PPPHealth4All Persona – Celso Manangan, Senior PPP Advisor at PPPHealh4All

In our series of PPPHealth4All interviews with prominent PPP experts around the world we are proud to have today our senior PPP advisor, Celso Manangan, who is Asia regional representative for PPPHealth4All. He was formerly the project director of the UNECE-affiliated International Specialist Centre of Excellence for PPP in Health, Philippines. Long before, Celso was the director of the Special Concerns Department and Administration & Finance Department, Build-Operate and Transfer Center (BOTC), later renamed to Philippines’ PPP Center. He is a recipient of the European Commission’s Erasmus Mundus Scholarship Program and holds a postgraduate degree from the University of Trento, Italy.

Interestingly, you  have chosen to discuss Public-Private Partnership in Dialysis. Could you please explain why?

PPP Dialysis has been a significant project, where I worked in 2003, my stint working in the Philippines’ Build-Operate and Transfer (BOT) Center (now renamed PPP Center).  

The project concept was simple. The Philippines’ National Kidney and Transplant Institute (NKTI), a specialty hospital, established a partnership with a proponent/company with the necessary experience and capability to provide dialysis machines through a lease agreement. In addition, the company was responsible for maintaining the devices throughout the contract and for training the medical staff responsible for using the machines.

The project assumed that the increased efficiency of the machines would let more patients be treated, and therefore, more revenue will be generated. In addition, the hospital took off the table procurement of the devices.

It was the first successful PPP project in the health sector in the country, delivered by a professional team from the BOT Center and the NKTI. Other hospitals in the country had also replicated the project successfully. I am glad to know that other countries have also replicated such

What were the challenges that you experienced in developing this project in the Philippines?

Developing a PPP project in the health sector was a challenge for the following reasons:

  1. People perceive PPPs as wherein assets of the private sector are shared without risks and costs. It must be emphasized that governments must share the risks and provide their contributions for the project to be successful.
  2. Developing countries (like the Philippines) show that the private sector charges more regarding payment for their investments. Therefore, a significant challenge was the ability of the government to pay its obligations in such a PPP project. 
  3. Since this was our first PPP health project, we need to review and examine all relevant laws for the project to be implemented successfully. 

In our research, we found out that the implementation of the project was successful. What were the factors that contributed to its success? 

Let me share with you the findings of several organizations that reviewed and evaluated the project.

“Although relatively small in scale compared to some of the other projects considered, the NKTI Hemodialysis Project in the Philippines proved popular among the judges due to its more personable impact and its innovative procurement of equipment.” –  Emerging partnerships : top 40 public-private partnerships (PPPs) in emerging markets.

“The NKTI Hemodialysis Project offered improved service and top-quality hemodialysis with the acquisition of the latest available technology in dialysis treatment and expanded its services to more patients at the same time cost of treatment and less risk to the government.  And because of more machines and higher reliability of these machines, hemodialysis treatment was extended to more Filipinos.” – Infrastructure Public-Private Partnership Case Studies of APEC Member Economies 

“This was the first PPP in the health sector in the Philippines, and it was hugely successful.  Patients welcomed the improvement in the quality of their care. The NKTI project, as a pro-poor PPP, achieved this through generating more resources from a better quality of care, keeping costs down relative to the private alternatives, and widening access to top-quality care, even those who could not pay. The NKTI case demonstrated that the doctors chose the PPP, not because of ideological preference but simply because the PPP was the best and only way to give their patients a better quality of care.” – Ensuring Healthier Lives Through Public-Private Partnerships. Global Health and Diplomacy.

After receiving such high appreciation from the PPP community, do you have other plans promoting such initiatives and other PPP Health Projects?

