Proactive Strategic Pandemic Healthcare PPPs

It is impossible to overstate the importance of healthcare —after all, worldwide economic growth and development depend on it—but governments’ ability to provide affordable, quality healthcare dwindles every year. The challenge is now to engage private partners to deliver public benefits. Innovative, forward-looking public-private partnerships in healthcare do this, giving businesses an unparalleled opportunity to do well while doing good. (IFC-World Bank - Handshake Health PPPs – Laurence Carter)

PPPs as an Optional Solution

As we unwillingly enter into the Corona virus epoch - which will undeniably be around for the foreseeable future - Public-Private Partnerships (PPPs) are being globally bandied by political, economic and healthcare leaders as one of the foremost solutions to mitigating the enduring pandemic.

What Do We Mean By PPPs?

Listening to the many proponents of these partnerships it is clear that is a lack of a universal understanding and agreement on what is meant by leaders when they talk about PPPs.  One has to ask - Are they referring to voluntary short-term philanthropic partnerships and alliances between the governments (public sector) and industry (private sector)? or Are they referring to conventional PPPs which involve contractual arrangements where a formal partnership is entered into between the public and private sectors to provide public works, goods, and services over a defined period of time, in a partnership that improves delivery efficiencies though innovation, risk sharing and mobilization of both parties resources?

Both philanthropic and conventional PPPs approaches have merit.  The news is full of wonderful stories where corporations are voluntarily offering resources and supplies to immediately buttress breaches in the healthcare sector’s defense.  However, these generous activities are regrettably ad hoc at best, geographically limited, and unfortunately uncoordinated.  Philanthropy will go a long way to serve immediate needs – and should be stepped up where ever possible – but it is a need for a coordinated and strategic initiatives (based on facts) that consist of prioritized actions propelled by cohesive and unambiguous policy that will lead to medium- and long-term successes in the battle against the Corona Virus pandemic.  

Conventional Healthcare PPPs

I am a firm advocate of the formation of formal partnerships between the public and private sectors that harmonize the efforts of multiple stakeholders (at national and sub-national level).  Only once clear objectives are collaboratively established would it be possible to mobilize the strengths of both the public and private sectors to mitigate the current failures and challenges we are facing. Only then can we implement conventional healthcare projects that will support sustainable and resilient healthcare systems that can combat pandemics heads-on. 

A Multifaceted Approach to Healthcare PPPs

There are multiple healthcare facets (moving parts) that must be addressed immediately to improve resilience and sustainability.  They include strained supply chains (protective clothing, medical instruments, pharmaceutical etc.) improved and expanded facilities (labs, hospitals, emergency vehicles, etc.) and healthcare practitioners (doctors, nurses, clinicians, support staff, etc.) to name a few.

Current events have proven that most countries healthcare systems are not resilient due to poor integration.  If the resilience of the infrastructure, supplies and healthcare services is not addressed immediately, through sustainable practices, we face an implosive collapse in the face of the current onslaught. What is critically needed are partnerships between the public and private sectors that address short-, medium- and long-term challenges.  We most certainly need to identify long-term corrective strategies that will address future Corona virus pandemics that many epidemiologists believe could become increasingly common.

Components of a Recommended PPP Healthcare Strategy

Implementers of a PPP supported recovery strategy should implement short-, medium-, and long-term phased actions.  These actions need to successively build on enduring partnerships that encourage robust relationships between stakeholders.  The longer the required commitment of the PPP partnership, the more formalized the relationship between the public and private sectors needs to be to ensure longevity. They partnerships should also have a “People First PPP” approach that harmonizes long-term people focused healthcare strategies with countries Sustainable Development Goals (SDGs).  

After addressing immediate short-term needs, proposed healthcare PPP programs will need to focus on long term goals. This will increasingly require PPPs to be procured competitively and transparently to ensure maximum innovation, cost efficiency, value for money, and value for people.  In centralized national healthcare systems, partnerships should focus on creating healthcare enabling environments that allow the private sector to be meaningful partners and a back-up to the national healthcare system (e.g. private hospitals being incentivized to seamlessly align with national systems in a time of crises).  In privatized healthcare systems the focus would be different.  In this case of the USA, for example, private hospitals could be incentivized to align themselves with the Veteran’s Hospital system as well as Department of Defense in the case of national emergencies.  In all situations, stronger government led coordinated relationships supported by private sector innovators need to be established between users of services (and consumers of supplies), whether they are private or national healthcare systems.

