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Health NGO Meeting

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  1. Health NGO Meeting Sierra Leone 6th March 2012

  2. A global perspective on health PPPs in developing countries • Health trends • PPPs in health care • Lessons

  3. Health Spending

  4. Life expectancy

  5. Health expenditures • Rising faster than GDP due to: • Advances in medical technology (expensive equipment/tests) • Aging populations • More chronic diseases • Demand for better services • Growth of govt spending on health care is unsustainable, new funding sources needed.

  6. PPPs in health

  7. PPPs in health

  8. WhyPPPs in health care? • Improving cost efficiency • Improving quality of services • Modernizing facilities, equipment & services • Increasing access to underserved areas & populations

  9. WhyPPPs in health care? • Government pays Private Operator service payments but only once facility is operational • Government defines service and output requirements. Inputs, design, etc to bidders • Buying services, not equipment & facilities. • Private party is typically responsible for all or part of the capital financing • Payment is tied to performance not inputs/milestones

  10. Design & Construction Non- clinical Services Primary Care Clinical Support Services Specialized Clinical Services Hospital Mgmt Detailed designs Building construction Medical equipment Capital financing IT equipment & services Maintenance Food Laundry Cleaning Billing • Primary care • Public health • Vaccinations • Maternal & child health Lab analysis Diagnostic tests Medical equipment maintenance Ambulances Dialysis Radio- therapy Day surgery Other specialist services Managementof entire hospital or network of hospitals and/or clinics Public Private Partnerships in Health Under a PPP, a government or national health insurer contracts with a private partner (for-profit or not-for-profit) for a health care service and/or facility

  11. Enterprise Assistance Public-Private Partnerships Environment & Social Sustainability Business Environment Access to Finance Advisory Services and Financing IFC’s Role IFC also provides advice to governments and businesses World’s largest multilateral provider of financing for private enterprises Advisory services to governments and businesses $30+ billion in investment commitments

  12. Lessons from Global Experience • Use PPPs to expand service / improve quality - Not as means to simply finance new buildings/equipment • Define services needed (not facilities) - Give operators/bidders flexibility on how to provide (location, size, design, technology) • Buy from existing private operators where feasible/economic - Not necessary to duplicate in public facilities • Maximize private sector responsibility for greater benefits - PFIs are politically expedient, but “full” PPPs deliver more benefits • Long-term fiscal affordability is essential - but not reflected in “Value-for-Money” analysis • PPPs will only help if part of a broader health sector reform program

  13. Next Generation of Health PPPs We see several areas/themes emerging: • Contracting out public health insurance activities • Shift to defining PPPs in terms of services, not facilities/equipment • Integrated care (networks) • More “full” PPPs, but with varying responses to risk sharing • Radiotherapy • Diagnostics/ imaging projects • Medical education

  14. IFC Advisory Services in PPPs Emmanuel Nyirinkindi Manager: Sub-Saharan Africa Email: enyirinkindi@ifc.org ElanCusiac-Barr IFC Senegal Email: ecusiacbarr@ifc.org Peter Boeré Health Specialist Email: pboere@ifc.org