For this project, I am encouraged to form a Working Group on People-first PPP in Dialysis.  The Working Group will address the following broad desirable outcomes on this topic about the UNECE Guiding Principles on People-first Public-Private Partnerships in support of the UN SDGs. The five People-first PPPs outcomes are designed to:

  • Increase access to essential services and lessen social inequality and injustice. It implies increasing access to [health], water and sanitation, energy, etc., focusing on projects that consider the socially and economically vulnerable needs and contribute to eliminating inequalities.
  • Enhance resilience and responsibility towards environmental sustainability. It implies developing resilient infrastructure and improving environmental sustainability by cutting greenhouse gas emissions and developing “circular” rather than linear projects.
  • Improve economic effectiveness and sustainability. It implies successfully delivering projects that achieve value for money and fiscal sustainability and are transformative, meaning they have a sustainable, measurable impact.
  • Promote replicability and the development of further projects. It implies that projects be replicable and scalable to be repeated and/or scaled up to have the transformational impact required by the 2030 Agenda for Sustainable Development. This criterion also needs to consider whether the local staff and the governments can receive the necessary training and knowledge to do similar projects.
  • Fully involve all stakeholders in the projects. Engaging all stakeholders directly involved in the PPP project or directly or indirectly affected in the short and/or long run and creating new means for integrating special groups who have played a limited role to date.

Lastly, I will be glad to receive feedback from our subscribers and readers of their interest in joining us in this Working Group towards attaining the SDGs through People-first PPPs. For any inquiries, please communicate with me through my email address: celso@ppphealth4all.de.

Thank you very much, Celso. We wish you success on your initiative and we hope to work with you on implementing people-first healthcare PPPs worldwide.

Thank you.

The Government of Uzbekistan selected Nephroplus to deliver vital dialysis care for over 1,000 patients.

Nephroplus won the bid to finance, construct, equip, train personnel, and operate four dialysis clinics in the city of Tashkent, the Republic of Karakalpakistan, and Khorezm region to deliver vital dialysis care for over 1,000 patients.

As transaction advisor to the Ministry of Finance and the Ministry of Health, IFC, a member of the World Bank Group, assisted the Ministries in designing and tendering a public-private partnership (PPP) that will deliver dialysis care to Uzbek patients in line with best industry standards, providing higher quality care, reduced risk of infection, and no out-of-pocket payments for patients. IFC and the World Bank advised the Government in updating dialysis standards in line with international levels and developing a procedure for selecting and referring patients to dialysis in accordance with transparent selection criteria based on clinical and social conditions.

“The Government of Uzbekistan is committed to expanding access to affordable and quality health care,” said Timur Ishmetov, Uzbekistan’s Minister of Finance. “This first-of-its-kind, market-changing PPP will help upgrade health services and increase access to critical dialysis care to more patients in the country.”

Rural patients will particularly benefit from the project because Nephroplus will introduce the country’s first-ever peritoneal dialysis, a treatment that enables patients to receive dialysis care in their own homes, reducing travel time and costs for families, and extending the reach of dialysis care to rural and remote areas, an important innovation for the country.

More information

Nephrocare Health Services Pvt Ltd (NephroPlus) is the largest network of dialysis centres in India with 97 operations centres (as on Jan 31, 2017) spread across 63 cities in 16 Indian states.

The low-cost business model used by NephroPlus is influenced by 3 factors. Cost effective sourcing of consumables and equipment, staff costing and in-house maintenance and quality teams. Having an in-house training academy ensures that there is a steady supply of low-cost, well-trained technicians who are adept at quality protocols. This helps to not only keep costs under control but also to consistently deliver high-quality dialysis across the network. The model used by NephroPlus, not only reduces maintenance costs but elongates the life of machines, thus reducing CAPEX and maintaining highest standards of operations.

IFC—a member of the World Bank Group—is the largest global development institution focused on the private sector in emerging markets.

As transaction advisor to the Ministry of Finance and the Ministry of Health, IFC, a member of the World Bank Group, assisted the Ministries in designing and tendering a public-private partnership (PPP) that will deliver dialysis care to Uzbek patients in line with best industry standards, providing higher quality care, reduced risk of infection, and no out-of-pocket payments for patients. IFC and the World Bank advised the Government in updating dialysis standards in line with international levels and developing a procedure for selecting and referring patients to dialysis in accordance with transparent selection criteria based on clinical and social conditions.

