Review public-private deals for sustainable health enterprises
Empty beds at Meru Teaching and Referral Hospital last week due to health workers strike. PPPs have not helped health enterprises. PHOEBE OKALL
The World Bank is this week holding a webinar on public-private partnerships around Financing and Funding Kenyan PPPs – Emerging Trends and Issues.
This builds on initiatives by the bank and other development agencies in assessing previous local efforts on the PPP scene.
While the majority of such partnerships are in infrastructure like roads among others, health PPPs also have an opportunity. Most PPP engagement models are thought to be in terms of financing partnerships. In some instances though, what is needed more is the technical input.
An evaluation of Kenya’s local health system’s capacity indicates gaps in terms of buildings and “heavy” equipment, all possible areas for engagement through such approaches.
At the height of the Ebola crisis, Africa’s infrastructural health deficiencies were exposed. Makeshift hospitals had to be put up. This deficit isn’t just noted in medical crises, even in normal times both the human resource and building gaps exist.
A starting point for all health systems is the infrastructure, equipment and personnel in that order. Hospital construction work is a capital-intensive initiative and many county governments have been unable to initiate or even complete existing projects.
Many existing facilities were built in the 70s and 80s and are decaying.
Seven years ago I visited five rural health facilities whose upgrade was just beginning with financing from a regional development bank.
On a recent visit there a few weeks ago, the stalled construction had not moved an inch in almost all these facilities. The reason given was “lack of finances”. Can PPPs help tackle this?
The sluggish uptake of PPPs in Kenya’s health scene could be fear of political interpretations but lack of working models is to blame too.
As a relatively new concept, its adoption has not been as quick as thought. No doubt there is room to remarket the approach to stakeholders.
The poor uptake may also be due to a misplacement of the energies and efforts of those involved. Most PPPs are private sector wooing public sector, usually for profit and this is not lost on the latter.
However, a commonly overlooked side of the PPP discussions is the reverse: a private sector-centric approach where the government partners with the private side. There is more room for this in Kenya than the former scenario.
Kenya’s health sector is dominated by private sector low-cadre players. These serve client pools similar to the government’s public health system target demographic.
Could supporting these nurses and clinical officers with State-backed resources improve their infrastructure work?
To develop really robust and impactful private sector targeted PPPS, a few questions need to be asked.
These should take note of the Kenyan health entrepreneurs’ infrastructural needs, geographical areas infrastructural gaps and what resources are available where and their ease of access.
Unfortunately, the few initiatives spearheaded by financiers and development agencies mostly target SMEs.
Their definition of SMEs by the capital and turnover is, however, out of context with the realities of Kenya’s health system needs and highlights the truth about such initiatives: many are badly packaged.
The Kenyan chapter of the World Bank has answers to all of these questions and their health infrastructure approaches need to be repackaged.
