PPPHealth4All Advisory Board Meeting

On May 28 2021 the second PPPHealth4all Advisory Board meeting took place. The meeting started with paying a tribute to late Chidi Izuwah, CEO of Infrastructure Concession Regulatory Commission of Nigeria, a member of Advisory Board who passed away in March 2021.

The PPPHealth4All team shared the progress was made in the last 6 months and the plans for the second half of the year. As always, it was great to receive the constructive suggestions and comments from our members of the Advisory Board and also congratulations on the progress made. The next steps will be development of PPP healthcare project database based on AI and machine learning, further development of PPPHealth4Alll ecosystem and ensure entry to new markets with support of trAIDe GmbH/KPMG and financed by the government of Germany.

The best wishes were extended to all team members representing PPPHealth4All In Asia, Latin America, Europe and Africa and those who recently joined management echelon.  Natalia Korchakova-Heeb is leaving PPPHealth4All and will be leading PPPs globally at Siemens Healthineers. We are grateful to the members of our Advisory Board, namely Dr. Rosemary Kumwenda, Audrey Mwala, Mark Moseley and Dr. Tarik Linjawi and would like to acknowledge their continuous support and advice.

Internship Opportunity with PPPHealth4All

We are looking for young enthusiasts to empower our team! Are you a student or graduate in the field of marketing, business analytics, legal framework or sustainability who is willing to gain experience in healthcare PPPs? We are happy to welcome you to our team. As an intern, you’ll be part of a dedicated team and take ownership of your ideas from day one.

PPPHealth4All is a global award-winning platform serving 61 countries. Its objective is to bring better healthcare by promoting sustainable PPPs in the sector and bringing “Value for People” along with “Value for Money”. 

Join us to work on an interesting global project to promote sustainable public-private partnerships in the healthcare sector.

PPPHealth4All Database of PPP Healthcare Projects

PPPHealth4All platform was launched in April 2020 to address the profound knowledge gap faced by the national governments and civil society in developing healthcare PPPs. The platform assists by collecting and standardizing data and state-of-the-art asset models to create the performance benchmarks that are needed for asset allocation, prudential regulation and the sustainable design of PPP healthcare projects. There is a number of international databases on PPPs.  Some databases are free of charge, some of them are commercial. The key differences between databases:

  • target audience and objectives pursued (aiming mainly at investors, community of members);
  • source of information (information publicly available, provided directly by the governments or sources of information are no disclosed);
  • information categories (various parameters used in various databases);
  • project maturity (some projects are encoded only after financial closure);
  • access fee (free/via subscription);
  • availability of information on PPP healthcare (some database does not have health sector in focus);
  • include/non include non-infrastructure PPP healthcare projects.

In general, the information provided by all known sources is fragmented, not complete and does not reflect the actual status of the projects. The information about research PPPs, service PPPs, partnerships with NGOs on provisions medical services on public health or strengthening health systems is not available. 

PPPHealth4All strives to systemize the available project information and to map existing partnerships projects in the healthcare sector. Subscribe to our platform to get access to knowledge base in healthcare PPPs

PPPHealth4All Persona – Erjon Murataj, Senior PPP Expert at PPPHealth4All

We continue our series of PPPHealth4All  interviews with prominent PPP experts around the world. And today our senior PPP expert Erjon Murataj will share the insights for development of successful PPP healthcare projects and what problems could be faced. Dear Erjon, thanks for being with us today. Could you please introduce yourself?

My name is Erjon Murataj. I have more than 10 years of experience in developing the Public Private Partnerships from public side. I have worked in Albania PPP Unit and also in Ministry of Finance of Albania, where I have been involved in preparation of various Public Private Partnership projects. My education includes a Master Degree in Business Law from the Tirana Business University. Currently I reside in Spain.

What PPP healthcare projects were developed in Albania?

