Would Public Private Partnerships (PPPs) lead to sustainability & strengthening of health systems?

October 11, 2017
Source: Parul Budhraja Khanna | thebftonline.com | Ghana
Would Public Private Partnerships (PPPs) lead to sustainability & strengthening of health systems?


Healthcare demands in Africa are changing. Africa's healthcare systems are at a turning point and the reforms that governments undertake over the next decade will be crucial in improving overall health in the continent. It's because the way we design our healthcare systems speaks about our identities as a society. For no one would want an individual to be deprived of a treatment for their family member, or lead a family to bankruptcy due to the high cost of medical bills.

 It's basically a system of accessibility. Patients must get value for money because healthcare is the driving force pushing a 100 million people into extreme poverty every year. Therefore, it's time for sustainable healthcare. However, before the word sustainable is used loosely/misused we must be aware of its connotation.

Let's understand what it does not mean; it doesn’t mean that we build healthcare systems only for the rich who can afford or access it, it doesn’t mean that we choose a path of selective healthcare with bare minimum package. Just because this’ll make it cheaper and easier to execute, it shouldn’t qualify as the definition to sustainability. It should be used for the poor and underprivileged not against them. It shouldn’t just be satisfying the patients who are able to pay but should focus on solving patient problems as a whole regardless of their social strata. It should be based on one clear promise of building healthcare systems that poor can rely on to escape poverty rather than pushing them to it.

The essence of public private partnerships (PPPs)

Our healthcare system worldwide is divided into two; private and public. For productive change in the healthcare, we don't need to fight the system but unite the system. Public private partnerships (PPPs) are a collaboration, cooperation between the public and private sectors to ensure funding, construction, renovation, management or maintenance of provision of a health-related service. The risks are shared and there's a never-ending quest to improve policies, architecture, incentives to create health systems that can deliver on a universal public policy goal for the health sectors.

This includes access, quality, financial protection, responsiveness and improved health outcomes. All countries of the world have embarked on this journey to search for merit in health systems. Tragically half the countries of the world are far away from the adequate performance either in health financing or in healthcare delivery. A huge suffering and economic loss is a result of this deficit in health systems performance. This unsatisfactory performance in the health sector has stimulated many to critically reevaluate the past policies and procedures, which in turn has triggered a growing interest in innovation and mixed model in healthcare financing. Models that combine the strengths and competencies of the public sector with those of the private sector including NGO, faith based, non-profit and for-profit entities. Many of these approaches focus on building high performing, well-regulated mixed models. PPPs can achieve transformational improvement in quality and efficiency. Government capacity to manage PPPs should be enormously strengthened.

Ways private sector can curb the challenges of public sector

Understandably, governments face complex challenges in healthcare which encompass; demographical changes, growing chronic disease burden, increased urbanization, rising healthcare costs, more informed patients, rapidly changing technologies in healthcare etc. If government join hands with the private sector to strengthen the healthcare system and bring about innovation in financing and delivery of healthcare; there are many strategies that a government can take working with private sector to better improve the delivery of healthcare.

The chief strategy is PPPs. If PPPs are structured appropriately, it can inject competition, cost control and innovation in public health delivery. PPPs are long-term relationship/partnerships, generally through contract between government and a private entity, wherein, the skills and assets of the private sector are utilized in the delivery of public services. Risk allocation in such a partnership is very critical but it is seen that private sector takes on a lot of financing, operational and technical risks. However, these models should primarily be based on performance which can be assessed by the indicators in the contract. Predominantly, they should be looking at improving facilities.

 Those involved with policy decision making and strategies around PPPs should be mindful of their target and be clear on the needs and demands of the health services plus the cost required for delivering of those services. Each PPP needs to be customized to the specific health delivery needs of the population.

The drivers in which governments may look for implementation of PPP can be; infrastructure, financing due to budget constraints, access to skills and human resources for the delivery of services, improved technology and for additional service capacity. In PPPs the project should be clearly defined, the partners should be able to provide the right capacity and skills. There should be a transparent process from the bidding all the way to the implementation of the project. The contract should be flexible with clarity in communication and with meaningful stakeholder engagement as well as a strong legislative and regulatory environment.

African programs working towards health system strengthening

Africa Health Business Symposium (AHBS), is a similar program here in Africa, on the path of health system reinforcement. It is a platform for intra-regional discussion to fortify the roles played by both private and public health sectors with support from development partners, to promote an effective PPP dialogue within countries. The AHBS 2016 played a pivotal role in the beginning of a momentous change by unifying African countries under a single umbrella; the Africa Healthcare Federation towards overcoming challenges and achieving mutual far-reaching outcomes. Soon they're holding AHBS II for 2017 in Dakar, Senegal, 6th-7th November. AHBS events are planned and organized by Africa Health Business Ltd (AHBL), a registered company in Kenya that consists of experts from the health and business sector that have united strengths to significantly improve the development of the healthcare sector of the African continent.

 A growing urban middle class is willing to pay for better treatment has opened the door to the private sector, which is starting to play a new vibrant role, often working in partnership with donors and governments to provide better healthcare facilities and increased access to medicine at an affordable price. Substantial investment will be needed to meet the growing demand; largely from low and middle-income households, which comprise 70% of Africa’s purchasing power.

The AHBS program covers the 5 key game changers, identified that largely impact the healthcare industry across the continent: healthcare financing, human resources for health, fostering investments, supply chain management and digital technologies.

 We must design the healthcare systems that meet our moral aspirations too. Since all of this isn’t just about the money. We have a certain duty towards the people for having the privilege of being at a position of provision of healthcare. I'd like to conclude by quoting Pubilius Syrus, "Where there is unity, there is victory". Godspeed!


The writer is an Entrepreneurial Biotechnologist and passionate about creating awareness amongst the masses and steering a tangible change in the healthcare delivery systems.

Email: parulb@hotmail.com

Facebook page: The Health Plug