PRIVATE PUBLIC PARTNERSHIP
PPP in HEALTHCARE
Dr Simon I. Beshir
Consultant Cardiologist
NAMIBIA HEART CENTRE
Roman Catholic Hospital & Windhoek Central Hospital
8th December 2014
PPP in HEALTHCARE
 Introduction
 Overview of PPPs
 Views on PPPs
 Advantages and disadvantages
 PPPs in other countries
 Our Story
 Lessons learned
PPP in HEALTHCARE
DEFINITIONS
 A Public-Private Partnership = contractual agreement
between a public agency and a private sector entity.
 The resources of each sector (public and private)
are shared in delivering a service or facility for the use
of the general public.
 In addition to the sharing of resources, each party
shares the potential risks and rewards in the delivery
of the service and/or facility.
PPP in HEALTHCARE
TYPES OF HEALTHCARE PPPs
 Outsourcing non-clinical support services
 Outsourcing clinical support services
 Outsourcing clinical services
 Private management of a public hospital
 Private financing, construction and operation of a
public hospital

More incentives for private sector to perform

New facilities available earlier

Increased levels of efficiency and innovation

Risks transferred to private sector

Forward spending commitments known and able to
be planned for

PPP contracts can be very complex

Results assessment is often subjective

Public sector may be locked into contracts
while health demands change

PPPs may not gain the population’s trust

>60 new hospitals built

All projects were delivered within the public sector budgets

Estimated that PPP projects cost 17% less than public sector
projects – a saving of $4 billion on a $22 billion programme
– the equivalent of 25 hospitals

PPPs have failed to win the people’s trust

First wave of 8 PPP (DBFO) contracts awarded in 2006

8th hospital: Valdemoro Hospital – includes Care Contract

€72 million investment – awarded to Capio

Care Contract includes full responsibility for local population

30 year concession – total value c. €1.3 billion

Highest burden of TB worldwide

State government contracted with NGO hospital to
provide TB control services to 500,000 population

Better outcomes than Control Comparison:
 Cost per patient 10% lower ($88)
 21% more TB cases found
 14% better treatment success rate
 Cost per successful treatment 14% lower ($118)

Being extended across other parts of India (with
ongoing independent evaluation)
OUR STORY – CARDIAC UNIT @ WCH
NAMIBIA HEART CENTRE
VISION
 Only 300-400 000 Namibians have a medical aid
 The remaining 2 million rely on state health care
 Some advanced methods of treating heart disease not available
in Namibia (even at private facilities)
LET’S DEVELOP A HEART UNIT (CENTRE) THAT WILL PROVIDE THE
WORLD STANDARD OF CARDIAC CARE TO ALL NAMIBIANS !!!
OUR STORY – CARDIAC UNIT @ WCH
NAMIBIA HEART CENTRE
PREVIOUSLY
 Some patients with heart disease
transferred to RSA or Kenya at a
very high cost
 Most cardiac patients receive no
or minimal therapy and faced
suffering or death from heart failure,
heart attacks or strokes
OUR STORY
CARDIAC UNIT @ WINDHOEK CENTRAL HOSPITAL
 Established and inaugurated by H.E. President Hifikepunye
Pohamba in August 2008
 First step towards the national heart centre was made
 Some patients could receive
heart treatment in Namibia
OUR STORY
CARDIAC UNIT @ WINDHOEK CENTRAL HOSPITAL
GREAT SUCCESS BUT STILL SOME PROBLEMS
 Lack of qualified staff
(especially doctors)
 Inconsistent supplies of consumables >
service interruptions
 Inconsistent funding of the service
OUR STORY – CARDIAC UNIT @ WCH
GETTING A WELL QUALIFIED AND SKILLFULL DOCTORS
 State salaries for specialist physicians are below the levels of the
trainees in the EU/UK/US
 Private physicians not keen to work at the state facilities (loss of
income from private healthcare)
 BIG HURDLE ISSUE ……starting a new train is
more difficult than jumping into a going one
OUR STORY – CARDIAC UNIT @ WCH
Micro PPP CONCEPT




