Financing health in Africa – Africa-India Partnership

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Public-private partnerships in healthcare financing and delivery offer significant opportunities for accelerated improvements in health service access in fast-developing economies such as those found in Africa. This book acts as a resource for countries in Africa seeking ways to leverage private actors in the achievement of public goals. It traverses the knowledge and experience of health-related public-private partnerships on two continents, Africa and India, to accelerate the transfer of knowledge in their accountable design and implementation. The book provides information on how to regulate and implement health-related PPPs using case studies from India and South Africa.

As a research effort, this book, launched during the Annual Meetings of the African Development Bank on 25 May 2017 in Ahmedabad, India, is the outcome of a partnership, the India- Africa Partnership (Partnership), between the African Development Bank (ADB), the Health Systems Research India Initiative (HSRII) and the University of the Witwatersrand (Wits) based in Johannesburg, South Africa.

While the overall idea was always to explore the potential for health-related PPPs in Africa, the central question faced by the partners was how to achieve this. For instance, how would a project such as this succeed best in getting countries in Africa to consider and implement health-related PPPs where no prior experience existed and where private sector penetration may be low and, importantly, where financial capital and fiscal space may be constrained.

The approach adopted by the Partnership was therefore divided into four activities. The first involved running international workshops where officials from interested African countries were presented with case studies on PPP approaches from India and South Africa. The second involved site visits for the participating African countries to Indian health PPPs in and around Bengaluru. The third involved the provision of direct support to interested African countries, in this case Burkina Faso, Malawi and Zimbabwe, to develop pilot project proposals. This took the form of technical advice offered by the research partners - Health Systems Research India Initiative (HSRII) and Wits. The final phase of this latter support included a week-long workshop in Johannesburg during January 2017 where all the project partners and participating countries collaborated to finalise pilot proposals. The fourth involved drafting specific studies, or economic and sectoral works (ESWs), for incorporation into the book. A process which ran parallel to the various conferences and workshops.

This book represents the culmination of the complete process carried out by the research partners and supported by the Indian Trust Fund and the ADB. The contents are derived from extensive international engagements, direct contact with health PPP implementers from both India and South Africa, and technical support for project development. The pilot project proposals contained in this book were, consequently, developed during the course of this project and are entirely the inspiration and work of the officials from those countries.

Foreword

Improving the quality of life for the people of Africa is one of the defining priorities of the African Development Bank. And there are few things closer to the quality of life than public health.

Affordable and effective health services are a sign of sustainable and inclusive economic growth, as well as of stable, civilized and peaceful communities.

The challenges of delivering health services may in the past have been ascribed by most to public authorities but today is characterized in most African countries more by an accepted partnership between the public and private sectors working in agreed policy and regulatory ...

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Overview

Chapters 1 to 4 provide context and background to health public-private partnerships (PPPs) in sub-Saharan Africa. First, background to the book itself is provided in chapter 1, including the overall approach and sources of information. Second, the important idea of universal health coverage (UHC) is reviewed in chapter 2, together with a high-level overview of the sub-Saharan health context and some discussion of the emergence of PPPs in health. Third, the concept of PPPs is probed in chapter 3, together with more detailed discussions on the case for PPPs in health and their potential strategic role for Africa.

The enabling environment for PPPs is also examined to clarify the importance of institutional prerequisites for successful PPPs. Fourth, the institutional frameworks for successful PPPs are covered in some detail in chapter 4, with specific reference to the institutional architecture, regulatory frameworks and an overview of implemented health-related PPPs.

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Key contacts

CHAHED CHAWKI ,Chief Communications Officer, AHVP