A former minister in the government of Finland, a long career in business and chair of the board of the New Children’s Hospital Foundation in Helsinki, Anne Berner’s experience has a striking breadth. She is currently setting up a foundation with representation from across the Nordic countries to establish a Centre of Excellence for the Rehabilitation of Children in Ukraine. At the recent Nordic Foundations Conference in Norway, she spoke to Alliance about the project and about how she sees the role of the third sector in Nordic society.

AM: You’ve had a very varied career, ministerial appointments, jobs with various public and private bodies, TV appearances – where does your philanthropic impulse come from? Was there a specific motor for it, and how has your experience informed your philanthropy?

AB: I’ve been mostly focused on children and children’s healthcare in my NGO type of work, and that was triggered by my own experience. I have three sons and my oldest son was born with something that had to be taken care of, and so I had experienced the children’s hospital in Finland for many years as a parent, but that didn’t trigger the need to do something about it until very much later. The Nordic countries are very much welfare states, and we live with the assumption that the state takes care of the investments that are needed, and it took me a while to see that there was something that we could take in our own hands and help to do.

Our Helsinki University hospital had a huge debt and our first initiative was to see if we could raise 30 million euros and donate that to Helsinki University to build a children’s hospital. There was a long-standing and urgent need to build not only a new children’s hospital, but also a new cancer hospital, and a new trauma hospital, none of which moved forward because they couldn’t decide which one to prioritise. So they did nothing for 30 years, and all of the hospitals deteriorated until finally the children’s hospital was in a state where they said that it was an unsafe place to work.

As we are structured in our countries, raising funds for a public sector entity that has the right to tax revenues is not allowed, but I inquired and found out that by setting up a foundation, we could create a tool that could raise funds but that we would have to build the hospital completely, and then donate the building to the Helsinki University hospital.

So that’s the reason for setting up the foundation?

Anne Berner

Yes, and actually it taught me a lot because, as a foundation and as the board of the foundation, you take a lot of personal responsibility. You don’t get discharged by the owners as you don’t have owners as such. I don’t see myself as a specialist in foundations, but I see that there is a strong need for philanthropy and for the third sector to have more room to work in the Nordic countries where we live with the assumption that the public sector is the main caretaker.

My experience over the past 10-15 years is that the third sector has a very important role in disrupting the public sector and highlighting areas where the public sector doesn’t function. One of the problems with foundations is that they have a mission and then they get stuck in that field, whereas I think that in philanthropy we should be able to to point out where the public system isn’t working, create a new structure because we do it in a much more efficient and innovative way, then we should be able to facilitate the public sector to move into that space, withdraw ourselves and move on into the next issue area to develop. That happens too little.

So for you, the ideal of a foundation would be to point out the areas of need and test out a solution to show the government and use as a model.

Yes. I think that’s the important role of the third sector.

Can we move on to talk about the centre of excellence that you’re planning in the Ukraine. What will the centre do and what’s your role in it?

When I initiated the idea in 2022, I had 10 years of the children’s hospital and it was time to move on. Then the war broke out in Ukraine and I began to think whether or not I should take the experience I’d had with the children’s hospital in Helsinki and see if we could do something for the children in Ukraine with that experience. I know Ukraine from my business past and I’ve travelled a lot there for work. My role was really to initiate the project and to invite people to come in and see what kind of structure would we need.

The more I learned about it, the more it felt that what we need is not a traditional type of hospital, but something that concentrates on rehabilitation, on mental health care, of which there is very little provision in Ukraine, and which has not been really classified as a disease of children. And then I also learned that there is very little research on the rehabilitation of civilian children affected by war.

There are individual researchers, there are some good ones in the UK, there are good ones in Sweden and in many other countries, but there’s not really a centre where they come together and having discussions with paediatricians in Ukraine and seeing that, it slowly came together. I also felt that whatever we do needs to be something that creates a systemic change, new structures, new ways of thinking and working, not only for Ukraine but for all of Europe.

So the war in Ukraine was the trigger?

Yes.  Thinking about it, a few things became clear to me: that we needed something that would not be Finnish alone,  but would involve other Nordic countries, that it would need to concentrate on rehabilitation, that we would focus on children because that’s the area I know, and that it would have to incorporate research in a completely different way. So we decided to create a foundation that is based in Helsinki, but that has founders from Denmark, Sweden, Norway and Finland and has a board from those countries.