A.    Short-term Reactive PPP Projects and Partnerships between the Public and Private Sectors (0 to 12 months)

These partnerships are most likely to be reactive in nature to constantly emerging needs and will rely on the cooperative goodwill of both the public and private sector.  Activities could include:

• Encouraging informal philanthropic partnerships between the public and private sectors bridge immediate pressing needs
• Improving supply chains through incentives from the public sector (National Health Authorities) that avoid unnecessary escalations of cost of needed products
• Promoting collaborative actions where national and sub-national government agencies collaboratively identify pressing needs and mobilize responses to where they are specifically in demand 
• Supplying healthcare products (e.g. pharmaceuticals, medical instruments, and protective supplies), according to shifting locational needs
• Improving access to digital infrastructure that permits healthcare stakeholder partners to be fleetfooted in decision making and responsiveness in an age of digital medicine
• Creating healthcare data systems that collect information on how this pandemic spread and duplicatable “lesson learned” for future events with healthcare providers
• Incentivizing the private sector to create non-proprietary solutions that can be globally commissioned 
• Relaxing unnecessary bureaucratic red-tape that hinders meaningful partnerships between the public and private sectors

B.      Medium-term Proactive PPP Projects and Partnerships between the Public and Private Sectors (1 to 5 years)

During this phase strategies should move away from being singularly reactive to proactive, once a clear picture is established of the extend and magnitude of the current pandemic.  Proactive strategies should have a goal of implementing partnerships that are increasingly formalized and sustainable so as to improve resilience.  Activities could include:

• Identifying brownfield PPP project sites (infrastructure) that can be repurposed for the ongoing battle against the pandemic in case it does assume a repetitive annual cycle that many epidemiologists fear.  This includes the repurposing of existing facilities, as well as expanding them through design, build, and financing PPP agreements
• Exploring binding agreements between suppliers and consumers of medical equipment and goods to build medical stockpiles in joint venture government-private sector warehouses.  These warehouses could be launched as PPP projects and would serve as intentionally purposeful surplus storage facility for the private sector where medical supplies would be stored and circulated once a strategic supply threshold was reached.  PPPs for these projects could use the DBFOM PPP model and be operated by the private sector. These warehouses should be established regional centers in the medium-term and then be expanded to subnational locations in the long-term. These warehouses should be joint ventures between national healthcare institutions (i.e. Health ministries, Departments of Defense, state governments, and the private sector)
• Improving health risk detection infrastructure at airports through agreements with private sector airport concessionaires and government health agencies that would monitor future outbreaks as soon as they occur in an era of increasing global travel
• Developing strategies with the private sector to ensure that resources are constantly updated to mitigate technological and pharmaceutical obsolescence.
• Developing collaborative, harmonized and cohesive research and development (R&D) PPP programs where the private sector is incentivized by government to become a long-term partner. Healthcare solutions and remedies (vaccines) discovered through these partnerships need to supply generic remedies that can be duplicated by all competent and collaborating pharmaceutic suppliers without fear of copyright infringements
• Developing strategies where innovative national producers of medical goods are rewarded / incentivized to maintain a dormant production capacity that can be mobilized in a matter of days as soon as the need arises.
• Forming partnerships between the healthcare and the hospitality sectors where hotels (adjacent to existing and future hospitals) can be repurposed or built to certain specifications and serve as auxiliary units in a future crisis.  In many places in the world medical tourism and university medical school facilities exist that could serve as a second line of defense for example.  A good example is the Mayo Clinic Marriot Hotel in Rochester Minnesota, that was purposefully built to provide seamless accommodation for hospital patients from all over the world.

Medium-term Healthcare projects by nature will have to be more traditional PPPs to be effective. These projects should serve as the basis of a long-term approach that is sustainable and results in a resilient healthcare system at a national and international level.

C.    Long-term-term Proactive and Future Proofed PPP Projects and Partnerships between the Public and Private Sectors (5 + years)

It must be remembered that pandemics do not recognize borders. Long-term strategies that are globally focused should be adopted in this phase.  These strategies should also include the implementation of transnational PPPs that can operate without government restrictions.  The strategies should have a goal of introducing borderless global partnerships that are formalized, sustainable, collaborative and resilient.  There should also be a focus on identifying projects that are future proofed for global implementation.  Stakeholders that must be involved in implementing long-term programs should include all (if possible) national government health ministries, the World Health Organization (WHO), NATO and its equivalents, the International Red Cross / Crescent, AID organizations such as USAID and JICA, the multilateral banks, and regional associations such as the EU.  Once national these stakeholders have identified their national priorities they should harmonize them with international regional priorities which then should be harmonized in turn with global priorities. This is the only way that nations can protect themselves from global pandemics. Such an focus will require selflessness among nations and collaboration that has never seen before to combat global pandemics in the immediate interest of humanity as a whole. 

