Public-Private Partnerships (PPPs) as an Instrument to Achieve Sustainable Development Goals (SDGs) in healthcare. SDG Agenda sets new benchmark for infrastructure projects. A presention made for 3rd PPP Forum in China ( Bejing, 1 December 2018)

1. 3rd PPP Forum
1st December, 2018
Beijing, China
Ing. Natalia Korchakova-Heeb
Managing Director, SDG.17 Consulting GmbH
SDGs and PPPs
in the Healthcare Sector –
New Benchmarks

2. Agenda
A new policy agenda
SDGs01
PPPs in Healthcare Sector02
Case Study03
Case of PPP University Hospital Schleswig-Holstein,
Germany.
Conclusions04
New Benchmarks

3. 1.Sustainable Development Goals
New Policy Agenda

4. Sustainable Development Goals relevant to PPPs
in Healthcare Sector
SDG 17.17
Encourage and promote
effective public, public-private
and civil society partnerships
Clean water and
sanitation
.
SDG 6.
Ensure healthy lives
and promote well-
being for all at all
ages
.
SDG 3.
Poverty reduction
SDG 1.
Climate ActionDevelopment of
resilient
infrastructure
SDG 9.1
Affordable and clean
energy
SDG 7. SDG.13

5. Important Notions for Understanding PPPs in
Healthcare
.
Data Privacy
Resilient Infrastructure
E-heath, Healthcare Mobile
Applications, Telemedecine
Smart hospitals
.
People-first PPPs
IMPACT INVESTING
Circular economy
Sustainable
health
Social impact

6. PPPs as an Instrument to Achieve SDGs, in
particular SDG N3.
Access to FinancingAlignment and Ccntribution to SDGs
Demonstrating alignment with the SDGs help
governments attract financing from multilateral
development banks and funds.
PPP projects should demonstrate relevance to
SDGs and reflect on their contribution to
achievement of SDGs.

7. What Does it Mean Being SDG-Compliant for
PPPs in the Healthcare Sector?
A
• Applying UNECE concept of
“people-first PPPs” - along
with classical “value for
money”, “people-first” PPPs
strive to achieve also “value
for people”
B
Applying the Equator Principles
and Sustainable Finance
UNEP Inquiry into the Design of
a Sustainable Financial System
(2015), The Financial System
We Need: Aligning the Financial
System with Sustainable
Development
C
Alignment with the
European Consensus on
Development- a blueprint
which aligns the Union's
development policy with
the 2030 Agenda for
Sustainable Development
D
Applying ISO 26000 by public
and private partners ISO 26000
- international standard giving
guidance/recommendations
about how any organization can
improve its Social Responsibility
and thus contribute to
sustainable environmental,
social and economic
development
v Investing in sustainable health systems
and responding to SDGs relevant for
PPPS in the healthcare sector
v Investing in people’s health as human
capital
v Investing in reducing health inequalities

8. 2. New Benchmarks for PPPs in Healthcare Sector

9. Current Trends in Provision of Healthcare
Services
Less need for hospitals
Presentation
Vastly improved outpatient and home
management
04
Precision Medicine
Development of precision medicine
based on genomics revolutionase
production of medications and
treatments
05
E-health and digital
solutions
Examples of successful e-health developments include
health information management and networks, electronic
health records, telemedicine services, wearable and
portable monitoring systems and health portals, use of
blockchain technologies, smart hospitals, artificial
intelligence, etc
06
Preventive Medicine:
Prevention vs. Treatment
Policies and financing is switching from
treatment to preventive medicine. 01
Focus on primary care
Increased emphasis on primary care in
comparison to secondary and tertiary
care (Astana Declaration on Primary
Health Care: From Alma-Ata towards
Universal Health Coverage and SDGs)
.
02
Aging population
Aging population and a need for more
services for elderly people
Shift from a hospital - centred model to
community-based care and integrated
services
03

10. BENCHMARK N1.
Energy-efficient hospitals
• The average annual energy consumption of a German hospital under
normal operating conditions has been determined to be 0.27 MWh per
m2, 14.37 MWh per worker, and 23.41 MWh per bed. (Evaluation of
Energy Consumption in German Hospitals: Benchmarking in the Public
Sector ,Alfonso González González and others)
• North Rhine-Westphalia Energy Agency (NRW), successful examples
show that it is possible to reduce energy costs in hospitals by up to 40%.
• Passive House Standard - efficient thermal insulation
combined with a ventilation system
• Nearly zero energy standard - by 2020 the specifications of
the German Energy Saving Ordinance. They combine the
thermal insulation on the facade and roof for example with
triple insulated glazing, a heat pump and solar thermal energy
for water heating
• Energy Plus standard- more energy is produced by the hospital
than consumed (due to the use of renewable energy)
• Use of e-mobility in buildings - supporting the rollout of e-
mobility infrastructure such as e-charging points in buildings.

