THE UN endorsed Sustainable Development Agenda (SDA-2030) target health as a basic human right amongst its aspirational goals within its 17 goals and strategic directions.
Under the specific strategy of universal health coverage (UHC), increased effort is to be directed to health quality and reducing health inequities globally.
The aim is to address a wide range of health-related measures, inclusive of prevention, diagnosis, treatment, palliation and end of life support incorporated within the wide framework of public and clinical healthcare.
This is inclusive of primary health care entailing public and private sector healthcare components.
Historically UHC had been discussed with preliminary discourse within the last two decades. Acknowledging that at the end of the millennium development goals (MDG) and beginning of the SDG era in 2015 concrete effort remained at a “discussion stage” at global forums and with developed State
levels, largely. The concept of private-public-partnerships (PPP) took root following the global financial crises of the late 20th and early 21st century.
The need to address the various fiscal constraints faced even by the developed world was questioned. PPPs are at the top of development financing options of governments and multilateral development banks (MDBs) in the global effort to achieve all sustainable development goals (SDGs)
At the global scale, World Health Organization (WHO) has established a Health System Governance Unit which is responsible for studies into PPP inhealthcare and its delivery. The salient reporting features originating in the African and East Mediterranean States, indicate the need for open ended dialogue,
discussion and understanding the strengths and weaknesses of both the public and private primary-healthcare systems.
Bringing all interested parties, inclusive of communities, Civil Society Organization (CSO), Non-Governmental Organization (NGO) bilateral and multicultural partners and transnational philanthropic organisations to establish a country specific strategy for best outcomes. The fact remains that governments play a pivotal role, however, there remains no clear strategy nor there is a political will to
involve the private sector as co-investor and thought partner.
Realigning healthcare needs remain paramount not just as a basic human right in any given State but as the COVID-19 pandemic has demonstrated that health underpin social, environmental, economic and national development commencing at individual, group, national and at a global level.
Fiji’s response to addressing PPP historically was undertaken in the 2nd decade of the 21st century with preliminary discussions within the interim government to allocate 50 per cent of the Annual Training and Productivity Authority of Fiji levy to Accident Compensation Commission and the balance to developing and running the infrastructure of primary care public/private partnerships. The
PPP discourse was canned for various political reason. However, the COVID-19 pandemic unmasked a multifaceted, fragile public-health system with all its ramifications within the public clinical services.
With great haste a PPP appeared without national or professional dialogue as a last political straw by the ruling political party. The current areas of PPP in Fiji’s health system apply at both macro and micro
levels. The PPP with Aspen Hospital group (Macro) and that with the general practitioner level (Micro).
Fiji’s infant Coalition Government needs to open up the Aspen/FNFP (Healthcare Fiji Ltd) agreement for clarification, tabling its strengths, weaknesses and its sunset clause, if any. The need to invite national dialogue for a progressive forward pathway is mandatory.
PPP
1. The Australian Aspen Hospital recruitment agency was mated with Fiji National Provident Fund (FNPF) to create “Healthcare Fiji Ltd.”. This Australian Company, which delved into healthcare delivery in the Solomon Islands during the RAMSI period, having served “under makeshift tents” for emergency healthcare, akin to their activation in Afghanistan for the vaccination of Afghani children. The Australian
Post reports that Aspen Group profited over a billion dollars during the COVID-19 crisis out of “personal protection equipment” wholesaling and medical human resource placements in Australia.
Whilst FNPF remains a superannuation scheme to workers in Fiji, it remains the cash-cow for
the government’s fiscal needs viz a viz procuring investment funding and loans without questioning its original intentions, when board membership was politically restructured conveniently into 2023. The agreement between the two consenting parties needs public and professional scrutiny for best outcomes.
2. As the COVID-19 pandemic ravaged the frail healthcare system, alternatives for primary
health within the population mounted to a crisis with increasing excess morbidity and mortality in the domestic and clinical environments. A hasty plan to round up a cohort of private primary-health providers to service the population was devised without prior wide professional or community discussion.
The lack of close monitoring, dialogue and keeping the service politically centralised has resulted in several wayward outcomes inclusive of amendments to legally binding regulation which previously upheld medical laws suitably.
A recent announcement by our Minister of Health and Medical Services at the Annual Conference of the Fiji College of General Practitioners indicates a major audit of the 2022 government’s fiscal input into this scheme as fruitless to date, that a major reform is to be affected in 2023.
However, the PPP with the private medical sector is now purposely extended and inclusive of private laboratories, dentists, general practitioners and private hospitals.
Conclusion
The need to openly dialogue both these PPP’s for long term sustainability with best financial protective and health security is now. The evolving new system of governance in open democracy needs to open
“Pandora’s box”. Unlocking digital health and other digital platforms to address innovative delivery system will strengthen such PPP’s. All PPPs need to be based on good governance, transparency, fairness as well as equity and social justice.
Reference:
1.Towards Better Engagement of the private sector in health service delivery. A review of approaches to the private sector engagement in Africa. Geneva WHO (2022) License CCBY-NC-SA
2. Florian File et al (6). COVID-19 and Governance-key dimension Governing the Public-Private Partnership of the future: 3.0 IGOLearning from the experience of Pandemic time. EuroHealth-vol12/
No.1/2021 pg.49-53.
3. Lice Cokanasiga. PPP: Are they a Healthy Investment Model? Lautoka and Ba Hospital – Fiji A Case
Study. July 2020. Dawn Discussion Paper #22 (Development Alternations with Women for a New Era).
License CC by-NC-ND.4.0
DR NEIL SHARMA is a former health minister. The views expressed in this are his and not necessarily that of The Fiji Times
