The recently concluded Africa Health 2018 conference culminated with a forum on Public Private Partnerships (PPP), with Ministry of Health representatives and Ministers from Uganda, Namibia, Ghana, Lesotho to name a few, providing a high-level discussion on the challenges faced in their countries and their views on how PPPs can strengthen health systems.
Interestingly, the common denominator of the panellists, was that rural communities were underserved and I suspect that most of the budget from PPP funding is focused primarily on infrastructure; building hospitals, medical devices, equipment and other services that are required to run a hospital or health facility.
Does this mean that the emphasis of this partnership is to ensure that there is a blueprint for healthcare system infrastructure or is this is the first step to addressing the government’s goal to improve health systems and provide affordable healthcare access to all?
If it is the former, then it enables the government to budget healthcare expenditure over the length of the PPP term but depending on how the model is structured, benefits can be realised from the onset as we heard from the private sector representative in Kenya. Using the private sector to drive efficiencies, achieve KPIs and reduce overall costs is the mantra of PPPs, whilst enabling governments to address the most pressing healthcare challenges and provide affordable access to its population.
However, this type of arrangement is not a panacea to developing a sustainable health system, especially in countries lacking basic healthcare facilities as funding a PPP without first having a dialogue between all stakeholders can drain funding from primary care services to sustaining tertiary and acute care projects.
Including preventive health services and health and wellbeing programmes with measurable outcomes should be one of the objectives of this partnership. This approach would ensure that the patient is directed to the most appropriate level of care – reducing waiting time at hospitals, effective utilisation of equipment and resources and empower whole populations to take control of their own health.
Tele Technology – the Enabler
In driving prevention and early intervention programmes, consideration must be given for tele technology and assessing today’s mobile phone market penetration in the country. Health infrastructure projects have a timeline to realise tangible benefits and given the population’s access to mobile phones, these health and wellbeing projects can be initiated in a short period of time to give whole populations healthcare access and treatment from their own homes, thereby addressing rural areas challenges. In addition, supporting people to manage their long-term conditions with proactive interventions via technology will eventually reduce the cost of treatment for these non-communicable diseases.
Considering that natural disasters can cause widespread damage and chaos and these events sometimes cannot be prevented, if a population were more in control of their own health and able to manage their long-term conditions with minimum support, the chances are that the survival rates will increase and humanitarian aid will be more effective when it does reach the disaster area.
Clearly the goal of a PPP is to transform a health system and drive affordable healthcare access, but to ensure that project outcomes are achieved from the onset, the blueprint must consider the patient continuum and engage with providers of evidenced based solutions to develop a strategic transformational partnership.