believe that the value-add for BD specifically is that we're able to advance the world of health through these partnerships. So we are increasing access to knowledge and diagnostics and other treatment services for people around the world. So that's helping people in one token and then also expanding our footprint from a business standpoint in spaces outside of our normal focus area.

Maureen: And what are some memorable examples of PPPs you've worked on in the past?

Samara: Some memorable PPPs? Well, I definitely have to say one that I was a part of in 2018... and this was even before I joined the team that I'm on now. And I actually was on the other side of things. I was a BD Global Health Fellow and I was assigned to a three-week assignment in Kenya where half of my family is from. I'm half Kenyan and half Zimbabwean. And so from a personal standpoint, it was quite a moving experience to travel to Kenya for that purpose. But I was a part of this project that was a partnership between BD and a TB organization, and the goal of the project was to help the reference laboratories within Kenya achieve accreditation while expanding country capacity for universal drug susceptibility testing. So really focused on TB and how to improve testing and access and processing of those tests. So when I was there, my task was really to conduct assessments throughout the TB specimen referral system. So I was identifying gaps, and then at the conclusion of my time there, proposing recommendations to help alleviate gaps. Those assessments involved me interviewing clinicians, reference and referral laboratory staff, the people who transported the specimen to and from reference and referral laboratories, and other players that were involved, such as the Ministry of Health. So I conducted these interviews throughout Kenya. I'm seeing parts of the country that I haven't seen outside of my family trips to the country. So from a personal standpoint, my first time working in a country that I consider home and giving back to a country that means so much to me, that was a really awesome experience. And then walking into a space where my last name wasn't mispronounced. So that was also something that was quite memorable, but that personal experience was really rewarding. And then from a professional standpoint, I was able to learn more about TB and some of the gaps that people in these various roles face. And it was interesting because I think anywhere you go, you can always say poor communication is going to be a hurdle in anything that you do. And some of the same things that I'm sure you and I deal with at work each day are things that were also observed within the spaces where I conducted the interviews.

Another memorable PPP that I worked on was one that was related to patient and healthcare worker safety. It was an advocacy campaign where we partnered with a multimedia platform and worked with them on that campaign, which explored the challenges and the way forward to address the needlestick and sharps safety. What I liked most about this experience was that we were able to edit storyboards. That's more of a communications task that I'd never been exposed to. So I really appreciated that experience as well as designing the layout of the website, which was really exciting to be a part of as well, developing the campaign slogan and just learning more about the hurdles within the sharps safety space and what is needed to help address those. So enforcing policy and having better surveillance and reporting systems for our clinicians to report a needlestick injury, and then training. So some clinicians just don't have that at their hospitals, or it's not really enforced, but it's been a really great experience focusing in on an issue area and then just learning so much more about it through these partnerships.

Maureen: Wow. Those both sound like amazing experiences. I think it's great that you were able to have that personal connection and tie to the one in Kenya, as well as having that wealth of new experience and knowledge with the one related to needlestick injuries. I think that that demonstrates also that there's a lot of range in how these partnerships can take place.

Samara: Yes, exactly. Yeah. Yeah.

Maureen: And you provide some more insight into the process of PPP planning and what the dynamic is at these sorts of tables?

Samara: Sure. So when you think about the planning process, there is a lot of discovery. So what is the problem? And then from there, once you have that problem definition, it's finding the right players to help address that problem. So you may leverage past partners that you've worked with or colleagues outside of the project. It's great being a part of such a big organization like BD, where there's just a breadth of talent and information within the organization. So I can tap into our 65,000 associates and figure out who can help get us to the right place. So it's really great having that sort of wide range of internal talent. Another thing that you think about when you're planning is all the information that's being shared. When you have such unique partners involved in a project, they have their own experience working in TB and you come with your own. So there are a lot of strong voices at the table. So it's all about managing those and just making a safe space for people's insights and opinions to be heard.

Maureen: So on the topic of having a sort of space or creating a safe space, when you were beginning your career, how did you find these environments to be? If speaking to a fledgling career person entering these spaces, what would you tell them?

