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Health System Innovation in Lesotho Design and Early Operations of the Maseru Public-Private Integrated Partnership Healthcare Public-Private Partnerships Series, No Health System Innovation in Lesotho Design and early operations of the Maseru public-private integrated partnership Healthcare public-private partnerships series, No. 1 Copyright © 2013 PwC and The Regents of the University of California The Global Health Group Global Health Sciences University of California, San Francisco 50 Beale Street, Suite 1200 San Francisco, CA 94105 USA Email: [email protected] Website: globalhealthsciences.ucsf.edu/global-health-group PwC 300 Madison Avenue New York, NY 10017 Website: www.pwc.com/global-health Ordering information This publication is available for electronic download from the Global Health Group’s and PwC’s websites. Recommended citation Downs S., Montagu, D., da Rita, P., Brashers, E., Feachem, R. (2013). Health System Innovation in Lesotho: Design and Early Operations of the Maseru Public Private Integrated Partnership. Healthcare Public-Private Partnerships Series, No.1. San Francisco: The Global Health Group, Global Health Sciences, University of California, San Francisco and PwC. Produced in the United States of America. First Edition, March 2013. This is an open-access document distributed under the terms of the Creative Commons Attribution-Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited. Images Cover photo provided courtesy of Richard Feachem. Table of contents Acknowledgements . 5 UCSF®/PwC report series on public-private partnerships . 6 About the UCSF® report series. .6 About the Global Health Group ..........................................6 About PwC ...........................................................6 About public-private partnerships .......................................6 About public-private integrated partnerships ..............................7 Methodology .........................................................8 Audience ............................................................8 Executive summary . 9 Introduction . 12 Country profile: Lesotho healthcare system and population health status . 13 National population and health status. 13 Healthcare system ................................................... 13 Summary statistics: ................................................. 15 Health system need: Replacement of Queen Elizabeth II Hospital . 16 PPIP procurement and contracting . 19 Bid design ..........................................................19 Bid response ....................................................... 22 Bid evaluation ...................................................... 23 PPIP contractual design . 25 Financial terms ..................................................... 26 Capital expenditure ................................................... 26 Operating expense and financial model ................................. 27 Unitary payment ................................................... 27 User fees ........................................................... 29 Operational terms ................................................... 29 Co-location of private services ......................................... 29 Access to hospital services ............................................ 30 Excluded services. 30 Employment ....................................................... 31 Healthcare public-private partnerships series, No. 1 3 Broader impacts .....................................................31 Health system strengthening .......................................... 31 Local economic empowerment ......................................... 32 Community development ............................................. 32 Independent monitoring and certification ............................... 32 Construction and early implementation: Financial close to launch of hospital services . 36 Construction ....................................................... 36 Opening of the filter clinics ........................................... 37 Transition from QEII to QMMH . 39 Queen ‘Mamohato Memorial Hospital: The first year . 40 Human resources management. 40 Staffing levels and recruitment ........................................ 40 Policies and procedures ...............................................41 Training ........................................................... 42 Change management ................................................ 42 Information systems ................................................. 43 Quality management and utilization management ....................... 43 Supply chain management ........................................... 44 Independent monitoring of clinical operations ........................... 45 Partnership between Government and Tsepong .......................... 46 Public response ..................................................... 47 Ongoing and future initiatives in support of the PPIP . 48. Lessons learned . 50 Lessons learned: Appropriate expertise. 50 Lessons learned: Leadership ...........................................51 Lessons learned: Plan early, plan often ..................................51 Lessons learned: PPPs are not a panacea ................................ 53 Lessons learned: Contractual flexibility ................................. 53 Opportunities for future evaluation . 54 Conclusion . .. 55 References . 56 4 Health System Innovation in Lesotho Acknowledgements We are grateful for the expertise and experience so generously shared during the development of this report. While the report was prepared by the UCSF® Global Health Group and PwC, information and insights contained in the report were provided by the following organizations: • Apparel Lesotho Alliance to Fight AIDS (ALAFA) • Clinton Health Access Initiative (CHAI) • Ditau Health Solutions • The Healthcare Redesign Group • Lesotho Boston Health Alliance (LeBoHA) • Lesotho Ministry of Health and Social Welfare • Lesotho Ministry of Finance and Development Planning • Millennium Challenge Corporation • Netcare Limited • Partners in Health • Tsepong (Pty) Ltd • The World Bank Group Healthcare public-private partnerships series, No. 1 5 UCSF®/PwC report series on public-private partnerships About the report series Health Group has identified public- transport, infrastructure and energy. This report on the Queen ‘Mamohato private partnerships in general, and While starting considerably later and Memorial Hospital and the public- public-private integrated partnerships much more cautiously, a parallel trend private integrated partnership in particular, as a promising model has emerged in the health sector. In (PPIP) formed for the design, to improve health systems globally, the past ten years, there has been a construction and operation of the including in developing countries. rapid expansion and acceleration of hospital (including the provision of interest in public-private partnership clinical services) is the first in a series For more information about (PPP) models for health, across many of publications on public-private the Global Health Group, visit: continents and income levels. partnerships (PPPs) to be jointly globalhealthsciences.ucsf.edu/global- authored by the UCSF® Global Health health-group. PPPs are a form of long-term contract Group and PwC. This series aims between a government and a private to highlight innovative PPP models About PwC entity through which the government globally and to disseminate lessons PwC is one of the largest healthcare and private party jointly invest in the learned and leading practices for the professional services firms, advising provision of public services. Through benefit of current and future projects governments and private enterprises this arrangement, the private sector around the world. on every aspect of business takes on significant financial, technical performance, including: management and operational risks and is held accountable to defined outcomes. PPPs About the Global consulting, business assurance, tax, finance, advisory services, human can be applied across many sectors Health Group resources solutions, and business and typically seek to capture private The Global Health Group at the process outsourcing services. sector capital or expertise to improve University of California, San Francisco provision of a public service. (UCSF®), Global Health Sciences is an PwC’s Global Healthcare practice “action tank” dedicated to translating includes more than 5,000 health PPPs are characterized by the long- major new paradigms and approaches professionals with expertise in public- term nature of the contract (typically into large-scale action to positively private partnerships, medicine, 20+ years), the shared nature of the impact the lives of millions of people. bioscience, information technology, investment or asset contribution and Led by Sir Richard Feachem, formerly clinical operations, business the transfer of some risk from the the founding Executive Director administration and health policy. public to the private sector. These of the Global Fund to Fight AIDS, features distinguish a PPP from Tuberculosis and Malaria, the Global As healthcare becomes increasingly other contracts existing between Health Group works across a spectrum, interconnected with other industries, governments and the private sector, from research and analysis, through PwC’s global reach and resources help which might not be considered PPPs. policy formulation and consensus governments, businesses and industry building, to catalyzing large-scale players accomplish their missions in a
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