Not many, but in 2013, the Albanian government pledged to implement universal healthcare coverage and has since undertaken a series of steps toward implementation of this model. Since January 2016, roughly 600,000 uninsured Albanians benefit annually from free family doctor visits and reimbursable drugs, and close to one million Albanians aged between 35-70 years old, both insured and uninsured, are entitled to benefit from free medical check-ups provided under a PPP contract.

Also in February 2015, the Ministry of Health asked IFC to assist in designing a public-private partnership (PPP) with a qualified healthcare company to provide modern public laboratory services with international standards across 18 university and regional hospitals. After a competitive bidding process, the Consortium of Labopharma (Albania) and Exalab (France) was awarded a 10-year contract, with PPP agreements signed in April 2019.

Healthcare PPPs are different from other PPPs and often certain difficulties in preparation and implementation of healthcare PPPs. Why are the problems in your views and what could be potential grounds for PPP healthcare projects failures?

There are many issues that impact PPP healthcare projects. While some of them are obvious, the others are often disregarded. There are some key elements that needs to be addressed in the right way. Those elements are important for PPP project in any sector, but my focus today will be on healthcare PPP projects. Based on my experience as PPP public official with more than 20 years of experience, I could share what is important from my point of view and what I could derive from my past and current experience.

  1. Failure to proper assess the needs

When formulating an initial idea of the PPP project, it is important to understand what kind of problem the project is solving and with what means. After shaping the initial idea, further in-depth analysis and needs assessment have to be carried out. The following questions should be asked: what the project stands for? What is the problem to be solved or the needs to be fulfilled? Who are benefiting from this project? It is a brainstorming stage and various ideas and assumptions should be brought under discussion. When we will get all the answers for the questions, all the concerns addressed and all the opportunities realized, we will get a solid project idea. A lot of projects fail to address the real needs of the country, sector and stakeholders. This is I would say a fundamental flaw.

  1. Deficient planning

After evaluating the real needs, it is time for plan and shape the project. At this stage, project specifics gets shaped. Deficient planning is the second main factor why the PPP healthcare projects often fail. There are many issues that might lead to deficient planning:

  • Different perception issues (social, cultural, economic, environmental, religious… etc.). causing different expectations and conflicts in a certain socio-economic context

  • Problems at Design-Build stage. Design-Build issues refer to the implementation of the project and mostly with the project requirements (functionality idea and main requirements). Bad design or problems during the construction affect the whole project life-cycle.

  • Costs issues. The healthcare projects in general are expensive (due to the equipment and their lifetime), this is why the planning of the real costs is very hard.

  • Lack of proper market sounding. Market sounding is a process that involves many steps and various market players – without checking market readiness, it is impossible to launch a successful project.

  1. Failure in procurement

Another important factor is the transparent procurement – the process of awarding the private partner that will build (operate, finance) the PPP project. Many countries have very strict procurement procedures. In my view, the procurement process and procedures should be also transparent, which is not always the case, especially in developing countries.

It is also important to properly formulate the main criteria for implementing the project. Criteria that describe the functionality of the project should be “pass or fail”. Sometimes the choice of awarding criteria is designed in the way that prevent selecting the best bidder and this would hamper a fair competition.

  1. Insufficient contract management and monitoring

After the contract has been signed, it is crucial to start monitoring the contract implementation. Many governmental entities neglect contract management and monitoring and rely on the goodwill of the private partner. The importance of this phase is vital. The public partner could collect important data and lessons to be used for improvement of this project and also for developing the new ones. Monitoring of the healthcare PPPs is orientated to the high quality medical services to be delivered through the project.

  1. Failure in getting a right advice

Many governments spend millions on mega healthcare PPP projects, and do not have the money for advisers or fail in approaching the right ones. It could be a serious drawback if the public entities do not allocate funds for advisory services. The advisers must be engaged from the beginning and they do not need to be the most expensive ones. Although hiring an adviser is not very simple and especially when they are not local based. Nowadays this process is getting more simple through the implementation of the digital solutions and information technologies. PPPHealth4All could play a vital role here in helping to identify suitable consultants. I see a great service offering from PPPHealth4All platform, which offers a lot of support for governments and PPP Units on different matters. The best offer, in my view, are the consultations on the demand with “best in the class” experts. These consultations allow to reduce time and costs for preparation of PPP projects but also to increase quality.

