Public Private Partnerships (PPPs)�for the health sector
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Vikram Rajan
World Bank
Tamil Nadu, India
December 7, 2022
#1: Health System Goals Should Drive Private Sector Engagement
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Health Status
Improvements
Equity, Quality
& Efficiency
Financial
protection
Source: Adapted from Harding & Preker, Private Participation in Health Services, 2003.
Public services assessment; gaps & priorities identification
Private Health Sector / Market Assessment
Identify opportunities
Activities
Ownership
Expand Private
Enabling & incentivizing
Harness
Contracts/PPPs
Constraint
Regulation
Strategy
Assessment
Goal
Focus
Private Sector
Public�Sector
PPPs are used to mobilize private finance, increase access, improve quality of service, introduce efficiencies in the delivery of public health services, introduce innovations and technology, and finally improve health outcomes.
#2: PPPs Can be Interpreted in Different Ways
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PPCs
“PPPs”
PPPs
Global health
Health servicesexpert
Infrastructure
PPP expert
#3: Responsibility is with both partners and need to focus on the entire PPP life cycle
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Arrangement
Between public & private
Provision
Of services for public benefit by private partner
Investments
In and/or management of public assets by private partner
Time Period
For a specified time
Risk Sharing
Optimally between contracting parties
Standards
Focus on quality of service / performance
Payments
Linked to performance
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The final responsibility for service delivery continues to remain with the public sector agency 🡪 Execution is by private partner
CONSULTANT
7 essential conditions that define PPPs
#4: Different PPPs for different country needs
Management of hospitals or networks of hospitals and/or clinics
Country examples:
Brazil, Lesotho, India
Clinical Services
Management Contracts
Infrastructure PPP (PFI)
Contracting out services such as dialysis, radiotherapy, day surgery etc.
Country examples:
Romania, Peru, UK, India, Bangladesh
Contracting a private provider to design, build and manage facilities
Country examples:
UK, Spain, Italy, Mexico, South Africa, France, Australia
Non-clinical Services
Contracting out works and services such as IT services, cleaning, catering, maintenance, waste management etc.
Country examples:
global
Contracting a private provider to design, build, and manage facilities as well as deliver clinical services
Country examples:
Portugal, Lesotho, Spain, Turks, Caicos, India
Infrastructure and Services PPP
Contracting out support services such as laboratory and radiology diagnostics, ambulance services, supply chain management
Country examples:
Global
Clinical Support Services
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#5: Public Sector Capacity is key for success of PPPs
Government role increases with increase of complexity
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Nandri!
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300,000 people with improved access to services
Lesotho: Medical Waste PPP (2012)
Services agreement for the regional collection, treatment and incineration of hazardous medical waste.
Prepares the groundwork for further PPP arrangements at 168 health-care facilities in 10 districts of Lesotho.
Awarded to Mediwaste, a consortium of Ditau Health Solutions and Matsete Investments.
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98,800 people with improved access to services
$6 million in investment
Upgraded diagnostic imaging and radiology facilities.
7-year concession to provide advanced imaging and radiology services across 4 government hospitals/medical colleges.
Awarded to Wipro GE Healthcare Ltd. and Medall Healthcare Private Ltd.
India: Andhra Pradesh Radiology (2010)
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Two new 120-bed hospitals.
25-year PPP to design, finance, construct, equip, maintain, and provide dialysis, imaging, and lab services.
Awarded to Prodemex (Toluca) and Marhnos (Tlalnepantla).
Mexico: Toluca &Tlanepantla Hospitals (2010)
20,000 people with improved access to services
$120 million in investment
33% decrease in operational costs.
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Romania: Outpatient Dialysis Services (2002)
Four 4-year contracts to refurbish, operate, and manage dialysis centers at 8 hospitals around the country.
Awarded to local operators for B. Braun, Fresenius (Germany), Baxter (USA), and Gambro (Sweden).
224,640 people with improved access to service
$40 million in private investment
Over €2.9 million in fiscal benefits