2017-04-25 10:50:10

By Harvey DE HARDT-KAFFILS,
Communications and Knowledge Management Specialist / WAHO

Introduction

In today's world of complexity and rapid pace it is almost impossible to do anything alone. This is especially true in health where constantly rising prices, changing disease patterns, and increasing use of sophisticated technology for diagnosis and treatment have made it virtually impossible to imagine any single organization providing services without some type of institutional partnership. These partnerships may take many forms, ranging from global partnerships between multinational companies and multilateral donors to local partnerships between private physicians and government clinics. The partners, too, may vary from private-for-profit companies, not-for-profit organizations, governments, donor organizations, to community groups. Partnerships may vary in terms of financing from millions of dollars to the sharing of non-financial resources. However, all partnerships have one thing in common: they have come about because both partners believe they have something to gain from the partnership agreement.

Public Private Partnership

Public Private Partnership (PPP) is collaboration between the public and private sector that enables fulfilment of certain common goals by overcoming the visible limitations. Based on studies and sample surveys conducted, the Government has the pivot role of framing health policies and programmes specific to the requirement of each country. However, over the years the health sector has witnessed a demand supply mismatch attributed to a couple of factors. The private sector has served as a catalyst to deliver these services to the people by ways of greater efficiency, better management skills and focused strategies and stronger resource base whether in terms of monetary resources or human resources.

Why PPP in the Health Sector?

Given the effort that is required to form and maintain a successful partnership, one might sensibly ask why bother. This is particularly true, given the air of mistrust that has typically existed between the private and public sectors in health. There are three primary reasons that partnerships in health have become a major force in health care. These are a shift in philosophy about the roles of the private and public sectors; a recognition by both the public sector and private sectors of their interdependence; and a better understanding of how each party can gain from partnership.

In the past, the private and public sectors in health operated more or less independently in most countries. The theory was that the private sector provided services mostly to the wealthy in any country, while the government served the poor who were unable to pay for services. However, recent evidence has suggested that this model does not accurately represent reality. According to a 2012 World Bank study, it now appears that in fact the government is not really providing a safety net for the poor and furthermore, it would appear that it is often the wealthy urban population rather than the poor who benefit the most from government spending. This is largely because such a large portion of health care budgets in most West African countries is spent on sophisticated hospital care, usually found in urban settings, rather than primary health care that serves the needs of the rural poor. The result is a predominance of resources used for upper income, urban groups with little left over for the kinds of programs that are geared towards basic health services.

Another shift in philosophy has occurred with regard to the private sector. Whereas most developing country governments in the West African sub region and most donors paid very little attention to the private sector in the past, the recent focus on health sector reform has shined a spotlight on the role of the private sector, and especially on the qualities of innovation and efficiency that are generally seen as more common in private enterprises than in government bureaucracies. It is generally felt that the private sector, as a result of the competitive environment and the subsequent need to survive, is more able to respond to change and more able to deliver services at low cost when there is an appropriate stimulus to do so.

Perhaps there was once a world in which the private and public sector were completely independent, but today that world does not exist. There is probably no country in which the private sector is not deeply affected by government regulations and laws, by policies on practice and pharmaceuticals, and increasingly by government funding of private services. Similarly, almost all governments today rely on the private sector for pharmaceuticals and equipment, and increasingly contract with private (often not-for-profit) organizations for training, IEC development, and often for direct service delivery in areas where the government does not provide services. Governments have also become more rigorous in their regulation of the private sector in an effort to ensure quality, access and equity. Since regulations affect who can provide medical care, what types of treatments are acceptable, pricing, taxation, and other elements of the health care industry, the private sector has learned to work within the regulatory boundaries that are set by the government. This interdependence of governments and the private sector has led to a change in the relationships between the two. Although often still mistrustful on each other, both government and private organizations have had to learn how to work together, making it possible to work as partners rather than as adversaries. The interdependence has also made each sector understand how cooperation and partnership might be mutually beneficial despite the effort that is required to maintain the relationship. Although many governments and private organizations find the need for trust and transparency difficult, they also recognize that their interdependence must lead to an environment of mutual cooperation.

Benefits of PPP in the Health Sector

There are enormous benefits of PPP in the health sector for ECOWAS members. An effective PPP in the Health sector will increase access and availability of health services especially to the rural areas. It will also increase the quality and quantity of human resource for health, as more private sector will help in establishing training institutions to train more human professionals to help bridge the ratio of health professionals to the patients. It will also improve delivery of primary healthcare services which will in turn improve the quality of life. The expertise and experience of the private sector will bring on board innovation, resulting in shorter delivery times and improvements in the designing and delivering of improved health services. PPPs will also help create efficient and productive working relationships between the public and private sector in the delivery of health services.

PPP will allow both government and the private sector to share thier knowledge and experiences in health interventions and adopt the best model. Such partnerships that can help identify innovative financing mechanisms to provide finance health protection in the most underpriviledged populations. Strong PPPs will also afford the country the opportunity to respond to global epidemics such as Ebola and reduce its impact on the livelihood of its citizens. The West African Health Organization (WAHO) together with its partners are championing PPP in the Health sector for members of ECOWAS and it is believed that, the implementation of PPP in the Health sector will help ECOWAS member countries improve on health delivery and improve the livelihoods of citizens. Ultimately, PPP in the Health Sector will help member countries to achieve the Goal 3 of the Sustainable Development Goals and the AU Agenda 2063.

Conclusion

As the pressures of cost control, globalization, and reputation continue to influence health care worldwide, PPP will continue to become both more common and more varied in the future. Partnerships can be a powerful force in the shaping of health care, and can lead to improvements in efficiency, quality and access to health services for member countries in the ECOWAS sub-region. However they are not a panacea for all the challenges that remain for the delivery of health care in the sub region. If partnerships are to be used as a positive influence in the improvement of health care, attention must be paid to the values of the partnership and the way in which partnerships are planned and implemented.

Toutes les versions de cet article: [English] [français]