Center for Health Market Innovations (CHMI)

“Both parties must come to the table with trust and respect for one another” – Dr. Ladi Awosika, CEO of Total Health Trust, an HMO from Nigeria.

This quote from Dr. Awosika reflects the main message behind “Partnering with the Private Sector to Sustain National HIV Responses”, a satellite session at the 2012 International AIDS Conference held by Strengthening Health Outcomes through the Private Sector (SHOPS) on Wednesday, July 25. Many low- and middle-income countries (LMICs) across the world have public sectors which do not have the capacity to provide the range of health care services necessary to support their population - often lacking the necessary facilities, qualified personnel, and transportation capabilities. As a result, many countries have come to rely on public-private partnerships (PPPs) to close the gap in the delivery of healthcare services to the population.

There were four main questions surrounding PPPs that were posed during the forum, with possible solutions proposed by the panel members (representing Tanzania, Kenya, Namibia, and Malawi):

1. Why should the private and public sectors engage one another?
2. What are some of the major barriers in creating and facilitating PPPs?
3. How can the private and public sectors be mobilized?
4. Which areas are ripe for future PPP collaboration?

While the main reasons why the public sector needs to engage the private sector are readily evident to many, Dr. Samwel Ogillo, CEO of the Association of Private Health Facilities in Tanzania (APHFTA), stressed that the private sector should also facilitate engagement as it makes business sense and is the socially responsible thing to do. The public sector often brings a variety of benefits to its private counterparts through PPPs, as they can provide additional clients, bring legitimacy to an organization, and subsidize the costs of production. For example, a private company may be able to transport pharmaceuticals, faster, cheaper, and more efficiently than their public counterparts, though they may not have the money to do so on a greater scale. Through a PPP, initial capital for scale-up measures is provided, greater legitimacy is brought to the private organization’s service, and profit margins and reach are increased.

Despite their many benefits, there are numerous barriers in creating PPPs. Edgar Lungu, Desk Officer of Malawi’s Ministry of Health Public-Private Partnership Division, explained a few of these barriers, citing legislation, general mistrust, transparency, capacity, and a lack of communication as some of the major issues. Private institutions often wish to keep a few of their practices secret in order to maintain their competitive advantage. This does not always mesh well with government institutions, which may require a great deal of information when facilitating partnerships. In addition, many organizations simply do not have the capacity to locate, analyze, and provide the government with the information that it wants. There are also many different types of private organizations (faith-based, for-profit, non-profit, etc.), with panel members agreeing that they cannot, and should not, be engaged in the same way. Helping the government understand these issues along with the private sector landscape, and creating a discourse that is structured, informed, and equal has helped solved these problems in many countries. Institutionalizing the construct of PPPs, just as the MOH in Malawi has done, has also helped facilitate the creation of these partnerships and has dissolved many of the long held barriers, and ended the “turf wars” that have traditionally occurred between the private sector and public sector.

Creating a discourse between government and private organizations has mobilized both sectors within countries such as Kenya, and created opportunities to scale up delivery of all types of healthcare services: from circumcision and healthcare IT, to counseling and health insurance, as was explained by panelist Dr. Margaret Kaseje, Executive Director of GoldStar Kenya. Governments have begun to understand that the private sector can help in areas they traditionally covered such as mass campaigns, especially when dealing with HIV/AIDS. Some governments are also beginning to realize that the word “for-profit” is not a dirty one. An understanding has also been created that different countries are at different levels of PPP facilitation. Some countries need more beneficial legislation, while others need more engagement at the local level between the two sectors. Identifying these areas where PPPs can have the most benefit will allow countries to make the best use of their resources, which is particularly important now as the flow of donor aid has significantly slowed down in many areas of the world due to the global economy.

In the end, all of the panelists agreed that the continued development and success of public-private partnerships will decide the future of healthcare in many countries. Central to this success will be an increase in transparency, dialogue, and cooperation between the two sectors.