Dialogue with Authors of World Bank Public/Private Partnerships Report

PSP-One invites you to join in a dialogue with authors of the World Bank Public/Private Partnerships Report, “Public-Private Partnerships to Improve Health Service Delivery in Africa” by Tonia Marek (pictured left), Catherine O’Farrell, Chiaki Yamamoto (pictured below), and Ilyse Zable.

PSP-One has the pleasure of introducing you to two of the co-authors who are behind this World Bank report released in November 2005. Below you’ll find a quick summary and links to the report, as well as a brief dialogue in which the authors share some of their own views and background.

We invite you to participate too. If you have questions for the authors about the issues they raise, the study’s background, or ideas for the future, please send them to info@psp-one.com and they will be answered by these experts.

Report Background:

This report, in its first part, destroys three common myths regarding the private health care sector in Africa:

• The private sector is for the rich and the public sector is for the poor
• Health is mainly financed by the public sector
• The private sector is not very developed in most African countries

The second part of this report tries to determine "how to engage the private sector effectively," using examples of some successful public-private partnerships (PPPs). This report defines PPPs in health as any formal arrangement between government and a private entity established for the purpose of providing health services. The report also highlights some of the new trends in public-private partnerships and how to make use of opportunities that present themselves. Finally, it identifies what governments, the private sector, and the World Bank Group could handle more effectively.

Download the report and related communications strategy now:

• "Building Support for Public Private Partnerships for Health Service Delivery in Africa: Critical issues for communication: Results from a stakeholder consultation"
• "Trends and Opportunities in Public-private Partnerships to Improve Health Service Delivery in Africa"
• Building Support for Public Private Partnerships for Health Service Delivery in Africa: A Communication Strategy

Dialogue questions from PSP-One:

Question 1: What was the motivating force behind the creation of this study and the final report?

While the private sector has been playing a critical role in providing health services in Africa, we have little documented information on types of public-private partnership.

We also realized that the World Bank needed to look beyond the public sector to have any impact and we wanted to put some numbers on this in order to convince our colleagues.

Question 2: How do you hope this report will be used by your colleagues at the World Bank, by the development community, by the private sector, and by those it’s intended to assist?

We hope it will help colleagues at the World Bank and in the development community become more aware of what can be done in terms of PPP, and inform them that they are not starting from scratch. This report provides a snapshot of existing PPPs in hopes that it would better inform aid communities and governments exploring innovative ways to achieve their public heath goals.

Question 3: What would you say are the three to four “take away” messages from this report? To which audiences would you want to convey these messages?

We’d hope that the report destroyed the main 3 myths about PPP (as outlined in the paper), and that the reader would see the important role the private sector is playing in delivering essential health care services. The messages are targeted specifically to African parliamentarians, multilateral and bilateral agencies, health practitioners in both sectors, private sector leaders, specialized media and World Bank staff. The communication strategy provides more detail on the targeted messages (key ones listed below).

Health systems should include not just the public but private sector service delivery as well. In some countries, the private sector provides half of all health services and in most others at least one-third of health services.

• Each sector -- public and private -- has its own comparative advantage. If both sectors were to work together -- with the public sector providing a health policy framework for the population and the private sector providing management, efficiency, new technologies and capacity, Africa can come closer to reaching the MDGs.
• As public funding is limited, it is time to ensure that the money being spent by populations using the private sector is being spent in the most efficient way possible in buying quality services from the private sector. Hence, utilizing the private sector will optimize use of limited resources.
• Working with the public sector alone will not achieve much progress. The development landscape has changed a lot over the past few decades. Specifically looking at how health problems in Africa are addressed, you really do need to look at a multi-sectoral approach, which means involving the private sector to focus on sustainability. MDGs are unlikely to be achieved through the official resources alone. Estimates of the financing gap range from US $50 billion to US $100 billion a year (approx. double the current level of aid). (WEF)

Question 4: What does your group plan to do to promote the role of the private sector in delivering health care in Africa?

There’s need for more advocacy. We would like interested individuals to read the strategy and share with us their own thoughts and ideas for how to promote the private sector. Readers can also view more information about the project at http://www.cendevcom.org/nz_projects.html.

Question 5: What advice or other information would you like to offer professionals working on private sector health issues in Africa and other regions of the world?

Make sure to document any PPP experience and share it widely. We all need to learn from successes as well as failures. (Also, let us know now if you have anything to share via this dialogue.)

Question 6: Please provide a brief bio and any experience you’d like to share that is relevant to the private sector partnerships audience (i.e. those focusing on how the private sector can play a bigger role in positive health outcomes).