How to support public officials during the process of preparation of PPP healthcare projects?

PPP healthcare projects are critically needed, especially during these difficult time of global pandemic. The governments need help in developing and implementing PPP healthcare projects. It is great to have such a platform that could serve as one-stop shop for preparation of healthcare PPPs and where public officials could receive a necessary support when required.

Dear Erjon, thanks a lot for sharing your views and for your valuable insights. Thanks for joining us today.

Thank you.

Interview by Natalia Korchakova-Heeb

Celebrating Experts in Healthcare PPP Industry

Guess what is in common between Nathaniel Munetsi, Head of Structured Finance at Gauteng Infrastructure Financing Agency in South Africa, Natalia Korchakova-Heeb, Founder of PPPHealth4All in Germany and Christian Kingomber, Managing Partner, 4IP Group Sàrl in Switzerland? They all are working with PPPs/ healthcare sector and celebrating their birthdays today!

Best wishes to you all, wishing you a further success in your careers, and thanks for your contribution to development of healthcare PPPs.

Partnerships for Global Health – A key instrument to achieve the Agenda 2030

On March 23rd, 2021, the GHHG working group “Partnerships for Global Health” is organizing a Working Group Meeting as part of the Week of the Working Groups 2021. The session will particularly discuss the issue of “Partnerships for Global Health – A key instrument to achieve the Agenda 2030”. 

Organizers: GHHG Working Group “Partnerships for Global Health” in collaboration with the Global Health Hub Germany.

Natalia Korchakova-Heeb

Natalia is coordinator of the Working Group on Partnerships for Global Health within the Global Health Hub-Germany, Founder of PPPHealth4All, an award-winning global platform to facilitate sustainable healthcare partnerships in the healthcare sector and Managing Director of SDG.17 Consulting GmbH, PPP-Speaker of the German Health Alliance and Chair of the Health Chapter in the World Association of PPP Units and PPP Professionals (WAPPP).  She translates her passion for the Sustainable Development Goals and public-private partnerships into concrete actions and commitments.
Myron Aldrink

Myron has over 25 years of corporate experience including executive vairous  positions . He also has 15 years of experience with healthcare NGOs including; International Aid, Medical Teams International and International Medical Equipment Collaborative. Mr Aldrink has been a consultant with Johnson & Johnson since 2005 and chairman of the Medical and Surgical Skills Institute (MSSI) in Ghana West Africa Currently, Myron is the Director in the Advocacy for the Global Health Partnerships (USA).

Prof. Dr. Shailey Prasad

Shailey Prasad MD MPH is the Executive Director & Carlson Chair of Global Health at the Center for Global Health and Social Responsibility, and a Professor of Family Medicine at the University of Minnesota. Dr. Prasad has extensive experience working in underserved areas around the world, from forest tribes in southern India to rural Mississippi and other parts of the world, advocating that health is critical to overall development. He has been part of research teams in health services research and rural health and is actively involved in developing primary care in various parts of the world.

Bruce Compton

Bruce Compton is senior director of global health for the Catholic Health Association of the United States. Mr. Compton is responsible for assisting and supporting CHA-member organizations in their outreach activities in the developing world.  Mr. Compton lived in Haiti from 2000 to 2002, and he continues to work in support of health missions in the developing world. He did so in his capacity as founding president and chief executive of Springfield, Ill.–based Hospital Sisters Mission Outreach, a ministry organization bringing surplus medical supplies from Midwest hospitals to medical missions in the developing world.

Description: The Working Group meeting aims to explain different types of partnerships and how partnerships can help achieve Universal Health Coverage by mobilizing funds, augmenting health service delivery and delivering extraordinary results towards the Sustainable Development Goals.

To participate in this session, please CLICK HERE

For more information on the  Global Health Hub-Germany Week of the Working Groups 2021, please click here.

