Namibia Health PPP Conference

PRESENTER: Sithembiso Mkwanazi08 - 09 December 2014

Infrastructure: Equipment and Medical Technology

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OVERVIEW OF PRESENTATION

• Introduction • Motivation to manage medical equipment through PPP• Roles of Government and Private Partner• Medical Equipment to special vehicle services

– Fleet Management – Specialised Vehicles – Lessons Learnt

• Medical Equipment directly – Types of PPP Contracts with Medical Equipment– Medical Technology– Refurbishment, Maintenance and Replacement – Hand over – Lessons Learn

• Conclusion

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INTRODUCTION

• When designed well and implemented in a balanced regulatory environment, PPPs can bring greater efficiency and sustainability to the provision of such public services as water, sanitation, energy, transport, telecommunications, health care and education. PPPs also allow for the better allocation of risk between public and private entities, taking into account their capacity to manage those risks. (The World Bank)

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MOTIVATION TO MANAGE MEDICAL EQUIPMENT THOUGH PPP

• Quality of service improvement • Attracting public funding • Attract skills required to manage medical equipment• Lowering cost of service• Better monitoring: through output/outcome• Risk transferred to a party best suited to manage it

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MOTIVATION TO MANAGE MEDICAL EQUIPMENT THOUGH PPP: PRIVATE PARTY

• Experts/specialists in a field of medical equipment• Brand specialists as well• Wider market network • Their core business • Profit made through operation• Better and shorter procurement processes

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ROLES OF BOTH PARTIES: GOVERNMENT

• Regulator and Technical Advisory • Principal and contracting party• Define main objectives of public service (output specification)• Plan public service budget (feasibility study)• Select management model (feasibility study recommendation)• Ensure value for money, risk transfer and affordability • Performance monitoring and evaluation

– Risk management – Quality assurance

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ROLES OF BOTH PARTIES: PRIVATE PARTY

• Fund, build, operate, maintain and hand over • Manage the facility on behalf of the institution • Ensure continuous service • Provide support to the institution • Ensure risk transferred, value for money and affordability is maintained• Take full control of risk assigned to them

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MEDICAL EQUIPMENT TO SPECIAL VEHICLE SERVICE: FLEET MANAGEMENT

• Specialized vehicles being part of the general fleet • Specification as per Nation Department of Health Specification • Operated by department of health personnel • Fully equipped at all times • Penalties imposed for non-availability

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MEDICAL EQUIPMENT TO SPECIAL VEHICLE SERVICE: LESSONS LEARNT

• Improved availability of specialised vehicles • Specialised vehicles always equipped • Better turnaround times in terms of repairs and replacements

• Minimum kilometers of about 2500 per month • Additional charges based on extra km • Vehicles treated similar to general fleet

• If considered specialised vehicle should have its own PPP contract

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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: TYPES OF PPP CONTRACTS WITH MEDICAL EQUIPMENT

• Full operational PPP (Inkosi Albert Luthuli and Lentegeur and Rehabilitation Centre) None core – Existing building – Conditional Survey, upgrade and equip (IALCH)– Upgrade and Refurbishment (L&RH)

• Co-location Hospitals (Hummansdorp, Settlers and Port Alfred and Universitas and Pelonomi)– Public and Private medical care within the same facility – Upgrade, refurbishment and equip

• Specialised unit (Renal Dialysis)– Renovate and equip

• Concession PPP (Phalaborwa Hospital) full Private use

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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: MEDICAL TECHNOLOGY

• State of the art technology • Full risk of technological changes• End User Training• Adhere to conditions and hospital needs • Most medical equipment carries high penalties with very short response and

restore times

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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: ICT SUPPORT

• ICT Infrastructure with proper capacity • Medical ICT interphase with Institutional ICT• ICT services provided:

– Medical Records– Graphic images:

• Radiology services, Nuclear Medicine, Cardiology Services, Physiotherapy, Obs and Gyn etc

– Telemedicine infrastructure available but not fully utilised

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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: OPERATIONAL

• Technology refreshment• Obsolescence replacement• Purchase cost including exchange and taxation risks• Equipment performance/availability• Maintenance costs• Life of Equipment Responsible for periodic planned preventive maintenance• Repairs and or change of equipment due to equipment breakdown• Cost of repairs borne by the institution/government incase abuse and

negligence has been proved beyond reasonable doubt• Reactive maintenance due to equipment failure or poor performance normally

results into penalties• Periodic equipment replacement as per the PPP agreement

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MEDICAL EQUIPMENT DIRECTLY TO HOSPITAL: HANDOVER

• Conditional survey conducted towards the end of the PPP contract• Joint appointment of the inspector • Medical Equipment to be handed over in a condition specified within the PPP

agreement • I terms of the PPP regulations the ownership of the equipment returns to the

Government at the end of the period.

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LESSONS LEARNT

• Advantages – Efficiency– Quality of service – Quick response and restore time– Readily available services – Free from government procurement processes

• Disadvantages – Loss of opportunities to use transversal contracts– Single or limited suppliers utilised– Equipment subjected to limited preferred brands

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CONCLUSION

• SA PPP medical Technology at institutional level at this stage• Requires stringent:

– Contract management with: • Strict monitoring system• Fault reporting system (Help Desk)• Stringent penalty model • Risk management plan • Financial Management

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Sithembiso MkwanaziSenior Project AdvisorPPP Division, GTAC+27 12 315 5255Private Bag X115Pretoria 0001Republic of South Africawww.ppp.gov.za