Cross-Sector Collaboration: Lessons from the International Trachoma Initiative

Alliances between for-profit and nonprofit organizations are evolving from arms-length relationships into strategic partnerships. A study of the collaboration between the Clark Foundation and Pfizer, Inc. reveals what it takes to make them work.
by Diana Barrett, James Austin & Sheila McCarthy

Cross-sector partnerships between for-profit and nonprofit organizations are increasing in frequency and importance. Such collaborations, write Diana Barrett, James Austin and Sheila McCarthy, "are moving from an arm's-length 'philanthropic relationship' towards more strategic collaborative relationships that are more intense and involve joint value creation.

"The shift," they continue, "represents an opportunity to magnify the social value and the benefits to the partners, but carries with it greater challenges and managerial demands than the traditional financial donation."

In "Cross-Sector Collaboration: Lessons from the International Trachoma Initiative," Barrett, Austin and McCarthy examine one such collaboration, a joint effort of the Edna McConnell Clark Foundation and Pfizer, Inc. to combat the devastating effects of the eye disease trachoma.

The aim, write the authors, is "to deepen our understanding of the process of cross-sector collaboration in the public health arena and the factors contributing to effective partnering." They begin with brief descriptions of trachoma and the evolution of the Clark-Pfizer relationship. The working paper then examines, in detail, critical elements of the partnering process: connection, congruency of mission and strategy, creation of value, and relationship management.

The following excerpt describes the importance of emotional commitment on the part of the partners to both the social purpose of the collaboration and to each other.

Cross-sector partnerships do not happen; they are built. To trigger the relationship there generally needs to be an emotional connection with the social purpose. The prospect of a program that prevented blindness from trachoma resonated with leaders at both Clark and Pfizer. The Clark Foundation had spent 25 years funding research to prevent tropical diseases and now had an opportunity to leverage this experience and see its research applied in affected communities. Indeed, it had funded the research that was credited by many with moving the scientific field of trachoma control forward and now had the opportunity to "finish the job." That is, it could help to make operational its research in a way that directly improved the lives of disadvantaged people, the core mission of Clark.

Leaders at Pfizer were also able to connect on an emotional level with this initiative. As one Pfizer manager put it, "One of the reasons people enjoy working at Pfizer is that we conduct medical research that helps with the illnesses that mankind suffers." Indeed, this type of initiative fit with Pfizer's stated value of providing care to those in need. Specifically, managers throughout Pfizer, including its marketing and clinical staff, were motivated to pursue the use of Zithromax® [a Pfizer anitbiotic] in the prevention of trachoma. Indeed, the internal working group that was formed to analyze the issues surrounding a philanthropic program was voluntary and required participants to take on this work over and above their existing responsibilities. Clearly, there was an emotional connection that served as a powerful motivator.

But connecting with the social purpose is not enough. The key staff involved in the collaboration must also be compatible. Bad interpersonal chemistry can quickly kill an alliance. Therefore, a "getting acquainted" period and process is needed to ascertain compatibility and develop a positive relationship. Clark and Pfizer interacted over eight years, beginning with the initial pilot studies in the early 1990s. This interaction intensified through their collaboration on the Moroccan Pilot. This incremental engagement process also enabled them to undertake a due diligence assessment of each other to assess attitudes, capabilities, and commitment. Internally, Pfizer had considered several options in managing a trachoma initiative. These options including housing the program internally, partnering with other organizations, or partnering with Clark. In the end the group recommended a partnership with the Clark Foundation, citing among other things the history of successful collaboration with Clark, both in the initial studies and the Moroccan Pilot.

These interactions built understanding and trust, which are important building blocks for strategic alliances. Ongoing management of an effective alliance or collaborative venture requires a mindset and a set of attitudes that allows them to function in an environment characterized by risk, instability, and the unknown. Indeed, many collaborations evolve in rather unpredictable ways, depending to a great extent on trust and confidence. Pfizer Executive Vice President for Corporate Affairs, Lou Clemente, observed, "We felt comfortable with Clark from the beginning. We didn't have to sell them on things that were important to us. They knew what we were about, what would be important to us. And I think we were sympathetic with what they wanted to achieve."

Austin's work on cross-sector collaboration supports the importance of an emotional connection. He has found that, beyond traditional measures of effective leadership such as involvement, consensus building, and strategic implementation, these innovative partnerships are fueled by the emotional connection that key participants make not only with the social mission, but also with their counterparts in the partnering organization. Perhaps this personal connection is at the nexus of the confidence and trust that allows these collaborations to develop. Personal connections become invaluable in developing the necessary levels of trust to proceed as the alliance unfolds and matures. This is particularly important when operating in an uncertain environment without the clear benchmarks that are often used by corporate managers.

There was a range of personal connections that helped to facilitate and solidify the Clark-Pfizer relationship. For example, some of the researchers funded by Clark had worked previously with Pfizer's scientists, so the two organizations had a small historical base of cooperation. This scientific connection continued with the trials of Zithromax®. At the corporate level, the positive relationship between Ms. Luff [Paula Luff, Manager, Corporate Philanthropy Programs at Pfizer, Inc.] and Dr. Cook [Joe Cook, head of the Program for Tropical Disease Research at the Clark Foundation] was facilitated by a personal connection that helped to initiate the relationship. Ms. Luff recounted: "There were a couple of fortuitous things. I came to Pfizer from CARE and it was around that time Clark's Tropical Disease Research Program had hired someone who used to work for me at CARE. She informed her boss, Joe Cook, that I was at Pfizer, and so we had breakfast at the Harvard Club and that is how it all started. At the same time internally, our marketing and clinical trials folks had been working with Joe and they came to us and said, 'We've got a great opportunity here, but we do the commercial side of things and we need help figuring out how to launch an international humanitarian effort.'"

Both Dr. Cook and Ms. Luff were instrumental in building support for this collaboration within their respective organizations. It is important to note that Austin's research revealed that top leadership support for the business-nonprofit collaborations studied was essential to their becoming strong alliances. Within Pfizer, Ms. Luff and the working group were able to present the program to senior management, and to build a "business case" Ms. Luff stressed that they needed to demonstrate that it was a sound, workable program that would achieve results. The pilot program in Morocco provided an opportunity not only to learn about complexities of implementing this type of program but also to build support within the company and strengthen the personal relationships between the two organizations. For example, several of Pfizer's key top managers made field visits to Morocco, as did senior leaders from the Clark Foundation.

Likewise, Dr. Cook was able to build support for this program within the Clark Foundation. The support of senior leadership at both the Clark Foundation and Pfizer for the trachoma program was clear and vital. As one foundation official put it, "If [Clark Foundation President] Mike Bailin had not been convinced of this, it never would have happened." Indeed, Mr. Bailin worked with Dr. Cook to build support for this collaboration at the board level.

About the Author

James E. Austin is a professor at Harvard Business School.