The Role of Public-Private Partnerships in Health Systems Strengthening Workshop Summary (2016) / Chapter Skim
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2 Setting the Context
2 Setting the Context
Pages 5-18
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From page 5... ...
Since the adoption of the MDGs, governments have been held more closely accountable and official development assistance has increased, with global aid reaching record levels in both 2013 and 2014. Bland enumerated several measurable outcomes of the MDGs: global poverty was halved 5 years ahead of the MDGs target; 9 out of 10 children are enrolled in primary school, with as many girls as boys in school; remarkable gains have been made in the fights against malaria, tuberculosis, and HIV/AIDS; the likelihood of a child dying before the age of 5 has been nearly cut in half; and the number of people who lack access to 5
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From page 6... ...
Moving into the era of the SDGs, which will be defined as 2015 to 2030, Bland emphasized that this new set of goals is not intended to be an updated version of the MDGs, but rather transformational through combining the social, economic, and environmental pillars of sustainable development. Within the health-focused SDG, there are nine targets governing maternal health, child health, communicable diseases, noncommunicable diseases, substance abuse, road traffic safety, sexual and reproductive health services, universal health coverage, hazardous chemicals, and air, water, and soil pollution.
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From page 7... ...
During the past 15 years, however, both the Internet and the ICT sector have acted as important facilitators to spur progress across the development goals and to bring together vertical sectors in the process. As an example, Jafari highlighted the Broadband Commission for Digital Development, which was established in 2010 at the suggestion of the United Nations, with the intention to boost the importance of broadband on the international policy agenda and to create ecosystems based on a PPP business model that can facilitate and enable cross-sector implementation (e.g., the health, agriculture, education, and manufacturing sectors)
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From page 8... ...
The inclusive PPP model of Smart Africa recognizes that, through cooperation and collaboration, there is potential to achieve results more efficiently and at scale. Experiences in the ICT sector that led to the development of the inclusive PPP model and initiatives such as Smart Africa illuminated several critical success factors for PPPs, which Jafari summarized: • Focus on the end-user; • Joint vision and deliverable results; • Sustainable business model; • Shared risks and rewards; • Transformational regulatory environment/framework; • Transparent and accountable governance; • Contingency plan for unintended consequences; • Collaborative innovation; and • Continuous improvement of processes.
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From page 9... ...
Globally, individuals are living longer but with greater disability and morbidity and increased prevalence of multimorbidity; and, as Atun noted, the complexity of these conditions and co-occurrences demands coordinated collective action (IHME, 2010)
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From page 10... ...
Atun believes these inclusive coalitions, which comprise proto-institutions, the public sector, civil society, and the private sector, are what have characterized global health partnerships of the past decade. Along with changes to the makeup and structure of global health partnerships, Atun explained that the role of these partnerships has also evolved.
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From page 11... ...
These PPPs range from private financing initiatives where the private sector provides financing based on a risk-and-reward calculus, to operating the entity that was developed through a joint venture, to managing the whole operation for decades. Like hybrid organizations, these partnerships exist at the primary, secondary, and tertiary care levels, as well as in public health.
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From page 12... ...
MIC Bilaterals Global Fund Gavi UNITAID Gates Academics and Think Tanks Core Promotion of Research and development ü ü ü ü ü ü global public goods Information and databases for ü ü ü ü ü ü ü ü ü shared learning Comparative evidence and ü ü analysis Harmonizing norms and ü ü ü ü standards for national use and international regulation
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From page 13... ...
Management Border control, especially ü ü ü of externalities during epidemic outbreaks Stewardship Convening for consensus ü ü ü ü ü ü ü ü ü ü building, priority setting, and cross-sector health advocacy Supportive Act as Provision of basic needs in ü ü agent for failed states disposessed, mobilize Assistance in natural or ü ü ü ü ü global artificial disasters solidarity Protection of vulnerable groups ü ü ü ü ü ü ü Support International technical co- ü ü ü ü ü ü ü ü ü ü development operation Development financing ü ü ü ü ü ü ü ü NOTE: Gates = The Bill & Melinda Gates Foundation; Gavi = Gavi, the Vaccine Alliance; HIC = high-income country; MIC = middle-income country; WHO = World Health Organization. SOURCES: Blanchet et al., 2013; presented by Rifat Atun on June 25, 2015.
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From page 14... ...
Hybrid organizations New organizational Public–private Outright forms partnerships privatization Transformation Outsourcing within FIGURE 2-3 The public–private partnership continuum. SOURCES: Atun, 2007; presented by Rifat Atun on June 25, 2015.
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From page 15... ...
Atun noted that there are efficiency gains to be had in managing health systems, and the private sector, through relentless innovation, provides an opportunity to realize these gains, which may be missed when partnerships are not in place. Beyond clinical support services, Atun suggested there are opportunities to improve efficiencies through PPPs in the areas of information technology and accounting, among others.
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From page 16... ...
This includes understanding how data can be captured, but more importantly, how data can be analyzed and then translated to improve real-time management of individual patients as well as the populations. Other areas ripe for PPPs based on private-sector expertise include the management of the supply chain, single-procedure providers, specialty hospitals, disease conditions, intermediaries such as managed care organizations, general hospitals, and primary care or primary care networks or provider networks for an entire district, region, or province.
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From page 17... ...
In most countries, primary care is still being defined and administered based on the 1920 Dawson Report, which sought to distinguish primary care centers as regional centers for health services.1 However, recent advances in technology have enabled countries to change how primary care is administered by moving primary care services outside of the hospital and closer to patients. Further, patients can now take part in managing their health conditions through technology.
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From page 18... ...
Atun referred again to Figure 2-5 and suggested focusing on developing enablers, such as data systems that demonstrate variance from the standard in quality and safety across multiple conditions. The first investments, he continued, would need to be in developing information sets and datasets to generate baseline knowledge and in identifying and predicting risk for individuals and populations with regard to safety and quality errors.
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