INTEGRATED INFRASTRUCTURE DELIVERY –
FINDING A PPP MODEL
Integrated Approach
The integrated approach to Infrastructure Delivery entails that all the
facets of the infrastructure and aspects that will impact on the design
and construction of a facility must be addressed up-front and
throughout the infrastructure delivery process in order to achieve a
fully functional facility that addresses the needs of the community it is
meant to serve
Hospital Revitalisation Infrastructure Management
Composite Functions
Facility
Management
&
Maintenance
Strategic
planning
Commissioning
&
Operationalisati
on
Facility planning
& Costing
Staffing &
Organisational
development
Design &
construction
Equipping HT &
ICT
Strategic &
Health Planning
Macro – Strategic Level
 Develop Standards and Norms
 Develop Service Transformation Plans
 Develop Referral Pathway Structures
Facility Level
 Business Cases/ Feasibility Studies
 Health Briefs
 Operational Narratives
 Accommodation Schedules
 Room Data Sheets
 HT Schedule
 Staffing Complement
 Design Brief
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Facility Design
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Rezoning, subdivisions and consolidations
Environmental Approvals
Bulk services reports
Traffic Impact Studies
Master planning
Architectural design
Engineering design – civil, structural, mechanical
electrical & electronic
 Peer reviews & value engineering
 Approvals from relevant authorities
 Building contractor procurement
.
Project Management
Construction
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 Site handover: construction process
 Monitor and manage:
- Construction Program
- Quality Assurance and Cost Control
- Health and Safety Management
 Legal contract compliancy
 Technical Support
 Financial Control
 Progress reports
 Practical Completion and snagging
 Building Commissioning
Health
Technology
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Health technology gap analysis
HT- schedule – start with Health Brief
Development of specifications
Lead time management
Space and fitting implications
Equipment procurement process
Program and oversee supply and installation
Technical training on equipment
Maintenance Manuals
ICT &
eHealth
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ICT Gap analysis
Integrated Platform and Interoperability
eHealth – telemedicine
Digital equipment
Lead time management
Equipment procurement process
Program and oversee supply and installation
Technical training on equipment
Maintenance Manuals
Organisational
Development
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Organizational Development
Change (Behavioural) Management
Business re-engineering
Quality of Care and Customer satisfaction
Quality Assurance
Business flow and administration systems
Functional Narratives
Monitoring & evaluation methodology
Logistics &
Operationalisation
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Logistical Program
Physical move
Testing of equipment and systems
Operational Training
Hand-over
Commissioning of facilities
Clinical Handover
Decanting of patients
Operationalisation
Facility
Maintenance
 Maintenance Plans and Programmes
 Maintenance needs for equipment and life cycle
management
 Clinical engineering
 Develop facility management options for buildings
 Planning routine and incidental maintenance
 BMS – Building Management System
 Management of facility maintenance program
 Control Centre: Call Centre and
Maintenance Inspectorate
Facility
Management
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Facility Management regime
Building Management Systems
Energy management
Cleaning Services and Infection Control
Security
Porter Services
Garden Services
Security
Mortuary
Hotel Services
 Laundry
 Catering
Considering PPP’s
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What motivates our interest in considering
PPP as a model
 Are we looking for a funding model
 Provider of funded infrastructure
 Provider of facility management services
 Provider of maintenance
 Provider of funded and maintained equipment
 Provider of Clinical services
Or a combination
Are we really looking for a partner
PPP Models
 Most Comprehensive – Where the Private Party
 Designs, builds, equip, finances, maintains, do facility
management, staffing and clinically operates
 Clinical services to public patients at a unitary fee per
patient with a fixed fee component
 With the right to treat private patients for its own account
• In this model is Government not essentially outsourcing its
constitutional responsibility?
• Most of the time we find that Government wants to retain the
clinical operations – and rightly so
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PPP Models
(Continued..
 Question is whether the Comprehensive Model can
work on the various levels of care
 Primary Health Care (Clinic) and Community Health Centre
 District, Referral and Tertiary Hospital
 Answer is probably at the first two levels not at all
 At the other three levels it could probably work – but in an
adapted format
 Where it could work is for specialist units where special centres
of excellence can be created and where the population does not
justify duplication of facilities
 i.e. cardiac centre, oncology centre and high tech facilities
such as imaging, CT-scans etc.
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PPP Models
(Examples...
 If it is not the comprehensive model we must
consider what the PPP service-package would
encompass:
 What is popular is packages for delivery of a
specific service which is structured as a PPP
rather than outsourcing
 Typically where there can be centralization of
services 
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Laundry
Kitchen/catering
Pharmaceutical
Laboratory
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PPP Models
(Examples...
 PPP at the Universitas Hospital in Bloemfontein –
Netcare provided and runs a component of the
hospital with public and private patients
 Inkosi Albert Luthuli Central Hospital – Impilo
Consortium supply, own, maintain and life cycle
management of equipment and ICT & provide
services cleaning, security, parking, laundry
 Few PPP’s where Life Health runs a private ward
in a district hospital in exchange for upgrade
facilities provided to the public side of the hospital
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PPP Models
(Examples...
 Limpopo Provincial Department of Health and
Social Development had a hybrid PPP model for
infrastructure delivery
 Operated on the principles of a BOT – Design
Build Operate and Transfer
 The design, construction, commissioning and
maintenance responsibility and risk were passed
to the Private Party
 Still funded by the Department
 Period covered design, construction and
commissioning with a 5-year facility maintenance
obligation
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PPP Models
(Question...
 Are we not looking for a model that can deliver
with the capital outlay of the Private Party infrastructure and equipment, maintenance and
life cycle replacement, complemented by specific
FM services, i.e. security, cleaning, gardening, at
an affordable unitary fee within a regime of
performance indicators and penalties that can
create the environment for Government to deliver
its core function of medical and clinical services to
the public?
 If that is so, are we not essentially looking at an
Accommodation PPP Model?
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PPP Models
(Accommodation..
 Accommodation PPP Models generally works
because the service delivery indicators and matrix
of risk transfer can be concretely defined – costs
are known and risks can be properly priced.
 South Africa examples of successful
accommodation PPP’s – Head Office PPP’s for
DTI, Foreign Affairs, Basic Education
 Typically the Private Party is responsible for
design, finance, build, maintain, life cycle
management and replacement and management
of utilities all within a clearly defined set of user
requirements, performance indicators and a
penalty regime
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PPP Models
(Accommodation..
 Concession Agreement for twenty five (25) years
inclusive of the design and construction to
commissioning period
 Serves as an incentive to get to commissioning as
soon as possible as the payment of the unitary fee
only commences on commissioning
 BOT – Build Operate and Transfer – including
design and finance
 Unitary fee tied to an index like CPI
 Certain rates (like for utilities) may be reviewable
or adjustable
 Replacements costs reviewable 5 year intervals
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Commitment to PPP
 Government must make a clear commitment to PPP’s
as an infrastructure delivery model
 Government must have a clear definition of what it
wants to achieve through a PPP Model and the model
must be clearly defined
 Turnaround time on PPP process must be reasonable
from EOI – RFP – Preferred Bidders – BAFO –
Financial Close
 If this is not there and proven - Private Sector will
loose confidence and loose interest and will overprice or not participate sufficiently to provide a broad
base of competition
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Advantages PPP
 Advantages are that a capital budget gets converted
into a unitary fee structure and more facilities can be
delivered with the same amount of money
 Private Party best placed to manage and control
infrastructure delivery, maintenance and life cycle
management and facility management
 Government can focus on their core constitutional
function of service delivery
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&Answers
Questions