Globally focused PPP programs that are launched under long-term strategies should be proposed and implemented by global healthcare organizations. Long-term national PPP programs would continue to be implemented by national institutions and supplemented when and where needed by international agreements.

All medium strategic actions, once established need to be revised constantly and fine-tuned so that they can become the basis of long-term actions. Long-term actions could include the following:

• Implementing greenfield PPP projects that supplement brownfield PPP projects (infrastructure) for the ongoing battle against future cyclical annual pandemics
• Signing agreements between international suppliers and consumers of medical equipment and goods to build international medical stockpiles located in joint venture government-private sector warehouses.  These warehouses could be launched as transnational PPP projects and would serve as storage facilities for the international suppliers where medical supplies would be stored and circulated once national strategic supply thresholds are realized.  PPPs for these projects could use the DBFOM PPP model and be operated by competent private sector stakeholders. These warehouses should be established in larger regional centers well connected to transportation networks and supported by viable supply chains. These warehouses should be seen as essential components of strengthened international supply chains. These warehouses could be joint ventures between international healthcare institutions (i.e. national government health ministries, the World Health Organization (WHO), NATO and its equivalents, the International Red Cross / Crescent, AID organizations such as USAID and JICA, the multilateral banks, and regional associations such as the EU.) and the private sector
• Improving detection infrastructure at airports through private sector airport concessionaires and government health agencies to monitor future outbreaks as soon as they occur in an era of increasing global travel. This will require the international collaboration of large air carriers if this is to be successful
• Developing strategies with the private sector to ensure that resources are constantly updated to mitigate obsolescence
• Developing collaborative, harmonized and cohesive research and development (R&D) programs where the private sector is incentivized by international agencies to become a long-term partner. Healthcare solutions and remedies (vaccines) discovered through this process need to become generic remedies that can be duplicated by all competent pharmaceutic suppliers without fear of copyright infringements.  This approach should also consider measures that ensure - in the event of a reoccurring pandemic - that no nation tries to hoard or monopolized resources
• Developing strategies where innovative international producers of medical goods are rewarded / incentivized to maintain a dormant production capacity that can be internationally mobilized within days of a need being identified. International bodies should be collaborative decision makers who decide how and where resources are mobilized in the interest of a common good
• Implementing PPP best practices that follow guidelines established by international organizations

Long-term-term PPP healthcare projects by nature will have to be formalized partnerships and should serve as the basis of a overall strategy that is sustainable and results in a resilient healthcare system at a international level.

Conclusion

Although these strategies and actions might seem utopian, the world as a whole, needs to ask whether it can ignore the need for global strategies to combat global pandemics in the future.  The increasing globalization of the private sector, might compel national governments to think increasingly of the need for and value of global healthcare PPPs in the near future.

We must not lose focus on the fact that this health care pandemic needs solutions that are not only economic in nature, but also should be humanely focused on society as a whole.

Recommended Resources and Readings

IFC Handshake  - Health PPPs - https://www.ifc.org/wps/wcm/connect/2a14d44b-ed82-47ba-b129-930bd4114e33/Handshake3_Health_WEB.pdf?MOD=AJPERES&CVID=lKbDPRM

Asian Development Bank (ADB) - Public–Private Partnership in Hospital Management  - https://www.adb.org/publications/guidebook-public-private-partnership-hospital-management

How will coronavirus affect public-private partnerships?  https://blogs.worldbank.org/ppps/how-will-coronavirus-affect-public-private-partnerships

Regenerative PPPs (R+PPP): Designing PPPs that keep delivering. https://blogs.worldbank.org/ppps/regenerative-ppps-rppp-designing-ppps-keep-delivering

2018: Are we ready to commit to building resilient infrastructure? https://blogs.worldbank.org/ppps/2018-are-we-ready-commit-building-resilient-infrastructure

Future-Proofing Resilient PPPs https://blogs.worldbank.org/ppps/future-proofing-resilient-ppps

The Need for Sustainable PPP Recovery Strategies in a Post-COVID-19 World https://www.dhirubhai.net/pulse/need-sustainable-ppp-recovery-strategies-world-david-baxter/

WAPPP (follow link -https://wappp.org/) and the ISRC (follow link -https://ippprc.org/) are leading efforts to leverage the skills of the global community of PPP practitioners to recover from this pandemic.  If you want to be a collaborator, please reach out to me or visit the WAPPP and ISRC websites.