Tribute to Engr. Chidi Izuwah, Member of PPPHeath4All Advisory Board

With deep sadness, we have learned today about the passing away of our dear friend, colleague and the member of the PPPHealth4ll Advisory Board, Engr. Chidi Izuwah. This is a big loss not only for his country of Nigeria but also for a whole international PPP community as Chidi was a driving force for many programmes and initiatives, including PPPHealth4All.

Сhidi was Director-General in the Infrastructure Concession Regulatory Commission of Nigeria where he was responsible for catalysing public and private expertise towards putting in place a PPP regulatory framework and guidelines for the preparation and development of PPP projects.

We will remember him as a person with a big heart and a great affection for Africa’s people. He always wanted to bring the best international practices to the African continent and was sharing his knowledge with our team and giving us valuable advice in his capacity of the member of the Advisory Board.

"My dream is to see a better and healthy Africa via 
the impact of innovative healthcare PPPs."

We will keep warm memories of Chidi Izuwah in our hearts. Our sincerely condolences to his family and colleagues.

PPPHealth4All Persona – Ann M. Casanova, International Global Health Consultant

We continue interviewing experts in PPPs and global health. And today on the occasion of Women’s International Day, we are talking with Ann M. Casanova. Ann is an independent consultant based in the US with more than 20 years of experience in international development in Latin America, Africa, and Asia. She worked for 6 years in global health for International Finance Corporation (IFC), which is the private sector lending arm of the World Bank, authoring over 20 publications on a range of topics including PPPs. Thank you, Ann, for being with us today.

Thank you very much for inviting me, Natalia, I’m very excited to be here with you and your audience as we celebrate International Women’s Day together and as we discuss some interesting PPPs. Yes, I have written extensively about the ‘secret sauce’ of what makes private hospitals and clinics successful. And I’m looking forward to discussing those with you and your audience. 

What made this project successful?

That’s a great question. So what made this project successful? it solved many problems for the state of Bahia, the state hospital did not have access to imaging. So the patients who got care, were getting highly invasive surgeries. And that increased the health risk, and it was also costlier to the public health system. Those that were getting surgeries had longer recovery times. So, for instance, a patient that needed a simple gallbladder removal surgery, the recovery time would take 35 days to turn over the bed, and that was having a domino effect on other patients that were waiting for that hospital bed. But with this PPP, it was reduced to five days. So the result is accelerating bed turnover, and more patients had access to care. Now for the patients that were still waiting for care, it was a very stressful time because they had to endure long delays to get a diagnosis. There’s one woman that I spoke with who waited a year and a half to get a biopsy to detect if she had breast cancer. That’s an extremely long period of time. And for some patients, that translates into a death sentence. So this was a big problem. And the PPP was a game changer. And I’m happy to report that at the end, it was beneficial.

In 2015, the state of Bahia established a statewide PPP and a company called Alliar and its consortium won the tender. Alliar is one of the top 10 diagnostic imaging companies in Brazil. It operates a network in 43 cities and in 10 states in Brazil. And they won the contract to build, operate and staff new diagnostic imaging centers in 11 hospitals in the state of Bahia. So why outsource? Well, Alliar brought a depth of expertise that was scarce in Baia. They are a large scale network that brings inefficiencies. So, for instance, Alliar was able to acquire expensive equipment at lower cost. So, for instance, one MRI machine at that time would cost about $1.5 million, but Alliar had established a contract with Siemens given their size and their needs for 60 MRI machines over the period of three years, and that volume allowed them to secure preferential pricing. And Alliar also had addressed skill shortages for highly specialized radiologists that were lacking in the market. And they established a solution using telemedicine where they centralized command centers and staffed those with top radiologists. And this meant that a patient living in the Amazon could have a top radiologist living in Sao Paulo interpret their images. So this increased the quality of care. And it also meant that patients were getting results much quicker in the space of two days.

Ann, to whom would you attribute the success (IFC, government, private partner) or it was a teamwork?

