Private Sector Participation (PSP) and Public Private Partnerships (PPP) have in recent time gained relevance in the health sector of developing countries which are increasingly looking toward the private sector for assistance in meeting national health goals.  A variety of models for engaging private sector organisations exist.  PPPs include virtually any type of collaboration where the public and private sector come together in mutually beneficial arrangements that are designed to meet the health goals of the nation. PSP and PPPs can be structured in a variety of ways: contractual arrangements, joint ventures, leases, and arrangements where the private sector builds and operates a facility, with ultimate ownership in some instances remaining in private hands and in others reverting back to the public sector.

A large private health sector exists in low-income countries. It consists of a great variety of providers and is used by a wide cross-section of the population. There are substantial concerns about the quality of care given, especially at the more informal end of the range of providers. This is particularly true for diseases of public health importance such as tuberculosis, malaria, and sexually transmitted infections. How can the activities of the private sector in these countries be influenced so that they help to meet national health objectives? Although the evidence base is not sufficient yet, there is a fair amount of information on the types of intervention that are most successful in directly influencing the behaviour of providers and on what might be the necessary conditions for success. There is much less evidence, however, of effective approaches to interventions on the demand side and policies that involve strengthening the purchasing and regulatory roles of governments. Options for PSP and PPPs in health can be found in the following areas:

• Promoting healthy behaviours to address risk factors
• Promoting preventive health services
• Promoting essential health services in developing nations
• Outsourcing and privatisation of health facilities, or portions of their operations
• Dissemination of information and care to remote areas

It is now well recognised that large amounts of money are spent on private health care in low and middle-income countries even by the poor. This expenditure - especially in the case of catastrophic ill health or chronic illness - is a key factor in pushing people into, or keeping them in poverty. Whilst people are often willing to pay for health care which they consider to be of good quality, they are rarely in a good position to judge technical quality. As a result there are major concerns:

• that many of the services being provided by the private sector are of high cost but of low technical quality. Some may even be harmful; and
• that a growing private sector is undermining governments’ capacity to deliver an effective safety net for the poor.

Transparent regulations, as well as peace and economic and political stability (i.e. good governance) are considered to be prerequisites for successful PSP and PPPs.

EPOS’ Experience with PPPs

 

Kazakhstan

EPOS Health Consultants is currently preparing a technical and financial feasibility study for the establishment of a private clinic in Almaty, Kazakhstan, which shall provide a wide range of medical specialities and subspecialties, and other tertiary services to a particular clientele which seeks  high quality services. The facility will be financed by the German Development and Investment Bank (DEG) as well as by private investors from Kazakhstan.
The Consultant’s task is to assess the feasibility of this tertiary health care centre which shall offer high quality care according to International Standards for Diagnostic and Treatment Services while assuring high professionalism of medical, paramedical and other technical as well as administrative and managerial staff. as Apart from providing a wide spectrum of diagnostic and therapeutic services, it is intended that the facility shall become a Centre of Excellence in Kazakhstan.

 

Syria

EPOS, together with its partners, is currently implementing a 5-year Health Sector Modernisation Programme funded by the European Union (EU), aiming at strengthening the modernisation of the health system at central, district and local levels. EPOS supported the Ministry of Health in clarifying the possibilities and contractual regulations for concrete PPP projects. Among other things, the Ministry was supported in defining the overall political objective of PPPs and the framework of legal and procedural tools necessary for ensuring their sustainability (e.g., central policy statement on PPPs; legal framework; the setting up of an inter-ministerial PPP-unit; specification and costing of services). Further tasks included the development of concrete steps at central and governorate level to develop PPP projects in the health sector, the definition of possible interest of the private sector to start and maintain a PPP in the health sector, and the elaboration of recommendations of public-private mix in hospital care.

 

India

Through German Financial Cooperation a PPP was set up with the Department of Health and Family Welfare of the Government of West Bengal. EPOS Health Consultants and GOPA Consultants implement the Health Programme West Bengal aiming at the improvement of basic health services in eight districts, covering four components:
- Provision of community based ambulance services for emergency transportation;
- Provision of diagnostic services and Block Primary Health Centres and Rural Hospitals;
- Management of sub-optimally functional Primary Health Centres by private partners (NGOs);
- Procurement and supply of generic drugs increasing availability and accessibility of drugs.
For each of these areas intensive field based research was done using techniques of qualitative social and systems research. Based on those outputs, schemes for the partnership, business plans, Standard Operating Procedures, and contracts were prepared for each of the four areas. In the case of provision of ambulances, for example, the Government purchased equipped ambulances out of project funds and handed them over to selected NGOs under a legal contract to run the vehicles on a user fee basis, with the ownership remaining with the Government.

 

Yemen

EPOS Health Consultants conducted a feasibility study for a private German-Yemeni Consortium on the construction and management of a 100 bed hospital in the capital city of Sana’a. This study was co-financed (50%) by the Public Private Partnership fund of the German Ministry for Economic Cooperation and Development (BMZ) through German Development and Investment Bank (DEG).

 

Senegal

EPOS Health Consultants, together with a local IT company, developed a Hospital Information System (HIS) for the national level.  The objective was to establish an Application Service Provider within the framework of a PPP that would serve the public hospitals and the Senegalese Ministry of Health, and to improve information gathering and evaluation to better manage health facilities and the necessary resources at the national level.  The project was co-financed by the German Agency for Technical Cooperation, GTZ.

 

China

Within the framework of a pilot project and in cooperation with the Faculty of Hospital Management of the University of Beijing, EPOS introduced transparent outcome indicators for measuring the quality of clinical results in four hospitals in Beijing (Chaoyang Hospital, People’s Hospital, First Hospital of Beijing University, Third Hospital of Beijing University). 

 

Germany

Alliance for Excellence in Health Care e.V. (allexc) is a registered non-governmental organisation with at present six public German hospitals. The objective of the alliance is to offer high quality medical services to patients and organisations such as foreign corporate partners. EPOS founded this PPP alliance and constitutes its permanent secretariat in Bad Homburg.

 

The Mid German Health GmbH is an Application Service Provider (ASP) and as such deploys, hosts and manages access to a software application and delivers software-based services to customers from a central data point.  EPOS conceptualised and co-founded this PPP between the public hospitals of Chemnitz (1,800 beds), Görlitz (600 beds), and EPOS Health Consultants.  The objective of Mid German Health is to provide state-of the-art IT services to hospitals in the Federal State of Saxony by creating a hospital IT-service provider which took advantage of economies of scale. EPOS’ role is to facilitate the growth of Mid German Health and to supervise its customer-oriented operation.