Edinburgh Research Explorer

Delivering healthcare infrastructure and services through public private partnerships – the Lesotho case

Research output: Chapter in Book/Report/Conference proceedingChapter

Original languageEnglish
Title of host publicationAchieving Collective Ends with Limited Resources
Subtitle of host publicationAfrica's Struggle to Bridge the Infrastructure Gap
EditorsNuno A P Gil, Anne Stafford, Innocent Musonda
PublisherCambridge University Press
StateAccepted/In press - 2 Aug 2018

Abstract

Many governments in Africa are establishing public-private partnerships (PPPs) to provide healthcare infrastructure and services. We know very little about how healthcare PPPs are planned and implemented in Africa, and even less about the associated outcomes. This paper begins to address this gap through a detailed case study of an innovative, ambitious and complex partnership contract in Maseru, Lesotho. The scheme has been labelled ‘the future of healthcare delivery on the African continent’ and encompasses the design, build, partial financing and full operation of a new hospital facility alongside a wide range of core clinical services. This chapter draws on documentary data to evaluate the main features of the contract, the procurement process and monitoring arrangements, and the outcomes in terms of benefits and costs. A key finding is that payments to the private operator are far higher than was expected pre-contractually, and have become a major source of budgetary uncertainty, as well as a demanding call on government’s healthcare resources. We conclude that successful social infrastructure PPPs in Africa will require considerable investments in contract management skills, strong budgeting institutions and mechanisms, and enhanced (and more independent) scrutiny of plans and forecasts of financial impacts.

ID: 74744315