Tonia Marek, Dr.P.H., is Lead Public Health Specialist in the Africa Region of the World Bank. She is responsible for coordinating the Africa Region work on public-private partnerships, in addition to being a project manager. Dr. Marek was until recently also the coordinator of the World Bank’s Health Systems Development Thematic Group, a knowledge sharing group.

Dr. Marek has lived and worked many years in Africa and the Caribbean. She was instrumental in particular in designing and supervising two successful large scale community nutrition projects in Madagascar and Senegal that implemented PPP. Dr. Marek has over 25 years of experience in project design, monitoring and implementation. In the last seven years, she has focused her interest on public-private partnerships. Dr. Marek has published on topics related to health systems development and nutrition.

Chiaki Yamamoto is a Private Sector Development Specialist at the World Bank. She has contributed technical analysis on public-private partnership in several health projects supported by the World Bank. She has task managed production of Toolkit on Competitive Voucher Schemes in the Health Sector and co-authored technical briefs on typology of private participation in health care, as well as franchising in health care services.

Questions From Readers

Question 1:

From: Dr. Olayinka Ayankogbe

Title: Senior Lecturer/Consultant in Family Medicine Institute of Child Health & Primary Care College of medicine

Location: Lagos, Nigeria

Dear Tina Marek,

I am glad I finally surfed on to your dialogue page on PSP-1 website. I was one of the participants at the September 2006 on-line conference arranged by PSP-1 and I am glad I finally found you! Question five on the dialogue page is what really interested me. I am glad you are ready to share experiences.

First, I am a product of a programme that started 25 years ago of a unique public/private partnership for the training of Family Physicians in Nigeria. We are becoming a model for the rest of Africa. The partnership was between the Association of General Medical Practitioners of Nigeria, an association of gps in private practice, the National Postgraduate Medical College of Nigeria and faith based organizations (formerly called mission hospitals). We established a four year residency training programme supervised by the Post-graduate College but based in the mission hospitals with organizational support from the general medical practitioners who were in the private sector. They served in various capacities on the Faculty board of General Medical Practice of the National Post-graduate College. The partnership is still on, and more residents are being trained especially for the rural areas of Nigeria.

Secondly, I have just finished a study mapping out the illnesses and diseases that present in private medical practices in urban Lagos. I am a senior lecturer/consultant at the Teaching Hospital which is a public institution using the icpc-2. This is another form of public private partnership. I am being sponsored to present the work at an International Conference in Uganda in 3 weeks time.

I will definitely like to link up with you for exchange of information and research ideas and possibly collaboration. This is the area I intend to have my chair in Family Medicine-that is public/private partnerships in family medicine for the health of the rural poor.

Thank you once again for throwing up the gates of your vast knowledge to us working in the field!! More power to your elbows. You definitely are on the right track for attainment of MDG goals for the health of Africa!!

Answer:

From: Tonia Marek

Titile: Lead Public Health Specialist, The World Bank

Dear Dr. Ayankogbe,

Thank you for your supportive statement and for sharing your successful Nigeria experience, I am sure this will inspire others. Regarding question 5, which is: What advice or other information would you like to offer professionals working on private sector health issues in Africa and other regions of the world? I think a lot of information is given in the papers I and others wrote and which you'll find when you surf on the PSP site. However, I'd like to highlight two specific actions which the private health sector professionals need to make sure they implement:

• The first is to make sure you don't remain an individual, but that you belong to an association. This is important to be able to have your opinion heard, as well as to be able to enter into contracts with governments, or even to benefit from training, for example, that a government might want to give to private providers. It's harder for a government to deal with individual providers than with a network.
• The second is that you, the private health care providers, need to make sure you have your place at the decision making table. Make sure that you are represented at the national or sub-national level when budgeting and planning decisions are made. NGOs have already fought and won that battle, but the other private health care providers have not always succeeded yet.

From what you say, it seems you have already implemented the first step with the Association of General Medical Practitioners of Nigeria. I'd like to suggest you send your presentation which you'll make on your experience at the Int'l. Conference to the PSP-One people, and do cc me. Feel free to contact me directly at tmarek@worldbank.org if you have specific queries.

Again, congratulations, and continue the good work. We'll be watching your progress.

How to ask Dr. Marek or Ms. Yamamoto questions: If you have a question about the report and the strategy, or The World Bank's work in private sector health, send it by e-mail to info@psp-one.com. All questions will be collected and we will respond within about 10 days. We encourage your participation!