That’s a great question. So to whom do I attribute the success? It was definitely teamwork, all of the players played an important role. The government recognized that it needed a different strategy and that a PPP was the solution. IFC provided advisory services to the state of Bahia just structure the PPP and in 2012, IFC also provided a $50 million in financing for earlier to grow its network. And of course, Alliar is working in partnership with the government and the hospitals to provide a rapid solution. 

What are the lessons learnt for other regions/jurisdictions?  

What are the lessons learnt for other jurisdictions? Another great question. Definitely PPPs work. They solve problems for the government. And in this case Alliar was able to deploy a solution with greater speed to market, it improved the quality of care that resulted in better health outcomes and while reducing the cost to the state. So it was able to generate a more robust package with just one simple tender and it accelerated access within its first year of the PPP Alliar had conducted 183,000 exams, and when fully implemented, it will serve about 6 million patients over the course of 11 years. So PPPs are a win-win for all but especially for the patients and Adeni, who was one of the first patients to benefit from the PPP, said: ‘I got my life back!’

There’s a very interesting example of public private cooperation. Georgia had a problem, the country of Georgia had a problem. For 70 years, the health care system was funded and delivered through the state. But after the collapse of the Soviet Union in 1991, investment in health plummeted, and along with it, the quality of care. So for decades, patients were leaving the country to get good care. Now, fast forward to 2013 patients were really struggling, people were spending 1/3 of their income on health care, and some were even forgoing health care altogether. And that led to a political outcry. So one political party promised basic universal, basic universal health coverage, and they won the presidential election, so they had to deliver quickly. The problem was that Georgia had a limited tax base, had a very small population with about 3.7 million people, high levels of unemployment, and 25% of the population lived below the poverty line. So Georgia did not have the resources to become a provider itself. And the private sector had already been investing in infrastructure upgrades. So the government decided on a public private collaboration, the government decided it would not be a provider rather, it would take on the role of a policymaker, regulator and a payer, and it would reimburse the private sector to deliver treatments to patients for private facilities. So in Georgia, universal health coverage is funded by the government, but it’s 85% delivered by the private.

So Georgia is an example of good partners working well together. The model of cooperation aligns the strengths and the incentives of both sides. And it brings benefits. The benefits to the government are fiscal agility. And this is seeing through an asset light model that shifts the private sector, it shifts to the private sector, high capex investments. So for instance, one company, Georgia Healthcare Group, invested $300 million to transform the infrastructure. That was kept off the government’s books. Second benefit to the government is speed to market. Georgia Healthcare Group turned around and built 50 hospitals in 2-3 years. And thirdly, they improve the quality of care. They introduced western standards and established protocols and procedures, and invested in training medical staff. Now, the private sector also has benefits as well. It saw rapid growth, because now it has a reliable source of patient volumes. It’s able to scale and generate efficiencies, because large scale providers can deliver better quality at lower cost. And fourthly, it had a reliable payment source, the government of Georgia pays on a timely basis, which is roughly about 4,5 months. And this is really critical, because we’re seeing examples in other countries where providers are not paid on a timely basis. And this causes significant cash flows for private sector providers, and it sours the relationship. But this is working well in Georgia. So Georgia is a very interesting model of cooperation.

How PPPHealth44All could contribute to improvement of global health?

So thank you, Natalia. I guess I’d love to give some wishes to PPPHealth4All. So as the world embraces universal health coverage, PPPs will take on greater importance. Governments are realizing that they cannot do it alone, and they don’t have to. The private sector can deliver more services, they can accelerate speed to market and they can provide good quality at lower cost. Now one critical area for the future will be training on how to structure PPPs effectively. So I applaud your important work in bringing greater visibility to this.

As we are celebrating Womens’ International Day- what kind of message you would share with peers-women professionals?

