We are delighted and privileged to welcome our PPPHealth4All Persona, Dr. HM Goh, Executive Director of Singapore-based TAEL Partners private equity. With over 20 years of international experience in hospital management, transformational leadership, private equity and venture capital investments in Asia, Dr. Goh aspired to develop an ASEAN-focused healthcare platform integrating medical, pharma, medtech, and education sectors.
He is a true believer in the power of PPPs in healthcare and its most passionate advocate.
More and more developing countries have started to look at PPPs in healthcare, next in line after infrastructural projects like roads, ICT, or water treatment facilities. How can they ease the pain of the most critical stages of PPP healthcare projects?
Firstly they should look at a country’s regulatory framework (e.g. some countries already have some form of PPP law), and whether there was prior government experience, and track records of PPP in other sectors.
However, remember that healthcare PPPs are critical to have the so-called “software” part, a human aspect, that sets them apart from a typical infrastructure PPP which has a prominent component of “hardware” element.
We also need to be extremely mindful of a country’s political dynamics because PPP inherently will have quite significant political risks and exposure that impacts the project. Some projects are fast-tracked for political reasons such as election cycles or political tenure. Some projects were hijacked along the way or “adulterated” into a permutation of the original intent. And occasionally it might even look completely different compared to the projects’ initial designs. In some countries, government bureaucrats are rigid and inflexible and apparently too scared to make bold decisions and take accountability. And of course, there are always risks of corruption (e.g. cronyism, nepotism, “kick backs” etc.), market dynamics change, technological obsolescence and incumbent “vendor lock” situation.
Secondly, be selective about whether a project is suitable for implementation using a PPP format, special consideration must be given to its structure, and governance framework. We noticed many governments tend to over specify, overcapacity and over-build and this is further compounded by the tendency to enter into an addressable market too early. An example will be constructing an oversized hospital in an emerging catchment prematurely, resulting in low occupancy during the formative years of the project.
Be cautious over projects that transcend into two political cycles, that usually will adversely affect the project implementation and payment timeline.
Last but not least, a detailed, methodically and meticulously performed due diligence is critical. And a well designed market feasibility study and quality data points will mitigate those risks and challenges I described earlier.
How to use the tremendous potential of data to build a strong foundation for long-term partnerships?
Prior experience with PPP among stakeholders (i.e. project owners, users, consultants and advisors) is a critical success factor. References to case studies (data, reports, benchmarks, site visits) are extremely useful, as these are important lessons learned and knowledge base that can shorten the learning curve and minimise the project risks.
Notable success case studies in ASEAN can be found in Singapore, Malaysia and Vietnam. Although the insights to these projects can be limited partly due to disclosure restrictions (e.g. Official Secrets regulations and NDA) but it can sometimes be available via conferences and scientific publications. Or PPP fraternities can have more informal candid dialogues via PPPHealth4All or other similar platforms where experience can be exchanged for the benefit of the industry.
It helps to “prime” the public stakeholders, get them prepared. But first, you need to enlist those project management savvy and committed ones into the project. People tend to make project plans, budgets, scope of works that the project steering committee approves. It is not uncommon for us to see end-users and frontline clinical representatives were omitted from the committee – especially the nurses.
Different stakeholders will have different expectations, dynamics and implications due to the project. “What’s in it for me?” is probably the most important question to explore during the project stakeholder analysis exercise. This will guide us on how to realign all stakeholders towards a common set of project goals. And ensure that we will select, interact, engage and galvanize the right team right from the start.
Part of the gap analysis exercise. Be upfront about the need to “reconcile” the public and private corporations with respect to the organisational culture, processes, procedures and policies. You need an experienced project lead, well-prepared mentally, who reacts fast and resourcefully. At the same time, has transformational leadership qualities (i.e “change management”) and credibility to influence various stakeholders to embrace organisational change.
He/She must constantly re-strategise and manage the delicate balance between the two driving forces and frameworks namely corporate and clinical governance, championed by the Board of Director and Medical Board respectively.
The worst thing that can happen is allowing “identity crisis” to permeate into the project because of a conflict of corporate culture within public policy and private enterprise regulations.
Can proper PR strategy, visibility, and marketing campaign help?
Definitely, strategic communication is an important strategy to manage expectations, aligning interest, galvanising stakeholders and communicating purposes and benefits of a socially impactful projects. However, this is increasingly becoming more challenging due to the democratization of media and information. Fake news, leaks, misinformation are a threat to PPP projects if left unmanaged. Especially, like any large scale projects, there are bound to have challenges and whether we can address it before it gets amplified and distorted in the social media.
How to put into practice opportunities for genuine PPP healthcare
partnerships opened up by COVID?
First of all, it is in everyone’s interest to mitigate the widespread impact of the pandemic.
We all have been going through a deep learning and very visceral experience. We can compare it to the postwar world and hope that we’ll reform and won’t forget what we learned. Post pandemic healthcare will reform and transform – geopolitics, management systems, hospital design and basically everything in how we operate healthcare operations. (i.e. infection control regulation, supply chain management, manpower, cost structures etc.)
COVID-19 catalyses PPPs and galvanises the spirit of collaboration where different stakeholders swiftly realign towards common goals. We look beyond our differences, policy constraints and come together and find ways to collaborate to fight against a “common enemy”. We have seen unprecedented speed of responses, especially in the deployment of capital and resources. In pandemic crisis mode, projects have accelerated into “operationalisation” without the traditional contracting nuances, unnecessary micromanaging, legal complexities and jargons and painful bureaucracy. PPPs have become very fluid and adaptive. And interestingly we also see an emergence of a new element that enhances the PPP model. PPP in COVID times is PPPP (4P) Public, Private, Philanthropy Partnership, enhancing the value of PPP with good will. Healthcare, being a social enterprise, is always PPPP.
Interview by Natalia Domanska.