PIDS proposes PPP for universal health coverage

MANILA, Philippines - The public health sector stands to benefit from special forms of public-private partnerships (PPP) especially in expanding the provision of universal health coverage, state think tank Philippine Institute for Development Studies (PIDS) said in a new policy note.

PIDS said PPP projects that enable the government to retain ownership of physical assets and taking advantage of the expertise of the private sector can alleviate some of the burden in the public health sector.

Among PIDS’s proposals include the use of public-private investment partnerships (PPIP) and public-private interactions (PPI).

PIDS describes PPIP as “long-term, highly structured relationships between the public and private sectors designed to achieve significant and sustainable improvements to healthcare systems at national or subnational levels.”

PPIP allows a private entity or a consortium of private partners to co-finance, design, build and operate public health facilities but ownership of such facilities remain with the government.

“Here, the government is able to rely on the private sector’s expertise and investments to achieve public policy goals while still able to maintain ownership of the assets throughout the duration of the partnership,” PIDS said.

PPIP, carried out for at least 10 years, also provide for regular government review and third party monitoring.

PIDS said through this type of PPP, the government would be able to deliver high quality and affordable preventive and curative care at minimal to zero out-of-pocket expense to citizens because of sharing of investment and risk.

Similar to PPIP, PIP is also a long-term arrangement but only attends to smaller portions of healthcare service delivery such as infrastructure, service management, or concession-type contracts.

“PPIs are seen to merely cover gaps in health service delivery,” PIDS said, noting this type of PPP may only support the goal of providing universal healthcare.

Unlike PPIP, it is not sufficient to address the goal of achieving universal healthcare by itself.

These two types of PPP are especially beneficial in providing primary care, hospital care, and integrated healthcare said the think tank.

In implementing such partnerships, PIDS said these must be modified according to local knowledge and experience and must be in tune with the national health strategy.

“PPPs must be contextualized to the political landscape, economic situation, private sector interest, and commitment level of stakeholders involved,” PIDS said.

“They must be in sync with the national health mandate and strategy so as to avoid fragmented initiatives that clutter the landscape and confuse the key players in healthcare,” it added.

Other elements that may contribute to the success of PPP in public healthcare include a comprehensive health plan that clarifies the role of PPP in the heath system and in attaining universal health coverage; a clear legal framework that protects the interests of both the public and private sectors; and a regulatory framework that keeps track of the progress of projects.

A long-term health plan will also guide the government on what projects should be prioritized and who should it be collaborating with.

A legal framework should also spell out the liabilities of the public and private sector partners if the objective of the PPP is not attained. It should also provide for guidelines on how to go about the partnership, ensuring that there is enough incentive for private investors.

Under a regulatory framework, the public sector should also be able to police partners, and assist in the technical aspects of the partnership, among others.

“Both public and private sectors must be ready and willing to enter into the partnership. This means that the public sector should have the capacity to handle the technical requirements of the project, including regulation and enforcement, while the private sector should meet the quality standards so as to achieve better health outcomes,” PIDS said.