It is building a centre of excellence around the rehabilitation of children that consists of three pillars; one is the digital platform that reaches out to all children, that creates a tool for triage so that we can see how the war has affected them and the numbers we are speaking about. We know that there’s about a million internal refugees in Ukraine who are children and there are about six and a half million refugees outside of Ukraine, most of them women and children, so there’s a lot of dislocation, a lot of distress, so with the digital platform we can reach many of them and we can also introduce competencies and skills.

Also, Ukraine has a very good knowledge background already and infrastructure in the country to provide for a digital platform. The second pillar is to build a physical hospital. It’s become more and more clear that it will have a mental health part, but it also specialises in very high-level surgery, neurosurgery, brain surgery, plastic surgery, treating burn wounds and providing reconstructive surgery, types of thing where there’s not so much skill and competence in Ukraine because, like most countries, they haven’t previously needed to have specialised units in reconstructive surgery.

And that will be located in Ukraine?

That will be in Ukraine. And then thirdly, I feel that it is really important to set up a research institute around this topic so that we can follow the children that are being treated into adulthood and see if the treatments given are actually creating functional, healthy adults. This is something I learned from Finland; there was a study this year conducted with war orphans from the Second World War.

It showed that the trauma caused by the war on orphans and children is going from generation to generation, and since there was no mental health care for orphans or for veterans for that matter after the Second World War, it created something that is still very present in today’s Finland. We want to make sure that we avoid that, and create something that is sustainable in the longer term. And when I arrived in Oslo yesterday, I got the message from our lawyers that the foundation deed has been signed by all founders.

So that’s the first step?

There are many steps happening at the same time. So I have been working on building up the foundation for which the signing of the foundation deed was a big step and at the same time, we have already established an organisation with workshops in Ukraine that is doing legal studies, feasibility studies together with the World Bank and the IFC. We have consultants working on technology for the digital platform and we’re already planning our fundraising.

So many different sorts of thing are happening in parallel because the war is going on, children need help urgently, and I think one of the problems with reconstructing Ukraine, everything is planned for once the war is over so there very little that is concrete actually happening at the moment, whereas we are planning to do all of this regardless of whether the war is over.

What level of financing do you expect will be needed?

We are trying to raise 150 million euros. I can’t tell you really why that’s the figure in the back of my mind of what’s needed. I’m expecting that we will need to build up a new type of structure. The Ukrainian healthcare system is very different in that you have a structure that was very typical for the Soviet Union where hospitals were built based on different specialisms, then the cities and municipalities had their own. And the whole healthcare system is also suffering from corruption. But at the same time, I think we will need insurance so that every child has access to these services, which will probably result in our needing to finance operations, which we didn’t do in Finland.

So it’ll be an ongoing role rather than only the building?

Yes. And in this case, we would probably not be interested in owning the building but rather finding the right partner to donate it to, and that’s not so easy to clarify; will it be the state or a region or city or some type of organisation? And that’s the reason for the legal and feasibility studies I mentioned earlier.

Is the fact that it’s a Nordic initiative but it’s taking place in the Ukraine an extra challenge?

Yes, in that, as people who have grown up in the Nordics, we have a different understanding of how a healthcare system works. But we’re curious enough and interested enough in learning how they think and how it works in Ukraine and we are working with large institutions like the World Bank and the IFC, so we will be able to find a good way to work around that. And that’s also why we can’t do it only as a desk exercise.

You have to go there and speak to people and I’ve visited a couple of the hospitals in Ukraine, both public sector hospitals and private hospitals, to see how they operate, how the referral system works, how they are funded, how they select their patients and so on. But for us, I think the most important thing will be to reach out to as many children as possible to make sure that it’s free access, and to create a national platform in Ukraine. It’s a big country, so we also need to understand that we’re dealing with totally different volumes than what we are used to in the Nordics.

On the question of Nordic identity and Nordic co-operation. Finland to some extent is an outlier linguistically and culturally. When you were a minister, part of your responsibility was Nordic co-operation. How real is that and how difficult is it to achieve?

Finland is a little different by language, by culture, also the close presence of first the Soviet Union and then the Russian border meant that Finland was more closed up than the other Nordic countries. At the same time, that has created a much stronger reaction to events in Ukraine and we maybe feel more closely tied to Ukraine than other places due to similar experience in our past. Still, I feel Nordic co-operation is something which is very real and our attempt at the time as a government was to bring about closer integration of the countries.

What role do you see for philanthropy in fostering Nordic co-operation and making common cause between the Nordic countries?

