Capacity Building Workshop On Health Systems Development for Country & Regional Office Staff 20-24 May 2007 Alexand

1. 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

2. Outline Introduction Meaning & Strategies Some facts Experience in EMR : facilitating factors & Capacity of Private sector Requirement Next Steps

3. 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.

4. Public Private Partnership Strategies & Tools Three Main Strategies: Engaging Growing Conversion E G C Private Public Tools: Contracting, Regulations, Information

5. 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

6. Private sector is widely used in Ambulatory care: Pharmacies: OTC, Pharmaceuticals 20-25% of healthcare cost)

7. 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

8. 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

9. 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)

10. 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

11. Private Funding Government Provision Private Provision Public Revenue/Tax

12. Private Funding EQUITY QUALITY Government Provision Private Provision EFFICIENCY ORGANIZATION Public Revenue/Tax

13. 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

14. 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

15. 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.

16. Thank you