The Public-Private Partnership Center of the Philippines publishes new investment opportunities for healthcare PPPs.

The PPP Center of the Philippines publishes a new investment broshure that presents a row of PPP healthcare projects

-1 project to be approved by the relevant governmental authorities (University of the Philippines Philippine General  Hospital (PGH) Manila Cancer Center Project)

– and 5 projects under development:

  • Philippine General Hospital (PGH) Diliman Project;
  • Mental Wellness Center and ancillary facilities in the Mariveles  Mental Health and General Hospital (MMWGH) compound;
  • Baguio General Hospital and Medical Center (BGHMC) – Renal Center Facility Project;
  • Cagayan Valley Medical Center (CVMC) Hemodialysis Center Project;
  • Bicol Medical Center’s (BMC) Medical Arts Building and Upgrading of Health  Services Project.

Investment Opportunities Brochure (September 2020)

Approved the tender documentation for the PPP Project for Dialysis services in Uzbekistan

Image by falco from Pixabay

The Ministry of Health of the Republic of Uzbekistan, with the assistance of the Public-Private Partnerships (PPP) Development Agency under the Ministry of Finance, on 19th of August, 2020 approved the tender documentation for the PPP Project for Dialysis services in Uzbekistan and invited the pre-qualified companies  to submit their technical and financial proposals for the project.

It is planned to attract an international operator for the construction, financing and equipment of modern dialysis clinics in the city of Tashkent, the Republic of Karakalpakistan and the Khorezm region and for the provision of dialysis services in accordance with international quality standards for patients with chronic renal failure. The project will also introduce a new peritoneal dialysis technology that will allow patients to be more mobile and receive dialysis treatment while continuing to work and study.

Currently, four international companies are participating in the tender, which are some of the largest global dialysis companies and have many clinics in countries around the world. The completion of the tender and the signing of the agreement is expected by the end of the calendar year. The project was initiated by the Ministry of Health, the Ministry of Finance and the PPP Development Agency as part of the health sector reform to improve the quality of dialysis, to improve patient survival rates, to implement new technologies and training, and to attract foreign investment to the health sector in Uzbekistan.

The International Finance Corporation (IFC), a member of the World Bank Group, is the lead transactional advisor to the Ministry of Health and the Ministry of Finance for the Project.

PPP Development Agency (PPPDA)

Bangladesh to pilot a Dialysis PPP Project involving 150 hemodialysis stations across up to three different hospital sites in the capital Dhaka

Photo by Pujohn Das

To address the growing chronic kidney related illness in Bangladesh, GOB intends to pilot a Dialysis PPP Project involving approximately 150 hemodialysis stations across up to three different hospital sites in the capital city, Dhaka (“the Pilot Dialysis Project” or the “Pilot”).  The Government of Bangladesh (“GOB”), through the Directorate General Health Services (“DGHS”) and the Health Services Division (“HSD”) of the Ministry of Health and Family Welfare (“MOHFW”), is receiving Technical Assistance from the Asia Pacific Project Preparation Facility (“AP3F”).

The TA is intended to support in capacity augmentation at DGHS and HSD, creation of a PPP cell and for the establishment of a sustainable model in Bangladesh to identify, prepare, and implement healthcare PPP projects with private sector investments and participations (the “Programme”).  GOB considers the delivery of high-quality clinical services such as dialysis, pathology/labs and imaging as immediate priority areas for potential private sector interventions.

The Office of Public Private Partnership (“OPPP”) at Asian Development Bank (“ADB”) is assisting GOB in implementing the Programme.  The first of such consultant procurement phases and this Terms of Reference (“TOR”) relates to preparation/implementation of a new hemodialysis project under PPP modality and restructuring of an existing dialysis PPP project.

Read more: ADB Tender TOR Dialysis Bangladesh