Politically, we have achieved a lot in areas of free movement, in education, in co-operation between students in social welfare, in some digital areas, in transport areas, in fields of communications. We have also adapted our legislation to each other and so on. But in philanthropy, I don’t know if we’re at the same stage. There is co-operation, I think, between the different foundations, but as I’ve been looking to build a foundation that is founded by members from each of the Nordic countries, I discovered that it wasn’t that natural, or that easy.

The traditions around foundations are very different. Finland has a long-standing tradition of foundations, Sweden as well, Denmark and Norway, a little less. In terms of my project, it means I got foundations from Finland and from Sweden to come in as founders, but from Norway and from Denmark, I have companies instead. It was difficult to convince foundations to participate and to identify the right type of foundations to do so.

So your new foundation’s a kind of exemplar. What’s it called?

It’s called the Foundation for Children’s Hospital and Research Institute Nadija. Nadija means hope in Ukrainian, but it’s also a name.

Earlier on, you mentioned the strong welfare models that the Nordic countries have and the expectation that creates that the public sector will deal with social problems, rather than philanthropy. Do you see signs that governments are taking philanthropy more seriously in that respect in the Nordic countries? And how important is a gathering like this to show that that’s happening?

I’ve been on the board of some typical healthcare foundations – the Cancer Institute in Finland and the Foundation for Research on Heart Disease – they’re very technical and they’re basically there to support individual researchers in financing their research. It’s good work, it’s important work, but it’s not disrupting. It’s a very traditional way of working whereas the foundations that I’ve put up are very much about specifically addressing problems that have arisen. At the same time, I think it’s important that foundations are open-ended so that they have a long perspective, but it’s also important that they are able to change over time.

When the issue came up that the children’s hospital desperately needed new premises and the public sector was unable to make a decision about it, by building it and donating the building, we actually created space for the public sector to build the cancer hospital and the trauma hospital as well, because they no longer had the battle over what to prioritise and make political choices around.

One of the problems is that the public sector tends to want to regulate the NGO sector so that they are almost like a part of the authorities. If you look at the big voluntary pieces that we have in our country, they’re around sports. Sports wouldn’t function unless there were enormous numbers of volunteer associations. The other area is around firefighting. Finland would not have the capability to secure firefighting unless we had volunteer firefighters in the communities.

But while they are much more efficient than public sector organisations, their disruptive function doesn’t have room to develop because they are streamlined and integrated into the public sector system. So in recent years, we have not really had a strong growth of new types of foundations. We have a fantastic new generation of multi-millionaires that have made exits from their start-ups, especially in the gaming industry and digital platforms and these young people are building up foundations which are trying to fix things which they feel are not right in society.

So there’s a generational change happening?

Yes. Our traditional foundations are rather old, they’re from after the war. Now we see young people who have received a lot of money building up foundations which are mostly aimed at the young generation  – education for young people who are outside of the system or have problems like addiction. I have some of them as founders in our foundation, and their thinking is more about limited-life foundations – let’s address this problem, let’s do it for 10 years and then close and do something else, so thinking is changing.

Are there issues common across the Nordic region for foundations or philanthropy to come together about? 

I think so. As I’ve said, the most important thing that the Nordic countries have in common is that we are very much public-sector-driven, so the environment in which foundations are operating, regardless of cultural and historic differences, is similar and the public sector in our countries is a bit sceptical of volunteer organisations interfering in their field, and in areas like healthcare, for example, we don’t have very large offerings in private sector operators so we are actually a little dependent on philanthropy in that area. In the UK, where you have strong philanthropy and a lot of foundations, you are used to the fact that some things need funding from philanthropic sources in order to move forward, and the same in the US.

When HIV/AIDS came along for example, you [the UK] immediately had strong foundations putting funding into research and the same with Covid. The Nordic countries are wary of depending on private sector or philanthropic funding for these types of thing because we worry that it creates more inequality. But at the same time, we have to admit that, in our countries, children are left behind, so in Norway, in Sweden at least, and in Finland, new children’s hospitals have to depend on private funding and, if you look at cancer, a lot of the research is funded by philanthropy, the rose for breast cancer and so on. It’s very strong in the Nordic countries.

Are attitudes towards philanthropy generally changing?

It’s happening and it’s becoming more natural. There’s a huge difference between Finland and Sweden. When I was first setting up the Children’s Hospital Foundation, I looked at the facts and figures for the NGO sector and we had several times less people working in the third sector in Finland than in Sweden. Finland has a very, very small amount of people who are employed in the third sector. Even with volunteers, the number was still small. and when you look at the amounts of funds raised yearly from Finnish people, it is still very small compared to any other Nordic country.