Samara: Yeah, so there's a lot to tell, but I would certainly start by just acknowledging that these tables are going to feel intimidating, especially day one, starting your career in global health. And that's okay. This is something new and it's okay to feel intimidated by the wide range of experience at the table. But I recommend that you always ask questions. So you really don't know what you don't know. And by asking questions, that helps you figure things out. There's a lot of knowledge and experience at those tables, so that translates to a lot of resources for you. When I first started, I found an ally of sorts. So someone who I can ask questions to after a meeting that I might feel might sound dumb, but I know that this person won't think that the question's dumb and will gladly answer that for me. And that person for me was my manager and continues to be my manager. When I first started, I would ask questions a lot after a meeting for clarification. And while that worked for me in the beginning, I soon realized by doing so, I was silencing my voice in meetings and losing any sort of visibility within those meetings. So I learned over time to speak up and ask some of those questions so my voice doesn't get lost in the mix of everyone else's voices. So definitely ask your questions and then find an ally and lastly, speak up because you are to gain that confidence over time and it's okay that you don't have it immediately, but it will come.

Maureen: How did you find your way to this sector or line of work?

Samara: That's an excellent question. So I've always had an interest in global health and that stems largely from my desire to always want to help people. And then my experience traveling to Kenya as a child and seeing these big, light blue UN trucks and just asking questions like, "What's that, what do they do? Who are those people?" And then from there, that's where I learned about international development. And along my career, I've always found my way back to global health and development. And I started off at BD working in account management in a space where I was partnering with hospitals throughout the nation on their disease reduction efforts. So if you wanted to track any hospital-acquired infections that happened at your hospital and report those to the CDC, I would support you in that process. If you wanted to track how many patients came into your hospital with MRSA, that's something I could help you with by using our online application. So I was in that space, but going back to what I mentioned before, when I was a BD global health fellow, I was able to still do my account management job, but then tap into my interest, which was global health, just for that three-week period. And that three-week period was really the reminder that I needed that global health is my passion and I really need to move towards that. And I was just so lucky that an opportunity opened up on the team and now I'm a part of it.

Maureen: That's amazing. So building off of that, are there any additional ways that you feel like your background as a child of Kenyan and Zimbabwean immigrants has shaped your perspective and approach and understanding of the field now that you're in it?

Samara: Yes, absolutely. It certainly adds to... It's just who I am. I always present with the lens of an American having been born and raised in the US, but the African DNA and being raised in a Kenyan household, it shapes who I am in so many other ways. So I present as both an American and an African when I'm in these spaces. So I do have that... I'll say that competing perspective. And I feel like that allows me to empathize with both perspectives if I'm at a diverse table that has Western opinions and voices versus more from an African region or the African continent.

Maureen: That's such a unique quality to have, that duality of experience. That seems to be very beneficial to you in this field.

Samara: I agree. It definitely is.

Maureen: So how might diversifying the field impact its evolution? And do you see a need for this at the present moment?

Samara: Yes, I do see a need for it. I think diversity anywhere is a value-add to a project, organization, or group. So it will add value in the long run. And I think sometimes in global health, it's so driven by Western ideas and organizations that you lose sight of the local agents within the countries. So I think it's important that when it comes to a seat at the table, you have a diverse group of people at the table, some with perspective from the regions in question, and not just perspective, but being able to sit at that table and feel like it is a safe space and there isn't any hierarchy challenges that will prevent you from sharing your ideas and so on and so forth. So I definitely think diversity, value-add, and we definitely need to continue moving towards it. And even though we are working to support low- and middle-income countries, I think global health, in general, can do a better job of diversifying those voices at the table.

Maureen: You make a great point of mentioning having that voice at the table that truly understands the community that they are trying to benefit or improve. So on the topic of PPPs, what makes a PPP successful and why do some of them not work?

