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:
- 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.
- 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.
- 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: firstname.lastname@example.org.
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.