PPPs in health offer significant opportunities for strengthening healthcare systems, especially in Africa where the health financing gap is a major issue (for a broader look at PPPs in Africa, and the private sector’s role addressing the financing gap, read the headline article from this month’s GBCHealth News & Opportunities newsletter here). The African Business: Health Forum (AB:HF) 2019 featured a practical session, chaired by H.E. Isatou Touray, Minister for Trade, Regional Integration and Employment of The Gambia, providing insight into successful Public-Private Partnerships (PPPs). The panel shared their experiences and lessons learned from their work with PPPs in order to inform future collaborations, and shared examples that can be scaled up and replicated.
The first case study, presented by Carl Maas, CSR Manager of Marathon Oil and H.E. Mitoha Ondo’o, Vice Minister of Health and Social Welfare of Equatorial Guinea, looked at the development and implementation of the Bioko Island Malaria Elimination Project. Loss in productivity through absenteeism as well as high health costs motivated this 15-year project. This partnership between the government of Equatorial Guinea and three private sector partners (Marathon Oil Corporation, Noble Energy and Atlantic Methanol Production Company) has reduced the prevalence of malaria by 75%. The results are substantial, with 1,000 infected mosquito bites per capita annually in 2004 down to three bites per capita in 2018.
Lessons learned from this example include acknowledging the challenges caused by different management and operational styles between partners that can cause conflict, continuity of funding, and different expectations of potential outcomes and responsibilities. Also, a potential weakness on the part of governments is to develop national health plans without considering or including the participation of the private sector in the process, thus ignoring the symbiotic role companies can play in bolstering the services offered by the public health system.
The second case study focused on Ethiopia’s experience of implementing PPPs in the hospitals sector. Dr. Daniel Gebre Michael, former Director General of Medical Services and Advisor to the Minister of Health in Ethiopia, said there was no doubt this collaboration had improved health outcomes and delivery. For example, the collaboration means public services are backed up by private services, which has reduced the inefficiency of state health delivery and interruptions in services.
“For PPPs to succeed, we need political will and consensus as to the needs of the sector and the benefits of engaging the private sector,” said Dr. Michael. A clear legal framework with guidelines for each role is also needed. His country is also trying to improve tertiary care to attract investment and simultaneously stem the tide of citizens who travel abroad to get quality and specialized medical attention.
Minister Touray said that the quality assurance of private sector providers and their role in improving operations has been a focus of the health system of The Gambia. For example, distance from health facilities is a serious challenge in accessing health care, and The Gambia has contracted out transport of patients to the private sector. She ended by saying that clarity on legal frameworks, competitive bidding and political will are conditions for successful PPPs. This point was taken up by other participants, who pointed out the need for clarity at the continental level of PPPs in the health sector. Panelists also stressed that a strategic engagement of the private sector towards national goals and Agenda 2030 and Africa 2063 was important.
Through the panel discussion, some key recommendations surfaced:
- National development plans need to consider in advance where the private sector can play a role and allocate resources accordingly.
- Models should be explored to see how the public sector can make it attractive for the private sector to offer supplementary or specialist services through PPPs. This requires regular engagement with the private sector and changing of mindsets in government about the way PPPs operate and where each other’s obligations lie in the partnership.
- Using the example of Equatorial Guinea’s malaria program, other countries can see where similar PPPs can be instituted to solve challenges that will benefit the country and still be attractive for the private sector.
- Have a third party managing the relationship, for example an NGO, to make PPPs more attractive to the private sector, which does not want to spend time on issues that are outside its core business.
Overall, there were a few main takeaways from the panel. First, while working in silos might seem convenient, setting up coalitions is better for efficient and effective delivery on set objectives. This was evident in the case study from Equatorial Guinea, where the private sector joined forces with government to reduce infected mosquito bites incidents per capita from 1,000 to three annually.
Next, it is important to align and manage expectations between the government and private sectors for a seamless collaboration. This is best achieved through greater dialogue.
Finally, investing time, money and energy in human capital and R&D are necessary to help scale up impact. This was the takeaway from the Ethiopian PPP presentation, which outlined the government’s ambition and passion to develop tertiary care in the country and manufacture drugs domestically.
Trust and transparency are key ingredients of a successful PPP. Finance is only one area of collaboration; success will depend on having the right model and framework for the partnership to survive.
The AB:HF, held on the margins of the African Union summit in Addis Ababa on 12th February 2019, was the culmination of efforts by Aliko Dangote Foundation, GBCHealth and the UN Economic Commission for Africa to help mobilize private sector resources and expertise in order to strengthen health systems and consequently transform health outcomes across the continent. For a detailed snapshot of event proceedings, including other panels such as the one discussed in this article and many insightful speeches from regional leaders representing government, private sector and NGOs, visit this link.