Public private partnerships (PPs) are therefore one of the tools which enable governments to extend their reach in providing services to their citizens. But, says JP Labuschagne, Africa infrastructure and spatial projects leader at Deloitte in Kenya, it is critical that both parties understood their roles, responsibilities and risks, and that there were measurement structures in place.
There was general acknowledgement on the changing nature of PPPs and that the standard definitions need a recalibration in order to avoid a disconnect between current partnerships and those of the future. “Traditionally, PPPs were mostly focused on infrastructure, but this is evolving and in future we could see PPPs where the private sector could build a hospital as well as provide equipment services to government patients in that hospital for which government would pay a fee," says Strover Maganedisa, South Africa’s head of the PPP in the Treasury.
New technology and innovation will change the way PPPs are developed and implemented and provided a South African case study – the Nkosi Albert Luthuli project – which is a technology driven PPP which has turned an ordinary referral hospital into a state of the art, paperless environment which has been successfully running for 15 years.
The private sector encompassed all entities that were not state. This included for-profit and not-for-profit organisations such as faith-based organisations, says Professor Khama Rogo, lead health specialist and the head of the Health in Africa initiative at the World Bank. All African leaders come into power wanting to improve health. In instances where the private sector has been ignored, even if unintentionally, it has impacted on healthcare delivery.
He stresses the need for strong and sustainable government-led public private dialogue which looks at current policy and legislation. “We have always focused on PPPs as a sort of legal transaction but actually they start with the engagement process. In every country that the World Bank has worked in, we have established a forum for dialogue.”
As the the nature of PPPs evolve so laws and policies must change to accommodate this, adding that governments must lead on policy and regulatory reforms that are needed and must be able to project the implications of these and ensure that they understood at all levels.
Rogo added that it was crucial that PPPs are linked to the national health agenda and that systems are put in place to ensure continuity and to protect the interest of the public. “Government must see itself as the initiator, the protector and the prioritiser. The private sector entering into a PPP must be committed to invest in that country and be committed to sustainability of the project."
