On March 24th, as part of the Civil Society Policy Forum ahead of the upcoming IMF/World Bank Spring Meetings (5-11 April 2021), Wemos co-organised the interactive session ‘Universal access to healthcare: lessons learned from Public-Private Partnerships’. Dr Tlaleng Mofokeng (UN Special Rapporteur on the Right to Health) was among the speakers who voiced their concerns about healthcare Public Private Partnerships to the World Bank. “As we think about a recovery after Covid-19, it’s very important to put the public first, the people first, the human first,” Dr Mofokeng said.
Co-organisers of the session were Eurodad, Afrodad, DAWN, GI ESCR, ISER and SID. What unfolded was an engaging and direct conversation between Andreas Seiter (World Bank’s Global Lead for Private Sector in Health) and panelists Adrian Chikowore (Afrodad), Allana Kembabazi (ISER) and Masaya Llavaneras Blanco (DAWN), who have direct experience and knowledge of the reality of Public-Private Partnerships (PPPs).
The reality of policies
Panelists Adrian Chikowore (Afrodad), Allana Kembabazi (ISER) and Masaya Llavaneras Blanco (DAWN) shared their evidence-based lessons learnt from cases of PPPs in healthcare in Zimbabwe, Lesotho, Peru, Fiji, Uganda and Kenya. They learned that:
Lessons learnt from the World Bank’s point of view
World Bank representative Andreas Seiter emphasised that PPPs were originally meant to build infrastructure, not health service provision, and is personally not a promotor of PPPs in the healthcare context. He also commented on the high administrative costs that often prove to accompany health service provision and financing projects involving companies, but that these are also a problem when foreign non-profit organisations get involved. He called for more peer-reviewed research on projects that involve and strengthen the private sector in health and showed openness to a constructive dialogue on the topic with civil society organisations.
“The state has an obligation to fulfil the right to health”
Powerfully spoken, Dr Tlaleng Mofokeng’s intervention highlighted the importance of the public healthcare system as the main instrument for governments to fulfil their obligation to provide the right to health for all. “The obligations to fulfil the right to health lies on the state, and the state cannot delegate this obligation to other players in the healthcare system,” said Dr Mofokeng. Delegating this responsibility to private actors is therefore problematic, as people and civil society cannot hold private actors accountable in the same way as they hold governments accountable for equal treatment. Dr Mofokeng concluded with a pressing call: “As we think about a recovery after Covid-19, it’s very important to put the public first, the people first, the human first.”
Flip the cascade for a “public first” approach
In its 2017 publication “Maximizing finance for development”, the World Bank advises borrowing governments to implement a “Cascade” guide in decision making for financing development projects – and in which governments should explore all private financing possibilities of a project first, before resorting to public investment. However, this approach has been found unfit for social sectors such as healthcare, because commercialisation often leads to unequal access to these sectors as well as market failure. During the webinar, Wemos and other civil society organisations proposed to flip the cascade when it concerns the health sector, advocating a ‘Public First’ approach. This was also our message in our co-signed open letter to the World Bank Group: “[The Public First] approach implies using all possible ways to expand public resources for health, including official development resources, before resorting to private financing and commercial solutions.” Our call was based on our analysis of PPPs in healthcare as described in our new position paper ‘Risky business’: PPPs with commercial companies in the healthcare sector hamper progress towards universal and equitable access to healthcare.
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