Public-private partnerships (PPPs) are indispensable in preventing epidemics, as governments cannot do it on their own. Digital tools do offer new perspectives and possibilities, but without trust and regulations, PPPs are doomed to fail. This was the main outcome of last week’s panel discussion, co-organized by Cordaid, during the World of Health Care ‘congresstival’ in Rotterdam.
(Inspiring contribution by George Kimathi, Director Amref Institute of Capacity Development, on Public-Private Partnerships in Kenya. © Task Force Health Care)
The World of Health Care is an annual congress of high-level international decision-makers in health. Apart from lectures, panel discussions, and workshops, it offers networking and matchmaking facilities. The central themes this year were The aging society, Increasing quality, and cost-effectiveness and Preventing epidemics.
The world is witnessing a wave of non-communicable diseases. Infectious diseases nowadays travel around the globe in 36 hours. What is needed for the public and the private sector to prevent this?
This year’s edition took place on September 26th in the RDM submarine wharf in Rotterdam. One of the panel discussions was organized by Cordaid, Wemos, Amref Flying Doctors, PharmAccess and KNCV Tuberculosis Foundation. It was attended by some 40 participants from all over the world, working in ministries, NGOs and the private sector.
Moderator Paul L. Janssen (‘I’m a doctor by training but a public health person by conviction’) said the panel discussion couldn’t have come more timely, as the world is witnessing a wave of non-communicable diseases, while infectious diseases nowadays travel around the globe in 36 hours. What is needed for the public and the private sector to prevent this?
Serving patients’ needs
According to panel member Tobias Rinke de Wit of PharmAccess, many campaigns start private but end public. He gave an example: Heineken and PharmAccess initiated an HIV workplace program in Burundi. This program drew the attention of the population, who started to claim such HIV services as well and inspired the government to start its own program. Asked by Corinne Hinlopen of Wemos if this was a deliberate strategy, de Wit answered: ‘Not of Heineken, but it was in the case of PharmAccess.’
Getting the private sector on board in fighting epidemics can be difficult when it’s not clear what’s in it for them. They can be lured with taxes and subsidies, said panel member Serhii Kiral, a parliamentarian in Ukraine and vice-chairman of the Global TB Caucus. But this doesn’t assure long term commitment or a patient orientation. De Wit gave the example of African private clinics prescribing what’s on their shelves instead of what serves patients best. Regulations are needed to keep the private sector on board and on the right track, according to Kiral.
Electronic health wallet
In the past, an obstacle for establishing PPPs was that money streams were fragmented. Digitalization and mobile technology have helped to overcome this. It is now very easy to transfer money, to bundle private and public money, and to pay for (health) service without the help of banks. This causes a leapfrog effect in African countries, where mobile phones are widely spread.
‘The goal of public-private partnerships, or better said private-public partnerships as they often originate in the private sector, should always be to provide public services.’
Paul van den Berg, Political Advisor Cordaid
De Wit came up with an example: M-TIBA, an electronic health wallet that is used in Kenya. Without the interference of a bank, patients can pay health services with M-TIBA, while clinics provide them with disease management and monitor the quality of health care services. This can be combined with diagnostics for diseases like malaria. Platforms like M-TIBA can play an important role in the prevention of epidemics, as the authorities can act immediately on the data provided by patients, which makes it possible to detect disease outbreaks almost in real-time.
The biggest challenge lies on the demand side
In the opinion of panel member Dr. George Kimathi, director of the Amref Institute of Capacity Development, the biggest challenge is on the demand side. Communities have to be trained in working with this kind of apps, tools, and platforms. This is a task of governments and NGOs. Platforms like LEAP help to accomplish this.
Kimathi said that trust is crucial in PPPs. ‘You gain trust by putting everything on the table, by being very open to each other. But it comes slowly and it goes quickly.’
Privatizations need to be patient-oriented
An interesting question, raised by a participant from the United Arab Emirates, was whether all health care services could be privatized. Kiral answered that the local culture should always be taken into account. Public health care in Ukraine is free, so a shift to paid private services would cause huge protests. ‘Privatizations should at least be patient-oriented.’ The UAE participant later added that his country was seriously considering privatization of health services, but that maybe it should be done in steps, starting with one particular disease or population group.
In her takeaway of the debate, Femke Smeets of PharmAccess underlined that if the public sector isn’t able to prevent epidemics, the help of the private sector is welcome. And that technology makes cooperation easier, but that trust is indispensable. For Helena de Kat of Amref, a basic condition for PPPs is that the interests of the patients and the communities come first. Paul van den Berg of Cordaid said that private-public partnerships would be a better term than public-private partnerships, given that such partnerships often start private. But the goal of such partnerships, he insisted, should always be to provide public services. Corinne Hinlopen of Wemos concluded that in theory all health care can be privatized, but that regulation is needed to ensure its availability, accessibility, and affordability for all. Anika Snel of KNCV Tuberculosis Foundation concluded by emphasizing the importance of community care, trust, and credibility.
After the debate
After the debate, participants showed mainly enthusiastic about its theme and content. ‘It is interesting to see how PPPs, who normally operate in curative health care, are now given a role in preventive health care’, said the representative of the UAE, who wanted to remain anonymous. Nicolaas Moens of Africa eHealth Solutions was a bit surprised about the weight that was given to private parties in this debate. ‘In health care, you should distinguish the roles of provider, financer, and regulator. In my opinion, the private sector should concentrate on the provider role.’
Guido Geerts of Delft Imaging Systems elaborated on the subject of trust: ‘Generally, NGOs distrust the private sector. But our problem is the uncertainties in the NGO involvement. It takes time to explain what we as a social enterprise are doing. But once we are successful, NGOs might need to reorganize or lose their funding.’
(This article is written by Menno Bosma, Wereld in Woorden / World in Words)
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