PPP in shamble if govt policies not changed

19Nov 2016
Francis Semwaza
The Guardian
PPP in shamble if govt policies not changed

Healthcare is a challenge in most developing countries due to inadequate resources, attracting solutions with questionable sustainability.

Dispensary in Tanzania

Even the develop countries’ healthcare policies vary considerably with social safety nets virtually diminishing fast now that there services are limited to medical emergencies involving their citizens, otherwise covered by either insurance or individual payment where insurance fails.

Insurance companies would more often than not, resist from paying the bills for incurable and the related diseases like cancer and HIV/AIDS.

But, despite insurance helping a great deal in most countries since a person will not have to worry about paying from the pocket, it remains purely commercial. In fact, it is a speculative trend in which people pay less for high expectations while the companies make profit from subscribers’ premiums.

On the other side, even emergency healthcare services remain a challenge for most governments to pay for, thus making them resorting to finding ways to make up for the resource deficits in their efforts to fulfill their obligation of providing the people with goods and services a government is ought to provide.

In most governments, efforts to bridge the resource gaps in providing the services can be vividly seen. Hence, the relatively old notion of Public-Private Partnership (PPP) gradually gaining prominence in the developing world, though in a nascent stage.

More specific to Tanzanian settings, PPP discourse began appearing in the country’s policies in the early 1980’s, in the aftermath of the global economic shocks that dominated the previous decade caused by the plummeting prices of oil and agricultural products.

On the one hand, PPP brings partners from the public sector, but on the other, it brings partners from the private sector to address a challenge or embark on a project that would help provide better social services to the public.

The private sector partners can be private companies, non-governmental organizations and other entities, and are obliged to provide resources on a 1:1 ratio with their public partner collaborators. Another applicable formula, according to the European Union PPP Commission is that PPP partners are ought to commit at least 25 per cent of the overall needed financial resources to the realization of a given project.

Yet, the shaky financial sustainability of PPP poses a great challenge to its success as it does not only stunt the partnership’s progress into full scale implementation but also makes the projects short-lived and unreliable inr bringing long-term benefits to the recipient communities.

This is especially true with PPP projects under donor funding across Africa where the disjuncture of mindset between partners compromises most of the projects with regards to availability of funds for continued implementation after the donor funding cycle comes to an end.

While managing the PPP finances may not be a major concern since financial accountability could be ensured through joint or individual partners as provided for in the various memoranda entered by the project partners, the partners’ minds do not usually meet.

This tendency is especially dominant in healthcare financing whereby the private partners would push for increased public involvement through contributions to the services the end-users receive while the government would not entertain idea that the services should be provided free of charge.

The Health Policy in Tanzania, for instance, provides that maternal and child healthcare services will be provided for free although the reality on the ground suggests the opposite whereby for the lack of medicines and medical equipment in most public healthcare facilities, most women in labour wards are asked to bring with them their own supplies during childbirth.

Given this situation, it will not be surprising for the Tanzania Ministry of Health, Gender, Elderly and Children (MoHGEC) Affairs not to welcome the idea of allowing the PPP consortia to impose any charges, however minimal, to on the services for that category although the quasi-business model could prove to be the best in ensuring sustainability of the crucial services the public enjoys.

The otherwise state-resisted cost sharing mechanism that most private sector partners propose in health-related PPP projects is what the government has embraced as a policy in healthcare and education since the late 1980s.

However, there are exceptions in the services that include a few age categories such as the elderly and children, patients of such diseases like TB, cancer, and HIV/AIDS as well as maternal and child health services who are relieved from payments.

This relaxed mindset has even impacted upon the very people experiencing drug shortages in public healthcare facilities upon their hospital visits, and has been consequently deterring them from going to the public hospitals for fear of drying their wallets for services they would otherwise enjoy for free if at all found in the respective facilities.

However, channeling PPPs through either cost-sharing mechanism or going total commercial where the amounts paid to government healthcare facilities do not correspond with the costs charged by private healthcare facilities, would prove cheaper and more reliable than mere pretence of free services.

The government’s resistance to charge its citizens a minimal contribution to the costs with regards to maternal and child health services in public healthcare facilities, for example, could then be baseless and detrimental to the state’s own efforts at providing better healthcare services to the people.

Most importantly, the said reluctance to embrace the socio-commercial model impedes the sustainability of the very projects envisaged to foster antenatal and postnatal clinic attendance and general healthcare seeking behaviour among women and the public at large.
Francis Semwaza is a Dar es Salaam based development communication consultant. E-mail: [email protected]; Phone: 0717466044