How public-private partnerships can give more people better healthcare

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Alan M. Trager, Honorary Professor, University College London & President of the PPP Initiative LTD

• Health access is a defining challenge facing 21st-century governments.
• Even before the pandemic, slower-moving crises like non-communicable
  diseases and ageing populations threatened to put a strain on health
  systems.
• Public-private partnerships are emerging as innovative solutions for expanding and improving health access.

Our world today faces a host of complex healthcare issues making health access a defining challenge facing 21st-century governments. COVID-19 has killed millions around the world and brought entire economies to a halt. But even before the pandemic, slower-moving crises like non-communicable diseases and ageing populations threatened to strain national healthcare budgets and limit the length and quality of human lives.

Massive challenges like these require a “whole of society” approach. They are too large and too complex for either the public or the private sector to address alone, and thus it is essential that the public and private sectors address them together. Public-private partnerships (PPPs) – once thought of as financing tools best suited for infrastructure projects – have started to emerge as innovative solutions for expanding and improving health access.

At their best, PPPs leverage the strengths of the public and private sectors simultaneously. They can create economies of scale and expand access to care to underserved populations. And they can create sustainable returns for the private sector without compromising cost-effectiveness to the public sector.

But PPPs are complex structures. Each one is different, and each must be adapted to the problem it attempts to solve. As such, they require a nuanced approach – one that balances the interests of both sectors, ensures a workable method for sharing decision-making authority, and encourages accountability from both parties. As such, developing an effective, sustainable healthcare PPP is no small task.

The World Economic Forum has collaborated with the Joint Centre for Public-Private Partnerships at University College, London on its latest project: Learning Journey: Public-Private Partnerships for Access to Care.

The six-month project brought together a highly motivated group of influential institutions from the public, private and non-profit sectors. They developed a set of best practices for engaging in healthcare PPPs, which are published in a white paper titled Public-Private Partnerships for Health Access: Best Practices.

By learning from these varied perspectives, the group was able to identify key commonalities that successful healthcare PPPs share.

While it remains true that each PPP is unique, successful PPPs share the following structural similarities.

Credibility and trust

Trust is at the heart of every partnership. Partners in a PPP must be sure that their counterparts can be counted on to fulfil their obligations and act in the best interests of the partnership. But successful PPPs analyze trust holistically – a trustworthy partner has both the inclination and the ability to deliver on its promises. Is this partner incentivized to act in the best interests of the partnership? Does this partner have the capacity to deliver results?

Aligning vested interests

The interests of the public and private sectors will not always be in perfect alignment. But many potential partnerships have been abandoned at the first sight of a “conflict of interest.” Participants in the Learning Journey agreed that the presence of a conflict of interest doesn’t necessarily mean that a partnership is unviable. Conflicts can be managed through a process of aligning vested interests. By tying returns for either party to the success of the project as a whole (as measured through a set of agreed-upon quantifiable metrics), a PPP can ensure that both partners are incentivized to pursue what’s best for the partnership.

Accepting a range of returns

Participants in the Learning Journey from both the public and private sectors agreed that positive returns are essential in ensuring long-term sustainability. The need for a fair return on investment, they agreed, is not in and of itself a conflict of interest. But it was also noted that “returns” may go beyond merely financial. Partners in a PPP may be able to access greater value by considering a wider range of returns, including strategic benefits, reputational advantages, and improved relationships across sectors.

Engaging the public as a partner

In any successful PPP, the public represents a “third partner,” as either recipients of services or participants in solutions. To reduce the incidence of non-communicable diseases, for example, members of the public must be enthusiastic participants willing to make long-term lifestyle changes. The COVID-19 pandemic, which has seen the emergence of a strong anti-vaccine movement, exposed the disastrous effects of a lack of trust in medical systems and solutions. Public engagement will always involve a dedicated communications strategy, often with the help of communications professionals. But it is crucial to remember that the public is not a monolith—different segments of the population must be engaged in different ways.

The future is collaboration

Of course, no set of “best practices” will be able to successfully change our world’s approach to public-private partnerships without skilled professionals who are empowered to apply them. Professionals in both sectors must be armed with the analytical frameworks and skills that enable them to create and maintain real-world PPPs at scale. And therefore, capacity-building must take place. Executives must be trained. Dialogues must be fostered. And new partnerships must be supported institutionally, so that we can learn from every success and failure.

The potential for PPPs to improve health access has never been more apparent. With a new set of “best practices” and a highly engaged and motivated set of public- and private-sector partners, the path forward for increasing health access through cross-sector collaboration is clearer than ever.