The dance of power and trust-exploring micro-foundational dimensions in the development of global health partnership

The global health system has significantly evolved over the last 30 years, particularly since the UN Millennium Declaration in 2000. The transformation in global healthcare partnerships has been most visible in the area of neglected tropical diseases. Numerous strategic partnerships between different actors, including pharmaceutical companies, global and national health institutions and philanthropic organisations and disease specific foundations populate the landscape of neglected tropical diseases. Our research uses a rich longitudinal case study portraying ‘social change’ involving a tripartite public-private partnership formed to co-develop an affordable drug, for the treatment of malaria in Sub-Saharan Africa. By adopting a micro-foundational perspective, we analyse the strategic choices made by the Product Development Team in developing this drug and note the dynamic interplay between trust and power in underpinning the strategic choices by the Product Development Team as it co-evolved and adapted to institutional changes.