It is my firm belief that the Sustainable Development Goal (SDG) 3 – ‘Good Health and Well-Being’ -- underlies all 17 SDGs. We cannot consider eradicating poverty without focusing on the health of citizens who are involved in providing for their families, nor can we think about peace, justice and strong institutions with young children losing their families to epidemics. In our world today, political conflicts, climate change, the changing burdens of disease, technological advancement, and fragile economies have an observable impact on the health of our local as well as global community. The call to come together across different sectors and regions with a joint interest of ensuring a healthy and long life for all has become stronger than ever. When healthcare in a country improves, it has a direct impact on the standard of living; it shapes how individuals thrive.
For a person like me, who comes from a developing country with poor health standards, the idea of partnerships, in the form of relationships, contractual agreements, mutual benefits, and the pooling of resources is promising. For partnerships and investments to result in critical outcomes in healthcare, it is important to lay emphasis on how these can be structured for maximum benefits. This topic raises a series of questions. For example: Who should be leading these partnerships and investments? How does mutual benefit relate to social impact? Are partnerships aimed at improving healthcare a short term or long term solution?
Investments and partnerships are categorised as internal or external: internal partnerships include Public-Private Partnerships (PPPs), and external partnerships include partnerships between two or more countries (Country Partnership Frameworks<1>). Both forms of partnership are used to curb health related issues for mutual benefit. I have explored these examples of partnership to answer some of my questions on how to achieve maximum benefit.
In a PPP project, the services rendered by the private entity are not restricted to investing initial capital. They vary according to the management, regulation, innovation, development and distribution. The risk is distributed between the public and private entities factors like the capital that is invested by the private entity, the length of the partnership, the payment mechanism and the negotiation process are all key.
In every country the models of PPPs differ on the basis of financing and delivery. In most cases, one entity is responsible for the financing and the other for delivery:.
An example of a successful PPP implementation is the introduction of Telemedicine. In most cases people say that setting up telemedicine is an expensive affair. When there are grants to set up these services, a major challenge is the collapse of the system once the grant runs out, which leads to a population’s further health deterioration. Thus, in such cases it also becomes important that the financing comes from the right source in order to ensure an effective Public-Private Partnership. In looking at such examples, Professor Mahapatra, from the University of Texas Arlinghton (UTA), College of Business, looked at what made the Odisha Trust for Technical Education and Training’s (OTTET) successful. He identified two reasons for the success; (1) the investment of the local community and (2) upskilling of community members.<3>
Another example of the effective implementation of effective PPPs was in the UK. The UK was one of the first countries to develop effective and sustainable PPPs for public service projects. The Health Services Renewal Programme for Grand Turk and Providenciales in the UK is an example of how the hospital places a strong focus on lifestyle and wellness initiatives with the revitalization of Public Health facilities and services.<4> It successfully uses Personal Financial Initiatives to construct two new local general hospitals. The country focused on generating high quality service outputs rather than building infrastructure as an end itself. It also places emphasis on strong strategic and policy developments that are not limited to project-to-project approach.
Another important aspect of partnership is investment in research for improved health and social services. Non-communicable diseases are becoming one of the major reasons for death globally. This is due to the various socio-economic determinants of health like climate change, and changes in lifestyle. Earlier this year, The Medical Research Centre (MRC) and the Ministry of Education of Malaysia invited research proposals under the Newton-Ungku Omar Fund UK-Malaysia Joint Partnership on Non-Communicable diseases.<5> The research was on cardiovascular diseases and diabetes, which are the root causes of morbidity in Malaysia. Investments were made by the UK and Malaysia. The opportunity is also open to the UK scholars, but the context of the research needed to relate to the Malaysian Population.
From these examples it becomes clear that partnerships and investment is important at all levels in order to deal with a complex situation like global healthcare. The most important part of any investment or partnership is the financial pool and where it comes from. Health systems requiring direct, out-of-pocket, payments from people at the time they need care prevents hundreds of millions from accessing services. This results in financial hardship, and even impoverishment, for millions of people.<6> There is a danger that when financial investments come into the picture, the primary goal for any business becomes profit maximisation. Thus, in the case of investments it is important that both parties are mutually benefitted from the partnership. This can be seen with the innovative idea adopted by governments of countries like Germany and the Philippines, who carry out an international recruitment of health workers through a government-to-government bilateral agreement. This ensures benefits for the host country, the country of origin, and profession.<7> As much as it is important to find solutions for accessible healthcare, it is also important that these solutions are sustainable. Currently, there is not enough information to go about this. It is my view that both partnerships and investments should be lead by the implementing authority responsible for healthcare provision for the majority of a population. This will help us understand the impact of these initiatives and help establish the best practices
<1> https://projects-beta.worldbank.org/en/projects-operations/country-strategies
<2> http://ieg.worldbankgroup.org/sites/default/files/Data/Evaluation/files/lp_Health_PPP_1116.pdf
<3> http://www.iran-daily.com/News/201052.html
<4> https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/266818/07_PPP_28.11.13.pdf
<5> https://mrc.ukri.org/funding/browse/uk-malaysia/joint-partnership-on-non-communicable-diseases/
<6> https://www.who.int/health_financing/strategy/risk_protection/en/
<7> https://www.who.int/hrh/Oral-Governance-and-accountability-Beck-16Nov-17h30-18h30.pdf?ua=1
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Stacey Ann Pillay is the CEO of Africa Health Placements South Africa.
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