Yes. Finally, on the occasion of International Women’s Day, I’d love to share some gender wishes with the audience. There’s a strong business case for having more women in healthcare leadership. There are numerous studies from McKinsey, from the Peterson Institute, from the ILO, they’re multiple. And they all conclude that there is a strong correlation between the number of women in decision making roles. So women on boards, women in executive committees and women in senior management, and profit increases, these companies are seeing profit increases of between 5-20%. And in Africa, there are some companies that are reporting profit increases of 30%. So having more women at the top improves the bottom line and it also contributes to GDP growth. There are other benefits, there’s increased innovation, there’s better decision making, and there’s the ability to gauge consumer needs. But the problem is that in health care women, although they make up 75% of the healthcare workforce, few have really reached the top. So here organizational policies matter. Women need mentoring, they need sponsorships, and women need business skills. So I invite CEOs and government officials, both men and women to create a workplace culture that embraces women and gender balance, because women pay dividends.

Thank you, Ann for the interesting insights you have shared with us today.

Thank you for inviting me today. I enjoyed our conversation. And I hope to inspire others, to use PPPs to increase access to affordable quality health care around the world. Have a great day.

Celebrating Women-Professionals in PPP Healthcare Sector

Celebrate with PPPHealth4All International Women’s Day and remarkable women-professionals working in healthcare PPP sector. We are proud of you and we admire you!

Dr Rosemary Kumwenda, member of PPPHealth4All Advisory Board
Our theme: “Achieving an equal future in a COVID-19 world”-let us celebrate huge global efforts led by inspirational women and girls who continuously seek ways of shaping a more equitable future for us all to recovery greener and fairer from the COVID-19 pandemic. We can close the gender gaps including the digital divide for women and girls to fully and effectively participate and lead in of all areas of life to drive Sustainable development for all.

Sacira Coric, Director – Infrastructure Strategy, Delivery, Financing, Turner & Townsend LLP

“Every girl and every woman has the potential to make this world a better place.  To realise the potential we must dream bold, work hard and use excellence to fight inequality and injustice.  We must each leave legacy behind us to inspire young girls to take our place and achieve more than we have.” 

Dr Rosemary Kumwenda
Karine Bachongy
Audrey Mwala
Sacira Coric
Veronica Vecchi
Violeta Isabel Pérez Nueno
Monica A. Altamirano, PhD
Rosemary Ong
Beatrice Florence Ikilai
Dennis Rosete
Helena De Flaviis

PPPHealth4All Joins Effort to Improve Global Health

PPPHealth4All joins effort to improve global health by endorsing ethical principles for short-term global health engagements.
Advocacy for Global Health Partnerships (AGHP) announced on 3rd of March 2021 that PPPHealth4All has endorsed the Brocher Declaration and its call for the international community to make every effort to maximize the value and minimize the harm of short-term engagements in global health. PPPHelath4All joined dozens of universities, corporations, not-for-profits, and health delivery organizations committed to the principles included in the Brocher Declaration.

“PPPHealth4All and their work with Public Private Partnerships (PPPs) to help meet the U.N. Sustainable Development Goals are a significant addition to the growing list of organizations actively working towards the implementation of the principles outlined in the Brocher Declaration.” said Myron Aldrink, Acting Director at AGHP. He went on to say “PPPHealth4All will be an asset as we work to ensure appropriate partnerships and globally”.

According to the Declaration the following principles should guide global health engagements:
1) Mutual partnership with bidirectional input and learning;
2) Empowered host country and community define needs and activities;
3) Sustainable programs and capacity building;
4) Compliance with applicable laws, ethical standards, and code of conduct;
5) Humility, cultural sensitivity, and respect for all involved
6) Accountability for actions.

“The Brocher Declaration and the principles outlined are synergistic with our work on partnerships to attain the U.N. Sustainable Development Goals,” says Natalia Korchakova-Heeb, Founder of PPPHealth4All. She added: “By actively working towards the implementation of these principles PPPHealth4All and their collaborators agree to develop sustainable partnerships, build local capacity, advance accountability, and improve global health outcomes”.

You can find out more about AGHP and consider endorsement of the Brocher Declaration at ghpartnerships.org