Pakistan committed to Health PPPs: How can the ADB Help?

The Asian Development Bank announced its support to Pakistan to optimize the use of Public-Private Partnerships (PPPs) in healthcare

What do development banks know about the best contracting solutions in healthcare? The seemingly provocative question raises an important point, as relatively scarce evidence of a seasoned, demonstrated expertise in contracting for health infrastructure.

Such expertise would cover the whole spectrum or stream of services that is typically contracted out and which can include financing, designing, building, operating and/or maintenance.

While many development banks are extremely versed in infrastructure contracting, complex contractual arrangements such as PPPs or project finance modalities, the applicability of these sophisticated instruments to the health sector is seldom seen, at the notable exceptions of the Council of Europe Development Bank (CEB) and the Asian Development Bank (ADB).

Knowledge labs, repository of documents or case studies tend to overlook or perhaps avoid the health sector which intrinsic complexity inherent to the versatility of its core factors as well as other idiosyncrasies which call for an in-depth understanding of the scientific and clinical aspects of health in order to design and manage adequate infrastructure as well as supporting services.

In this regard, the Asian Development Bank stands as a prominent provider of technical expertise commensurate to the capital investment and infrastructure project management needs of its partner countries. Knowledge transfer and operational guides empowering health managers are available through the ADB (and also your Decide hub on the Capital Investment in Health space).

It is therefore with interest that capita investment specialists read the recent statement of the ADB announcing a partnership with Government of Punjab to support Health Care PPPs in Pakistan.

An MoU was signed between the Head of the PPP Cell of Planning and Development Board and the ADB Country Director. The rationale is to strengthen the care network in major cities and thus contribute to better access to care as well as improved health and well-being for the population.

Beyond this press statement (available here) the questions of interest and which Decide will strive to follow up on include: why complex contractual arrangements? What financial engineering and gearing behind this PPPs programme? What stream of services to be provided? Has market attractiveness been tested at country level to attract relevant capital?

And naturally, the final yet priceless question: are public capacities present and adequate to ensure optimal management of long-term, performance-based contracts over their life cycle?