11. BENCHMARK N2.
Resilient Healthcare Facilities
• Resilience - capacity of health actors to prepare for
and effectively respond to crises and to maintain at
the same time core functions when a crisis hits (war,
terror attacks, technological catastrophes,
humanitarian crisis, epidemic, natural disasters)
• The Hospital Safety Index of the World Health
Organisation
• Application of BIM - digital representation of physical
and functional characteristics of a facility helps at
critical situations

12. BENCHMARK N3.
Circular Economy
• Refurbishing/remanufacturing of equipment (Philips,
Siemens, GE)
• No use of plastic in the EU by 2021. Complete ban on
plenty of single- use products, the use of plastics for
which no alternatives currently exist – mostly food
packaging – will have to be cut down by 25 percent by
2025.
• Recycling of waste
• Use of recyclable materials
• Reflection of those requirements in procurement
requirements

13. BENCHMARK N4.
Public Accessibility*
• Short (max.600m) accessibility to the closest point
of public transport (bus, tram, train, etc.),
• Quality of the road connection (connection to the
developed main road, motorway access via a good
arterial road),
• Individual parking concept (parking for people with
mobility limitation, bicycle parking/ taking shelter
facilities, temporary parking for emergency
physician, delivery, etc.)
• Good accessibility (no crossing without traffic lights
or use of multi-lane roads that are designed solely
for motorized traffic)
• Development of the site by existing bicycle network
*(based on German Healthcare Partnership GREEN HOSPITAL STUDY)

14. BENCHMARK N5.
Digital Inclusion
• Many of the people who could most benefit from digital
services are the least likely to be online.
• One in five people lack basic digital skills and one in
eleven people have never been online. These are likely
to be older, less educated and in poorer health than
the rest of the population (Report on Digital inclusion for
health and social care, NHS, 2018)
• Closing the digital gender divide
• Smart hospitals, telemedicine, health mobile
applications, Blockchain for health, Artificial
Intelligence and Big Data

15. 3. Case Study

16. Total costs for construction and renovation: €520 million (US$658 mln)
Total costs of the project: 1,7 bln. EUR (US $1.9 billion)
Contract duration: 30 years
Sponsor/Investor BAM PPP PGGM JV (50%),
Vamed+DIF 50% (VAMED equity investment of 5% plus 45% by DIF)
Design and Build Contractor: BAM Deutschland AG (50%), VAMED Health
Project (50%)
Facilities Management Contractor: BAM Immobilien-Dienstleistungen (50%),
VAMED Management und Service (50%)
Start of construction: 2015
Completion of construction: 2021
The operational phase will include hard facilities management and technical
management services and will run until 2044.
Financing: 75% of the project finance debt - UKSH as milestone payments, the
consortium partners and commercial funders will provide the remaining 25% of the
debt as equity and long term funding.The long term debt from the commercial
funders will be provided by EIB, DZ Bank, KfW, LBBW, SEB and SMBC.
Other information: 13.000 staff employed by the University Hospital
450.000 patients per year (2.500 Beds)
Case Study
PPP University Hospital Schleswig-Holstein, Germany

17. 4. Conclusions

18. Conclusions
How it will effect PPP Projects in Healthcare Sector?
v Investors will be checking the healthcare projects as to SDG compliance and against
“people first PPPs” criteria.
v Size of the hospitals will be reduced.
v More care facilities for elderly people and integrated care will be built, possibly using
PPP model.
v More primary care facilities will be built, less secondary and tertiary hospitals but
highly specialized.
v Smart cities would require smart hospitals.
v A lot of renovation projects will be under way in the EU and other countries to bring
healthcare infrastructure in line with zero-energy requirements by 2020. Considering
the number of the projects required, PPP could be a solution.
v Along with infrastructure PPPs, we will see more non-infrastructure PPPs (IT PPPs,
pharma product development PPPs, service PPPs).
v Digitalisation of delivery of PPP projects- smart PPPs (use of BIM, Blockchain, digital
solutions, etc).

19. Contact us
Ing. Natalia Korchakova-Heeb
Managing Director
SDG.17 Consulting GmbH
https://sdg17consulting.de
Mobile : + 49 173 6117539
Landline: +49 69 2649 3122
Fax: +49 69 1504 1226
Email: natalia.korchakova-heeb
@consulting-frankfurt.com

20. Thank You!