1. PRIVATE PUBLIC PARTNERSHIP
Dr Simon I. Beshir
Consultant Cardiologist
NAMIBIA HEART CENTRE
Roman Catholic Hospital & Windhoek Central Hospital
8th December 2014
PRIVATE PUBLIC PARTNERSHIP
PPP in HEALTHCARE

2. PPP in HEALTHCARE Introduction Overview of PPPs Views on PPPs
Advantages and disadvantages
PPPs in other countries
Our Story
Lessons learned

3. PPP in HEALTHCARE DEFINITIONS
A Public-Private Partnership = contractual agreement
between a public agency and a private sector entity.
The resources of each sector (public and private)
are shared in delivering a service or facility for the use
of the general public.
In addition to the sharing of resources, each party
shares the potential risks and rewards in the delivery
of the service and/or facility.

4. PPP in HEALTHCARE TYPES OF HEALTHCARE PPPs
Outsourcing non-clinical support services
Outsourcing clinical support services
Outsourcing clinical services
Private management of a public hospital
Private financing, construction and operation of a
public hospital

5. Potential Benefits of PPPs
More incentives for private sector to perform
New facilities available earlier
Increased levels of efficiency and innovation
Risks transferred to private sector
Forward spending commitments known and able to be planned for

6. Potential Issues with PPPs
PPP contracts can be very complex
Results assessment is often subjective
Public sector may be locked into contracts while health demands change
PPPs may not gain the population’s trust

7. Many countries are adopting PPPs in Health Care

8. Hospital Facilities PPPs in the UK (DBFO):
>60 new hospitals built
All projects were delivered within the public sector budgets
Estimated that PPP projects cost 17% less than public sector projects – a saving of $4 billion on a $22 billion programme – the equivalent of 25 hospitals
PPPs have failed to win the people’s trust

9. Hospital services PPP in Spain
First wave of 8 PPP (DBFO) contracts awarded in 2006
8th hospital: Valdemoro Hospital – includes Care Contract
€72 million investment – awarded to Capio
Care Contract includes full responsibility for local population
30 year concession – total value c. €1.3 billion

10. TB Control PPP in India Highest burden of TB worldwide
State government contracted with NGO hospital to provide TB control services to 500,000 population
Better outcomes than Control Comparison:
Cost per patient 10% lower ($88)
21% more TB cases found
14% better treatment success rate
Cost per successful treatment 14% lower ($118)
Being extended across other parts of India (with ongoing independent evaluation)

11. OUR STORY – CARDIAC UNIT @ WCH NAMIBIA HEART CENTRE VISION
Only Namibians have a medical aid
The remaining 2 million rely on state health care
Some advanced methods of treating heart disease not available
in Namibia (even at private facilities)
LET’S DEVELOP A HEART UNIT (CENTRE) THAT WILL PROVIDE THE WORLD STANDARD OF CARDIAC CARE TO ALL NAMIBIANS !!!

12. OUR STORY – CARDIAC UNIT @ WCH NAMIBIA HEART CENTRE PREVIOUSLY
Some patients with heart disease
transferred to RSA or Kenya at a
very high cost
Most cardiac patients receive no
or minimal therapy and faced
suffering or death from heart failure,
heart attacks or strokes

13. CARDIAC UNIT @ WINDHOEK CENTRAL HOSPITAL OUR STORY
Established and inaugurated by H.E. President Hifikepunye
Pohamba in August 2008
First step towards the national heart centre was made
Some patients could receive
heart treatment in Namibia
OUR STORY

14. CARDIAC UNIT @ WINDHOEK CENTRAL HOSPITAL
OUR STORY
CARDIAC WINDHOEK CENTRAL HOSPITAL
GREAT SUCCESS BUT STILL SOME PROBLEMS
Lack of qualified staff (especially doctors)
Inconsistent supplies of consumables >
service interruptions
Inconsistent funding of the service

15. OUR STORY – CARDIAC UNIT @ WCH
GETTING A WELL QUALIFIED AND SKILLFULL DOCTORS
State salaries for specialist physicians are below the levels of the
trainees in the EU/UK/US
Private physicians not keen to work at the state facilities (loss of
income from private healthcare)
BIG HURDLE ISSUE ……starting a new train is
more difficult than jumping into a going one

16. Micro PPP CONCEPT OUR STORY – CARDIAC UNIT @ WCH
Attract a highly qualified Consultants to work at the state hospital
Allow them to conduct a limited private practice to supplement
their income
Set a performance standard for each consultant
Define precisely the proportion of consultant ‘s time dedicated to
the state unit

17. PUBLIC INVESTMENT OUR STORY – CARDIAC UNIT @ WCH
Consultant salary as per the national public service pay rates
Annual budget for the service provided + development

18. PUBLIC RETURN OUR STORY – CARDIAC UNIT @ WCH
Increased number of patients using the service
Newly introduced treatments
Less (or no) patients sent for the expensive therapy abroad
Increased patient satisfaction – high quality care in Namibia
Training of the young Namibian doctors and nurses = knowledge & skill transfer to benefit larger number of patients in the future

