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Capacity Building Workshop On Health Systems Development for Country & Regional Office Staff 20-24 May 2007 Alexandria , Egypt Public Private Partnership in Service Delivery Ahmed Ali Abdullatif Coordinator, Health Systems WHO/EMRO. Outline Introduction Meaning & Strategies

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Capacity Building Workshop

On Health Systems Development for

Country & Regional Office Staff

20-24 May 2007

Alexandria , Egypt

Public Private Partnership in Service Delivery

Ahmed Ali Abdullatif

Coordinator, Health Systems

WHO/EMRO


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Outline

Introduction

Meaning & Strategies

Some facts

Experience in EMR :

facilitating factors & Capacity of Private sector

Requirement

Next Steps


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Public Private Partnership (PPP)

Designates a relationship between a Government part y &

a Private party to run facilities and / or provide related

Services. The relationship is regulated by

a contract that allocates responsibilities, rights, risks

and rewards between the parties.


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Public Private Partnership Strategies & Tools

Three Main Strategies:

Engaging

Growing

Conversion

E

G

C

Private

Public

Tools: Contracting, Regulations, Information


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Some Facts

HealthCare is a Public service

PPP is a Means to an END: Improving Population Care

Thus PPP has to involve Staff & Users. Not only Politics

Not the Public Services that are at fault.

Root Causes : It is the lack of:

Coherent Strategic Plan for the health services

Managing change

Two Camps


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Private sector is widely used in Ambulatory care:

Pharmacies: OTC, Pharmaceuticals 20-25% of healthcare cost)


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Public Private partnership in EMR

Main features:

No organised collaboration tho Existing

No formal strategy ie division of labour

No detailed information on activities

No Forums i.e. participation of Syndicates ( ? Leb, Pak, Jord)

Limited Capacity: mind shift ( i.e. contract managers)

strategically frame & Plan, set standards,

negotiate, Implement, QA & Monitor

+Weak management at all levels

Experience in “ Buyability”

Contracting private for Auxiliary (Laundry, Catering..)

Contracting for support Activities &

PC (Afghanistan)

System wide active purchasing: Saudia


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Facilitating factors for PPP

Health Sector Reform: Donors & WB, Medical Tourism

Globalization & WTO

Decentralization & Corporatization (Qatar)

Efficiency Concerns: Hospital Autonomy

Politics & Ideology ( Lebanon, Jordan, GCC, Egypt,………….)

Weak public infrastructure during civil strife + donors:

Afghanistan, Sudan,

Low public pay & incentives (Multiple jobs & Unemployment)

Laissez faire: Private unregulated. ? Role of MOH

Social Health Insurance: Choice, Competition

Dissatisfaction: shortages, waiting, crowdedness, clinical


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PPP: Private sector in EMR

Organization: scattered individuals. Dual: Overlap with Public

HRH: Example 89% > 1 job

Planning: No Catchment Population, Ad hoc

Provision. Curative, Clinics, Beds

Purchasing:

OOP by users mainly for Curative services

Contractual by Public Institutions for

Intermediate & Supportive services

No capacity to run comprehensive Essential care

(even Lebanon, Afghanistan)


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Claimed Rationale for PPP

More funding for the public health services

Wider Range & Types of health service providers

Strengthen Quality & Management Capacity through competition

An Argument. MOH who could not manage its own,

can it mange PPP which it has no experience with?

& Vice Versa


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Private

Funding

Government

Provision

Private

Provision

Public

Revenue/Tax


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Private

Funding

EQUITY

QUALITY

Government

Provision

Private

Provision

EFFICIENCY

ORGANIZATION

Public

Revenue/Tax


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Optimal use & effect of PPP requires

COVERAGE; QUALITY; COSTS

Public Responsibility for poor, large externalities public goods

Fair competition & Incentives

Careful regulations

Justification & expertise n selection of partner

not to compromise Quality to save costs e.g.

Experienced Public Workforce moving to Private

Capacity Building

Lessons learnt (Lebanon escalating costs…

PPP Accountability ….ultimately to government & Socially

Transparency: well planned & performance data

Impact on Health Coverage; especially the POOR

Risk management

Quality/ safety Assurance / Audit compliance

Social engagement thru Public bodies


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Next Steps

Awareness (lessons learnt)

Know more. Mapping, Research, Database (SO 10.1….)

Develop a PPP framework

Share & Involve ….. Providers. At all stages of PPP

Consensus building on:

Strategic Vision & Values

Nation’s Health Gains

User/Patient centredness

Complementarities ( not Replacing)

Division of Labour

Transparency

Accountability to Public: First 24 hours Emergency

MoHs + Institutional Development …size & Complexity

Legislations & Regulations: “Poor Beds”

Quality Assurance & Accreditation

WHO PARTNERSHIP


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  • The state should be “strategic” in its choice of PPP projects

  • based on factors such as:

  • The size & Complexity of the project

  • The technical challenges or requirements for innovation:

  • The relative expense of private finance & PPP transaction cost

  • An assessment of where the private sector can add value; and

  • What stakeholders & other public interest issues might there be

  • that suggest contractual obligations & Safeguards might be

  • less appropriate than : routine” public delivery approaches.


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Thank you projects


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