Attract a highly qualified Consultants to work at the state hospital
Allow them to conduct a limited private practice to supplement
their income
Set a performance standard for each consultant
Define precisely the proportion of consultant ‘s time dedicated to
the state unit
OUR STORY – CARDIAC UNIT @ WCH
PUBLIC INVESTMENT
1.
Consultant salary as per the national public service pay rates
2.
Annual budget for the service provided + development
OUR STORY – CARDIAC UNIT @ WCH
PUBLIC RETURN
1.
2.
3.
4.
5.
Increased number of patients using the service
Newly introduced treatments
Less (or no) patients sent for the expensive therapy abroad
Increased patient satisfaction – high quality care in Namibia
Training of the young Namibian doctors and nurses = knowledge
& skill transfer to benefit larger number of patients in the future
OUR STORY – CARDIAC UNIT @ WCH
PRIVATE INVESTMENT
The time spent at the state hospital = loss of income in private
practice (far exceeding the state salary)
2. Know How
3. Unit management (ownership)
1.
OUR STORY – CARDIAC UNIT @ WCH
PRIVATE RETURN
1.
2.
3.
Opportunity to define and to develop a national heart service
Opportunity to introduce advanced methods and treatments . .
i.e. personal growth, prestige, experience
Ability to earn extra income from the limited private practice
OUR STORY – CARDIAC UNIT @ WCH
2012 - SERVICE ASSESSMENT
Performance analysis of the Cardiac Unit (2012)
•
•
No of patients treated ( outpatients, operations, etc) annually
Portfolio of treatment methods (CABG, stents, pacemakers)
Costing analysis of the Cardiac Unit (2012)
•
•
•
Salaries (doctors, nurses, technical staff)
Capital costs (equipment)
Consumables used for the procedures
BUDGET BASE
VISION & GOALS – 5 YEAR PLAN
NAMIBIA
Approx. 2,000,000 population (state patients)
vs
UK/EU/US PERFORMANCE STANDARDS
number of cardiac procedures per million population annually
=
NUMBER OF CARDIAC PROCEDURES TO BE DONE IN
NAMIBIA
OUR STORY – CARDIAC UNIT @ WCH
IMPLANTING PACEMAKERS &
OTHER DEVICES
OPENING THE
BLOCK
HEART
ARTERIES
WITH
BALLOONS &
STENTS
OUR STORY – CARDIAC UNIT @ WCH
PERFORMING OPEN HEART OPERATIONS
SUCH AS BYPASS SURGERY or VALVE
REPLACEMENT
OUR STORY – CARDIAC UNIT @ WCH
VISION & GOALS – 5 YEAR PLAN
INNOVATION & DEVELOPMENT
•
New treatment methods
•
Clinical research
•
Clinical data management system
VISION & GOALS – 5 YEAR PLAN
New treatment methods
RENAL DENERVATION THERAPY TO TREAT
HIGH BLOOD PRESSURE
VISION & GOALS – 5 YEAR PLAN
ROBUST DATA MANAGEMENT SYSTEM
VISION & GOALS – 5 YEAR PLAN
VISION & GOALS – 5 YEAR PLAN
ANNUAL BUDGETTING PROCESS
1.
ACTIVITY REPORT FOR THE PREVIOUS 10 MONTHS
2.
PROPOSED FURTHER DEVELOPMENT/EXPANSION
3.
UPDATED COST PER ITEM
4.
PROPOSED BUDGET FOR THE COMING YEAR WITH
MOTIVATIONS & JUSTIFICATIONS
5.
FINANCE DEPT. OF MHSS EVALUATION
6.
FINAL BUDGET SUMBITTED TO MOF
7.
NEW BUDGET RELEASED USUALLY IN APRIL/MAY
PAYMENT MECHANISM
A SINGLE SUPPLIER OF THE CARDIAC UNIT SELECTED BY A TENDER




Responsible for all the supplies for the Unit
Single point of contact for the clinicians
Bulk purchases – good pricing – good value for money
Deadlines and clinical support stipulated in the contract
1.
AN ANNUAL VOLUME OF SUPPLIES ESTIMATE BASED ON PREVIOUS YEAR
ACTIVITY + PROPOSED EXPANSION
2.
QUARTERLY REQUESTS SUBMITTED BY THE UNIT LEAD TO THE SUPPLIER
VIA THE HOSPITAL MANAGEMENT
3.
WHEN APPROVED THE SUPPLIES DELIVERED TO THE CENTRAL CLINICAL
STORES & INSPECTED FOR COMPLETNESS
4.
SUBSEQUENTLY PAYMENT RELEASED TO THE SUPPLIER
PRIVATE PARTY RESPONSIBILITY
1.
2.
3.
4.
5.
6.
7.
8.
9.
Clinical leadership of the Cardiac Unit
Staff training
Unit management
Performing complex cardiac procedures
Training of the junior medical & nursing staff
Setting up goals and targets for the unit
Putting together the annual activity report of the unit
Bringing innovation and new developments
Budget proposal – justfication.
GOVERNMENT RESPONSIBILITY
1.
Unit funding (staff salaries, annual budget)
2.
Analysis of the annual activity report
3.
Review and justification of the proposed budget
4.
Supervision of the unit ( via senior hospital
management)
CARDIAC UNIT @
WCH - OUTCOMES
LESSONS LEARNED
1.
The Vision & Realistic Goals are essential
2.
Micro-PPP can achieve Macro-RESULTS
3.
Open minded approach - don’t let a stupid rule to stop a
good project
4.
Robust data collection is necessary to avoid abuse of
public money
5.
Key players must be selected well !
THE FUTURE
OPTIONS
1.
Continue the current system = micro PPP
2.
National Heart Service – Country Wide Project = true PPP
3.
Outsourcing of the Cardiac service fully to a private
facility for a fixed fee per patient
4.
Reverting back to a full state based care
Thank You