Overview

PART 1: Setting the scene

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.

PART 2: Country case studies

An important part of the Partnership involved demonstrations of actual case studies from India and South Africa. A selection of the case studies demonstrated and discussed in various international workshops that occurred in Malawi, India and South Africa are provided in chapters 5 and 6. There are 12 case studies in total, eight of which are from India (chapter 5) and four from South Africa (chapter 6). While most of the case studies focus on health services and related support functions, two focus on financing healthcare. The first is from India where a PPP was used to expand coverage to families living below the poverty line. The second is from South Africa and focuses on a regulatory approach to expanded coverage for families able to contribute toward their own healthcare.

PART 3: Concept pilot proposals

An important result of the Partnership was to support the selection and development of potential pilot PPPs for three sub-Saharan African countries – Burkina Faso, Malawi and Zimbabwe. While there are similarities in the socioeconomic and health systems contexts of the three countries, there are also significant differences. For instance, while both Burkina Faso and Malawi face strong and consistent periods of economic growth, Zimbabwe has lost roughly 50% of its economy over the past decade. Nevertheless, all face fiscal and institutional constraints combined with rapid population growth and urbanisation – trends which will continue for the foreseeable future. The pilots are discussed in consecutive chapters with Burkina Faso in chapter 7, Malawi in chapter 8 and Zimbabwe in chapter 9.

PART 4: Guidelines for implementing health PPPs and the way forward

Public-private partnerships typically involve large-scale interventions of one form or another and therefore require strong processes to develop and implement projects. Chapter 10 offers detailed guidelines useful for any country seeking to expand the role played by PPPs. Once implemented, however, it is also necessary to learn from mistakes and make improvements to any new PPPs implemented. An overview of PPP appraisals, both before (to approve) and after project implementation, is therefore provided in chapter 11. Chapter 12 concludes the book with a brief comment on certain of the main thematic elements arising from the earlier chapters.