19. PRIVATE INVESTMENT OUR STORY – CARDIAC UNIT @ WCH
The time spent at the state hospital = loss of income in private practice (far exceeding the state salary)
Know How
Unit management (ownership)

20. PRIVATE RETURN OUR STORY – CARDIAC UNIT @ WCH
Opportunity to define and to develop a national heart service
Opportunity to introduce advanced methods and treatments . . i.e. personal growth, prestige, experience
Ability to earn extra income from the limited private practice

21. 2012 - SERVICE ASSESSMENT BUDGET BASE OUR STORY – CARDIAC UNIT @ WCH
Performance analysis of the Cardiac Unit (2012)
No of patients treated ( outpatients, operations, etc) annually
Portfolio of treatment methods (CABG, stents, pacemakers)
Costing analysis of the Cardiac Unit (2012)
Salaries (doctors, nurses, technical staff)
Capital costs (equipment)
Consumables used for the procedures
BUDGET BASE

22. VISION & GOALS – 5 YEAR PLAN
NAMIBIA
Approx. 2,000,000 population (state patients) vs
UK/EU/US PERFORMANCE STANDARDS
number of cardiac procedures per million population annually =
NUMBER OF CARDIAC PROCEDURES TO BE DONE IN NAMIBIA

23. IMPLANTING PACEMAKERS & OTHER DEVICES
OUR STORY – CARDIAC WCH
IMPLANTING PACEMAKERS & OTHER DEVICES

24. OPENING THE BLOCK HEART ARTERIES WITH BALLOONS & STENTS

25. OUR STORY – CARDIAC UNIT @ WCH
PERFORMING OPEN HEART OPERATIONS SUCH AS BYPASS SURGERY or VALVE REPLACEMENT

26. OUR STORY – CARDIAC UNIT @ WCH

27. INNOVATION & DEVELOPMENT
VISION & GOALS – 5 YEAR PLAN
INNOVATION & DEVELOPMENT
New treatment methods
Clinical research
Clinical data management system

28. VISION & GOALS – 5 YEAR PLAN
New treatment methods
RENAL DENERVATION THERAPY TO TREAT HIGH BLOOD PRESSURE

29. VISION & GOALS – 5 YEAR PLAN ROBUST DATA MANAGEMENT SYSTEM

30. VISION & GOALS – 5 YEAR PLAN

31. VISION & GOALS – 5 YEAR PLAN

32. ANNUAL BUDGETTING PROCESS
ACTIVITY REPORT FOR THE PREVIOUS 10 MONTHS
PROPOSED FURTHER DEVELOPMENT/EXPANSION
UPDATED COST PER ITEM
PROPOSED BUDGET FOR THE COMING YEAR WITH MOTIVATIONS & JUSTIFICATIONS
FINANCE DEPT. OF MHSS EVALUATION
FINAL BUDGET SUMBITTED TO MOF
NEW BUDGET RELEASED USUALLY IN APRIL/MAY

33. PAYMENT MECHANISM
A SINGLE SUPPLIER OF THE CARDIAC UNIT SELECTED BY A TENDER
Responsible for all the supplies for the Unit
Single point of contact for the clinicians
Bulk purchases – good pricing – good value for money
Deadlines and clinical support stipulated in the contract
AN ANNUAL VOLUME OF SUPPLIES ESTIMATE BASED ON PREVIOUS YEAR ACTIVITY + PROPOSED EXPANSION
QUARTERLY REQUESTS SUBMITTED BY THE UNIT LEAD TO THE SUPPLIER VIA THE HOSPITAL MANAGEMENT
WHEN APPROVED THE SUPPLIES DELIVERED TO THE CENTRAL CLINICAL STORES & INSPECTED FOR COMPLETNESS
SUBSEQUENTLY PAYMENT RELEASED TO THE SUPPLIER

34. PRIVATE PARTY RESPONSIBILITY
Clinical leadership of the Cardiac Unit
Staff training
Unit management
Performing complex cardiac procedures
Training of the junior medical & nursing staff
Setting up goals and targets for the unit
Putting together the annual activity report of the unit
Bringing innovation and new developments
Budget proposal – justfication.

35. GOVERNMENT RESPONSIBILITY
Unit funding (staff salaries, annual budget)
Analysis of the annual activity report
Review and justification of the proposed budget
Supervision of the unit ( via senior hospital management)

36. CARDIAC UNIT @ WCH - OUTCOMES

37. LESSONS LEARNED The Vision & Realistic Goals are essential
Micro-PPP can achieve Macro-RESULTS
Open minded approach - don’t let a stupid rule to stop a good project
Robust data collection is necessary to avoid abuse of public money
Key players must be selected well !

38. THE FUTURE OPTIONS Continue the current system = micro PPP
National Heart Service – Country Wide Project = true PPP
Outsourcing of the Cardiac service fully to a private facility for a fixed fee per patient
Reverting back to a full state based care

39. Thank You