Samara: Good question. You're full of all the good questions today. So I think the part that makes the PPP successful is having a solid plan, but in having a solid plan, recognizing that life happens and things may not go to plan, and being able to pivot as needed. So going back to just creating that plan. So having your clear goals, your activities, and indicators to track your progress. Now, once that plan is in place... and that could be in the form of a concept note or a statement of work, log frame, or other guiding document... buy-in from all players is super important. So buy-in at the implementation stage really helps to put your plan into practice. Let's say for instance, you have a lab intervention somewhere, let's say in India, and you're trying to have some outside players come into the lab and support the lab in that intervention that you're working on. Now, let's say that you have buy-in from the Ministry of Health. You have buy-in from the hospital administrators. You have buy-in from the lab manager. But once you go to the implementation phase and you're in the lab working with lab staff, you realize that there really wasn't buy-in from the lab staff. It was something that was thrust onto them. So just having a clear understanding of who the players are at every stage of your intervention, and then secondly, making sure that you have a good understanding of what their pain points are and can clearly define and articulate how your intervention can help to alleviate some of those pain points are super crucial to bridging the gap between having buy-in from those people or not. So that's one way that I think is important to making PPP successful. Why do some of them not work? I think this goes back to not having clear roles and responsibilities. So kind of going off what I said earlier, where I learned in the TB specimen referral system that communication was a hurdle... and that's something that we can all relate to. And as we reflect here now on clear roles and responsibilities, that's something that's important in anything you do. So I think that's one of the main reasons why some PPPs don't work.

Maureen: So how has COVID-19 changed the way that we view PPPs and impacted the progress or process of planning them? Are there any lessons learned from the pandemic so far?

Samara: Yeah, lots of lessons learned, and that's a good thing, all things considered. There are a lot of lessons learned from the pandemic. Now the pandemic has impacted the implementation process substantially. It's highlighted a lot of gaps in how global health practitioners do their work. So you might have a program that requires people to travel in-country. That's impossible now because a lot of travel has been impacted from the pandemic. So COVID has required us to be more creative in our approach. So one thing that we're doing is shifting to an online format. Okay. So we'll ask ourselves, "How are we going to shift to a virtual format?" And then from there, we'll ask ourselves, "How do you then make that virtual format engaging?" And then you just go through a period of question-asking, and then at some point coming to realize, "Okay, now that we're in a virtual setting, we can actually reach more people than we intended." So let's expand our target population. So how do we do that? And what's the strategy behind that? So COVID has thrown us a curveball, but it's challenged us to think more creatively and respond more creatively in our interventions. So it's a weirdly welcomed challenge because it's getting us to not do so much of the same.

Maureen: Right. And what do you feel is the most rewarding part of supporting PPPs? What's the most challenging part?

Samara: So the most rewarding part of supporting PPPs definitely has to be turning an idea into something. Watching an idea come to life is really great to see. So an example of that would be, I have an idea. We want to train nurses on infusion safety in China, and we can go from that idea to a year or two down the line saying, "Wow, okay, we're able to train over 800 nurses within three months in this specific region of China." And then think about throughout the duration of that PPP, how many nurses you're able to reach and intern, how many patients you're able to protect. That's the important part to me. And what is the most challenging part? The most challenging part about PPPs would be getting approvals. You don't realize how many approvals are needed within getting these PPPs off the ground. So that's something that was new to me and I'm learning along the way.

Maureen: And now my final question is what motivates or inspires you to put in these hours and do this work?

Samara: My motivation, well, my motivation it's twofold. I mentioned this earlier, where I've always wanted to help people. And I feel like, with this role, I'm able to do so because our reach is so expansive. We are able to reach populations all over the world with information, products, and services, and that impact really drives me on a day-to-day basis. And going back to just my culture, being half Kenyan and Zimbabwean, that just really shaped who I am as a person, and then knowing that the work that I do largely helps people on the continent of Africa makes the work that much more meaningful, knowing that the work ties into my DNA.

Maureen: That's a beautiful sentiment to close on. Thank you for coming on the show, Samara.

Samara: Thank you so much for having me. I really enjoyed it.