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Health NGO Meeting. Sierra Leone 6th March 2012. A global perspective on health PPPs in developing countries. Health trends PPPs in health care Lessons. Health Spending. Life expectancy. Health expenditures. Rising faster than GDP due to:

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Health ngo meeting

Health NGO Meeting

Sierra Leone

6th March 2012

A global perspective on health

PPPs in developing countries

  • Health trends

  • PPPs in health care

  • Lessons

Health expenditures
Health expenditures

  • Rising faster than GDP due to:

    • Advances in medical technology (expensive equipment/tests)

    • Aging populations

    • More chronic diseases

    • Demand for better services

  • Growth of govt spending on health care is unsustainable, new funding sources needed.

PPPs in health

Ppps in health
PPPs in health

WhyPPPs in health care?

  • Improving cost efficiency

  • Improving quality of services

  • Modernizing facilities, equipment & services

  • Increasing access to underserved areas & populations

WhyPPPs in health care?

  • Government pays Private Operator service payments but only once facility is operational

  • Government defines service and output requirements. Inputs, design, etc to bidders

  • Buying services, not equipment & facilities.

  • Private party is typically responsible for all or part of the capital financing

  • Payment is tied to performance not inputs/milestones

Public private partnerships in health

















Detailed designs

Building construction

Medical equipment

Capital financing

IT equipment & services






  • Primary care

  • Public health

  • Vaccinations

  • Maternal & child health

Lab analysis

Diagnostic tests

Medical equipment maintenance



Radio- therapy

Day surgery

Other specialist services

Managementof entire hospital or network of hospitals and/or clinics

Public Private Partnerships in Health

Under a PPP, a government or national health insurer contracts with a private partner (for-profit or not-for-profit) for a health care service and/or facility

Ifc s role

Enterprise Assistance

Public-Private Partnerships

Environment & Social Sustainability

Business Environment

Access to Finance

Advisory Services and Financing

IFC’s Role

IFC also provides advice to governments and businesses

World’s largest multilateral provider of financing for private enterprises

Advisory services to governments and businesses

$30+ billion in investment commitments

Lessons from global experience
Lessons from Global Experience

  • Use PPPs to expand service / improve quality - Not as means to simply finance new buildings/equipment

  • Define services needed (not facilities) - Give operators/bidders flexibility on how to provide (location, size, design, technology)

  • Buy from existing private operators where feasible/economic - Not necessary to duplicate in public facilities

  • Maximize private sector responsibility for greater benefits - PFIs are politically expedient, but “full” PPPs deliver more benefits

  • Long-term fiscal affordability is essential - but not reflected in “Value-for-Money” analysis

  • PPPs will only help if part of a broader health sector reform program

Next generation of health ppps
Next Generation of Health PPPs

We see several areas/themes emerging:

  • Contracting out public health insurance activities

  • Shift to defining PPPs in terms of services, not facilities/equipment

  • Integrated care (networks)

  • More “full” PPPs, but with varying responses to risk sharing

  • Radiotherapy

  • Diagnostics/ imaging projects

  • Medical education

Ifc advisory services in ppps
IFC Advisory Services in PPPs

Emmanuel Nyirinkindi

Manager: Sub-Saharan Africa

Email: [email protected]


IFC Senegal

Email: [email protected]

Peter Boeré

Health Specialist

Email: [email protected]