The role of public private partnerships in universal healthcare delivery

1. The role of Public-Private
Partnership in the
Universal Healthcare
Delivery

3. ▶Article 25 of the 1948 Universal Declaration of Human
Rights states that everyone has the right to a standard of
living adequate for health, including medical care, and the
right to security in the event of sickness or disability.

4. Reality Expectations
Opportunities

5. Reality
Life expectancy at birth 55 yrs
Infant mortality rate 484
Maternal mortality ratio 814
Under-five mortality rate 750
Births attended by skilled health personnel (%) 35
2015 figures

6. Reality
Life expectancy at birth 55 yrs
Infant mortality rate 484
Maternal mortality ratio 814
Under-five mortality rate 750
Births attended by skilled health personnel (%) 35
2015 figures

7. Reality
Current health expenditure (CHE) as % of GDP 4
Current health expenditure per capita $98
Government health expenditure as % CHE 16
Private health expenditure as % CHE 74
Government health expenditure as % budget 5
Government health expenditure as % GDP 1
Government health expenditure per capita $16
Private health expenditure per capita $72
2015 figures

8. Reality
Country Ranking Per Capita $1 Maternal death risk
rank
United States 1 9,402.54 46
Cuba 32 2,474.62 69
South Africa 62 1,148.37 112
Nigeria 140 216.87 176
1. PPP dollars

9. Former President Olusegun Obasanjo has described Nigerian health sector as one of the
worst health indices in the world, lamenting that the sector is underfunded by the
government. Obasanjo decried poor budget allocation to the sector, claiming that majority
of budgeted amount were spent on personnel salaries and emolument. Former President
while speaking at the Launching/Endowment for expansion of new site for the Federal
Medical Centre, Abeokuta disclosed that the poor state of health has made the country lose
almost N175billion annually on medical tourism.
https://www.vanguardngr.com/2018/07/nigeria-has-some-of-the-worst-health-indices-
in-the-world-obasanjo/

10. ▶A higher level of public health expenditure significantly
decreases infant mortality and increases life expectancy
(Kim & Lane, 2013)
▶Public health expenditure has negative effect on infant
mortality and under-5 mortalities (Yaqub, Ojapinwa, &
Yussuff, 2012)

11. Expectations
▶World class hospitals and health infrastructure
▶Universal health coverage
▶Improved health outcomes
▶13% - 15% budgetary funding

12. Universal Health Care
▶ All individuals and communities receive the health services they need
without suffering financial hardship.
▶ Includes the full spectrum of essential, quality health services, from
health promotion to prevention, treatment, rehabilitation, and palliative
care.
▶ Enables everyone to access the services that address the most important
causes of disease and death, and ensures that the quality of those
services is good enough to improve the health of the people who receive
them.

13. Universal Health Care
▶ Protecting people from the financial consequences of paying for
health services out of their own pockets reduces the risk that
people will be pushed into poverty because of unexpected illness.
▶ Achieving UHC is one of the targets the nations of the world set
when adopting the Sustainable Development Goals in 2015.

14. UHC is not…
▶UHC does not mean free coverage for all possible health
interventions, regardless of the cost, as no country can
provide all services free of charge on a sustainable basis.

15. Measuring UHC
▶The proportion of a population that can access essential
quality health services.
▶The proportion of the population that spends a large
amount of household income on health.

16. Achieving UHC
▶Robust financing structures are key.
▶When people have to pay most of the cost for health
services out of their own pockets, the poor are often
unable to obtain many of the services they need, and even
the rich may be exposed to financial hardship in the event
of severe or long-term illness.
▶Pooling funds from compulsory funding sources (such as
mandatory insurance contributions) can spread the
financial risks of illness across a population.

17. Funding models
▶Compulsory insurance
▶Single payer
▶Tax-based financing
▶Social health insurance
▶Private insurance
▶Community-based health insurance

18. Why PPP?
▶Given a minimum package of health interventions, two
major considerations arise:
§ health financing and
§ the organization of health-care delivery.
▶Private-sector health provision with public financing is
commonly thought to offer the best combination to
ensure efficient, high-quality, low-cost primary health
care.

19. Why public private partnership?
▶Government resources allocated to health have not been
sufficient to:
§ maintain the existing health facilities
§ meet the increased demand due to population growth and rising
public expectations
§ increase access to services; and
§ improve the quality and level of care provided.

20. National policy on public private
partnership for health in Nigeria
▶The public-private mix outlined in Chapter 8 of the
National
▶Health Policy strongly recommends an increased role for
the private sector in service delivery.
▶The policy permits the participation of the private for
profit and not-for-profit including health providers,
religious and other voluntary organizations, communal
bodies, and individuals in the provision and financing of
health care services.

21. Public private partnership
▶A “public private partnership” is a collaborative
relationship between the public and private sectors aimed
at harnessing (and optimizing the use of all available
resources, knowledge, and facilities required to promote
efficient, effective, affordable, accessible, equitable and
sustainable health care for all people in Nigeria.
▶PPPs are “a long-term contract between a private party
and a government entity, for providing a public asset or
service, in which the private party bears significant risk
and management responsibility, and remuneration is
linked to performance.”

22. Types
▶Contractual
▶Public Driven Partnerships:
§ Initiated by public administrations
§ Owned more than 50% shares
▶Private Driven Partnerships:
§ Mainly initiated by the private sector
§ Profit orientation may or may not be a primary goal
§ More than 50% involvement in PPP
§ Public sector acts as a monitoring and standard setting body

23. ICRC
▶The regulator for PPPs in Nigeria
▶Disclosure portal

24. Lack of
Access to
Health
Universal
Health
Coverage
Public private partnership
Health insurance

25. Bibliography
▶Federal Ministry of Health. (2005). National policy on
public private partnership for health in Nigeria. Federal
Ministry of Health.
▶Kim, T. K., & Lane, S. R. (2013). Government Health
Expenditure and Public Health Outcomes: A Comparative
Study among 17 Countries and Implications for US Health
Care Reform, 3(9), 6.
▶Lagomarsino, G., Garabrant, A., Adyas, A., Muga, R., &
Otoo, N. (2012a). Moving towards universal health
coverage: health insurance reforms in nine developing
countries in Africa and Asia. The Lancet, 380(9845), 933–
943.

26. ▶Sachs, J. D. (2012). Achieving universal health coverage in
low-income settings. The Lancet, 380(9845), 944–947.
https://doi.org/10.1016/S0140-6736(12)61149-0
▶Yaqub, J. O., Ojapinwa, T. V., & Yussuff, R. O. (2012).
Public health expenditure and health outcome in Nigeria:
the impact of governance. European Scientific Journal,
8(13), 189–201.