Public-Private Partnerships

Over the past ten years, there has been a rapid expansion and acceleration of interest in public-private partnership (PPP) models for health across many countries and all national income levels. PPPs are a form of long-term contract between a government and a private entity, through which the government and private party jointly invest in the provision of public services. Through this arrangement, the private sector takes on significant financial, technical and operational risks and is held accountable for defined outcomes. PPPs have previously been applied across other sectors (particularly infrastructure, transportation and energy) and typically seek to capture private sector capital or expertise to improve provision of a public service. In healthcare, the public-private partnership approach can be applied to a wide range of healthcare system needs: construction of facilities, provision of medical equipment or supplies, or delivery of healthcare services across the continuum of care. While relatively simple "design, build, finance and maintain/transfer" models remain the most commonplace, an increasing number of governments are experimenting with or considering more ambitious models such as public-private integrated partnerships (PPIPs), under which the private partner is additionally responsible for delivering all clinical services in one or more health facilities, including an acute care hospital, as well as one or more primary care facilities.

Since 2012, our Global Health Group has partnered with PwC Global Healthcare to form a joint fellowship to advance the study of PPPs in health around the world. The fellowship builds upon the two organizations' common interest in PPPs as innovative models to improve the quality, efficiency and accessibility of health care across countries at all levels of economic development. The goal of the fellowship program is to further the academic study, documentation and rigorous evaluation of PPPs, in order to increase understanding of their design, impact, costs and challenges.

The result of this joint research is a series of reports (see Resources) highlighting the many facets of innovative PPP models globally, and disseminating lessons learned and leading practices for the benefit of current and future projects.